Trust your gut feelings about these things. Your instincts are rarely wrong. Maybe your loved one chatters brightly and reminisces when you are on the phone but after spending hours together this holiday season something was just a little "off"... and no it was not grandma's yearly hi-ball alcoholic beverage.
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"Hindsight is 20-20." This is one of the most frequent things I hear caregivers say when are in the throes of a caregiving crisis. We live in a society where we often do not see or deal with issues that are in front of us for a whole host of reasons. We don't tend to face things until they are so big that they must be dealt with. Sometimes it is denial, sometimes things happen so slowly that it is simply just hard to see the changes and by golly we are a go, go, go society. Just taking a moment to sit back and reflect almost seems to be an impossible task at times.
Older adults are frequently hesitant to ask for help because they fear losing control over their lives. For example, how would you feel if someone told you that you should not drive anymore? Imagine how having your car keys taken away would change your world.
Here is a list of 10 things to look out for that would be signs that you should watch a little more closely or perhaps intervene:
1. Forgetfulness: I am not talking about your run-of-the-mill forgetfulness that we all experience in our chaotic, industrialized lives. I am talking about things like forgetting to take medication as prescribed regularly or taking too much, forgetting the names of close family members, being unable to find the way home from the grocery store, difficulty finding words or misusing words, being unable to complete a complicated task like plan a meal. If you start noticing that your family member is exhibiting signs like the ones above keep notes and contact their primary care physician. It may not be something as serious as Alzheimer's disease. As a matter of fact, the forgetfulness could be something simple to fix. However, this is something you should not let get out of control because a cognitive decline certainly impacts your loved one's quality of life and can pose real safety concerns.
2. A cluttered or disorganized house: Has your family member always been neat as a pin? Suddenly when you visit do you feel like you could be the host of the episode of "Hoarders"? Don't get me wrong, we all have stuff and sometimes our stuff does get out of control, but if you have noticed a big change in the ability of your loved one to keep their living space organized it should raise a red flag and be a cause for concern. Living in a cluttered home poses many risks including but not limited to: slip, trip, and fall hazards, pest infestation, and even fires. Living in a cluttered home may be indicative of a cognitive, physical, or even mental/emotional decline and should be addressed.
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3. Poor personal hygiene: Poor personal hygiene often follows or is paired with living in a cluttered home. Discovering that an aging parent or loved one is not physically manicured like they once were often sounds major alarm bells in the minds of close family and friends. It is usually when poor personal hygiene becomes an issue that you know things have been sliding down the slippery slope for quite some time. As a rule, most people pride themselves on being neat and clean. If there is a cognitive decline your loved one simply forgets that their clothes are dirty or does not even remember that the clothes that they just put on have yet to be washed. When you stop and think about it, getting up and dressed requires a lot of steps. Keeping track of bathing, grooming, and even brushing one's teeth can become overwhelming if there is a cognitive decline. Chronic or acute physical issues can also cause a decrease in ability to maintain physical hygiene. Arthritis and other mobility issues often pose a huge, exhausting, and painful challenge to completing these tasks. Not being clean is hugely embarrassing to people who are aware that they just can't do it and often they tend to isolate themselves which makes them even more at risk to other issues down the road. I once heard a man with MS say he has 100 good steps a day and he has to decide every day how best to use those steps because after he reaches 100 he just can't go any farther.
4. Trouble getting up from a seated position: Did you know that every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall (NCOA 2016). So many things compound the risks of falls in the home such as clutter, changes in vision and hearing, chronic conditions such as Parkinson's Disease, floor area rugs, and urinary incontinence to name a few. If you notice that a family member has to take a few attempts to get from a seated to a standing position (maybe pulling on those around them or pushing up hard on the furniture), this should be a cause for concern.
5. Poor diet or weight loss: Nutrition is a very big issue facing older adults. Many older adults live on a fixed income and find it difficult to afford nutritionally-rich foods. Others find it physically taxing to cook a meal and go for the frozen food aisle which often contains foods that are highly processed and sodium heavy. Not to mention, it's not too fun to cook a big meal for just one. So much about eating involves socialization and those who are alone often overindulge in foods that are not healthy. Or they may skimp and consume only one meal a day. Keep an eye out for ready-made meals filling the freezer and spoiled foods in the fridge.
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6. Loss of interest in hobbies and activities: Has your father stopped his regular rounds of golf? Has your mother stopped attending Bible study? As individuals start to slip physically and cognitively they are more likely to become secluded from family members and friends. Loneliness often begets greater physical and mental decline. According to a 2012 study recorded in the Proceedings of the National Academy of Sciences (PNAS), social isolation and loneliness are associated with a higher risk of mortality in adults aged 52 and older. And a study by The University of Chicago (Caciopp, 2010) showed major health risks were associated with loneliness, revealing that elderly people who are affected by "extreme loneliness" are up to 14 percent more likely to die a premature death. This is backed up by the English Longitudinal Study of Ageing (ELSA), which reported in Cohort Profile: The English Longitudinal Study of Ageing, 2013 that elderly people who are socially isolated are more likely to die earlier. Out of all 10 signs I would go so far as to say if you find your loved one becoming more isolated, do what you can to help them maintain their interests and relationships.
7. New dings and dents in the automobile: At some time you will feel concern or even fear that your parents should no longer drive an automobile. This may be one of the most difficult and important deliberations you will face as the family caregiver. Taking the car keys away not only changes the life of your loved one but it also will impact you as the caregiver. All the things that they were once able to do independently will now require careful coordination from either a transportation service or you. A person's age is not and should not be the reason for taking away the car keys. There are people in their 80s and 90s who hold licenses and drive actively and safely, while there are others in their 50s and 60s who are dangers to themselves and others when behind the wheel. Periodically ride along with your parents and see how they are doing. If they have had a recent decline in their ability to see, hear, or physically move then driving should be examined. It is also important to heed the warnings on the prescriptions that your loved ones are taking especially new ones as medications can greatly exaggerate limitations that they are already facing.
8. Unpaid or overpaid bills: Death, taxes, and personal finances are among the most "taboo" topics to discuss with our loved ones. But discussing personal finances with your loved ones is paramount. It takes mere moments for your family member to be completely wiped out financially by unscrupulous individuals. As the older adult population continues to grow, more and more people are targeting this population for their generally trusting and giving spirit. Sometimes they will simply pay someone for a service just because they want conversation with someone. So, keep an eye on your loved ones' finances; you may even offer to take over the bill paying task so you can see what's coming in and what's going out.
9. Unexplained bruising: It may be difficult to prevent elderly bruising as we age we tend to bruise more easily, but unexplained bruising should be carefully watched for many reasons. Often it could be because of mobility changes or, more concerning, a sign of elder abuse.
10. Growing healthcare needs: As we age, it is normal to start to experience a decline in our health. It is just a normal part of the aging process. However, you may find that your aging parent or loved one is becoming less able to manage their healthcare needs. If their healthcare needs start to require a lot of family assistance or intervention, it is time to have a conversation about next steps in the future of their care.
It's important to realize when thinking about your aging loved ones that an ounce of prevention is akin to a pound of intervention. You and your loved ones will be so much better off when you are as proactive as possible. It could mean the difference between an emergent hospital stay or premature placement in a long-term care facility. If you find yourself in a caregiving situation, we invite you to join our online community of caregivers.