Caring Currents

10 Signs a Senior Needs Assistance

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In dating lingo, it's known as "reading the memo." There's the bore who rambles on about himself the entire evening (narcissist), the annoying guy who orders for you (control freak), the dude who has never, ever been in a long-term relationship (commitmentphobe).

In each case, a "memo" is delivered -- key information or insight into a person is imparted -- but it's not always "read" by the other party. Sometimes it's ignored, sometimes denial plays a role, other times it's just glossed over -- usually at the other party's peril. When the light bulb moment does occur down the track, it's often too late to avoid pain, grief, or suffering.

The same concept holds true in caregiving circles.

In an unscientific study of adult-children caregivers who attend my Sunday morning dance class in San Francisco, I've found that in every case ailing parents offered clues that all wasn't well with them and that it was time to pay closer attention.

For Janice Shapiro it began a decade ago when her Philadelphia-based mom, now 93, started sleeping until 11, stopped bathing, and dropped 20 pounds she didn't have to lose. Judi Kaplan figured out her 81-year-old Southern California-dwelling mother needed extra help when she was ill last year, and Kaplan noticed a growing confusion and disorientation that turned out to be due to a mild cognitive impairment.

Barb Silver's situation was more dramatic: Her mother had long dealt with a variety of medical maladies stemming from obesity, including diabetes, high blood pressure, incontinence, and a lung disorder. Silver talked every day with her mom, who lived in Florida, had a paid caregiver (whom she later discovered was both inept and dishonest), and her mother was always her chatty, loud, boisterous self. Silver had no inkling all wasn't well until a physician called to tell her paramedics had found her mother in dire straits.

In all of these different situations involving long-distance caregiving, each daughter I spoke with revealed red flags that an older adult needed beefed up caregiving help.

Here, 10 telltale signs that trouble may be brewing, according to a recent Chicago Tribune story:

Hygiene. Poor grooming or unmet basic self-care needs, such as bathing, are often an early heads up that someone is in declining health. "My mom used to be very neat and clean, but she started to wear the same clothes over and over again, and she couldn't see the food stains," says Kaplan.

Nutrition. Unexplained weight loss is a sign of poor nutrition, as Shapiro found out. Her mother simply stopped cooking. Look in the refrigerator: Little or spoiled food could indicate that a senior isn't cooking meals or eating well.

Housework. A home that's dirtier or more cluttered than it used to be -- with piles of dirty laundry or dishes -- can indicate something is awry. Hiring a house cleaner can take care of such concerns, but an untidy or poorly maintained house may also indicate physical decline or depression, as it did in Shapiro's mother's case.

Health. Maybe there's just a general sense that something isn't quite right, such as persistent fatigue or lack of energy. Follow your instincts and make a doctor's appointment for the person in your care -- and go along with her, if you can.

Medications. Lots of unused pills in the cupboard, or confusion about how, why, or when meds should be taken are danger signs. Managing meds can take some initial set up (such as a pill box) but the need for reminders on a daily basis could mean bigger issues.

Bruises. Signs of injury, such as bruises, could be evidence of falls. Seniors who've fallen in the past are at greater risk for repeat falls, which can lead to serious injuries. "Mom used to say, 'I don't know how I got such a big bruise.' We quickly figured out she was falling," says Kaplan. Some seniors try to keep falls secret.

Orientation. Confusion about time of day was an early clue for Silver that something was up. "My mom kept asking why the caregiver wasn't there, and I kept explaining it was nighttime and she came in the morning." Difficulty navigating surroundings away from home can also be a telltale sign that someone needs help. On an outing to the shops or a restaurant, observe if she can walk alone and how she adjusts to new situations. Often the elderly function fine at home but challenges are more apparent in less familiar settings. The same holds true for driving.

Community. Neighbors or those who work for the person in your care may notice changes in her behavior. Maybe she goes out less than she used to -- or not at all. Perhaps papers and mail are stacking up outside. Check in with them. "My mom's gardener told me she kept calling him in to help her find her check book," says Kaplan. "He really noticed a marked change in her ability to cope."

Finances. Bills routinely left unopened or unpaid equal bad news. Setting up some simple systems may address this issue, but such disarray could also be a sign of cognitive decline, as Kaplan found. "Mom obsessed about her financial situation, and she seemed confused about everyday money matters."

Predators. Older seniors, especially those who live alone, are more vulnerable to con artists who befriend the elderly and try to scam them out of their money. Such situations could indicate that a senior's judgment is failing. Unfortunately, as Silver discovered, a predator could be a neighbor, relative, or caregiver. "My mother loaned a caregiver $3,500 that she never got back," she says.

Of course, even if as a caregiver you do read "the memo," you may still have a tough time getting a family member on board. "At one point my mom left the stove on and went out. The fire alarm went off and fire fighters came. It was scary," says Shapiro. "And yet she was pretty stubborn about leaving her home." She finally agreed to it about two years after her children thought she should move to an assisted-living facility. Silver and Kaplan both experienced similar resistance to change. "My mother adamantly wanted to keep her independence," says Silver. "You can't force someone to accept help."

If the person you're caring for won't listen to you, then it may be time to bring in reinforcements -- so don't be shy about soliciting the help of a family doctor, geriatrician, geriatric case manager, or mental health or social work professionals.

Have you encountered additional warning signs that you'd want to share with others concerned that a family member may be in declining health? I'd like to hear about them.

Photo by Flickr user Kim Scarborough used under the Creative Commons Attribution license.