What to Look for when visiting your aging parents or loved ones this holiday season.

The Initial Conversation

First, have a heart-to-heart conversation with your loved one about their present circumstances and both of your concerns. Suggest making an appointment with their primary care physician for a complete health assessment. The results of this evaluation will help you work together to determine what next steps are necessary to keep them safe, happy and healthy. It is most important when having any conversations that you want them to know you are concerned for them, and it would give you piece of mind to know they are taken care of. Perhaps have a conversation with a long-time neighbour as well, and see if ‘checking in’ on your parent is an option and if they would feel comfortable with that.

Pay attention to the following signs when visiting this holiday season, so you can be pro-active in assessing their needs and their ‘Activities of Daily Living’ or ADLs.

This determines a senior’s functional status based on what basic activities they can or cannot perform

If a senior is unable to complete Activities of Daily Living, some accommodations can be made to help your loved one remain safe in their day-to-day life. This index is also useful for determining if it may be time to consider relocating the individual to an assisted living facility or nursing home.

Activities of Daily Living can be split into two categories: Basic ADLs and Instrumental Activities of Daily Living ADLs.  If your loved one is unable to perform basic ADLs, then care planning is necessary. There are five main categories of basic ADLs:

  1. Dressing
  2. Eating
  3. Toileting
  4. Personal grooming
  5. Transferring and mobility

Daily living IADLs are activities that may not be everyday necessities but are still important for independent living. IADL scales measure independence in activities including:

  • Communicating with others
  • Meal preparation
  • Transportation
  • Shopping
  • Managing medication
  • Completing housework
  • Maintaining finances

Signs to Look for:

1. Do they have piles of unopened mail?

If your folks have always been organized but now you see stacks of unopened bills or letters sitting around, try to find out why. Maybe they’ve just been busy getting ready for the holidays. But unopened mail, especially if it dates back more than a few days, can also be a sign of cognitive impairment, financial problems your folks may not know how to handle, or vision loss.

Possible solutions: If Dad or Mom has trouble reading the mail, an eye exam is in order. If financial or memory issues are to blame, it’s time to talk to your parents about having another family member or a professional daily money manager help them manage their bills and mail.

Signs of Age-Related Decline

  1. Weight Loss
    One of the most obvious signs of ill health is weight loss. Possible causes could include cancer, dementia or depression. Seniors may also experience lower energy levels or fatigue, which can make it challenging to shop for and prepare nutritious meals and then clean up afterwards. Furthermore, an elder may consider all this effort unnecessary, especially if they live and eat alone. Certain medications and aging in general can also cause a reduction in appetite and change the way food tastes. If weight loss is evident, talk to your loved one about your concerns and schedule a doctor’s appointment to address the issue.
  2. Changes in Balance and Mobility
    Pay close attention to the way your loved one moves and how they walk. A reluctance to walk, changes in gait or obvious pain during movement can be a sign of joint, muscle or neurological problems. If your loved one is unsteady on their feet, they may be at a risk of falling. According to the BC Centers for Disease Control and Prevention (BCCDC), an estimated three million people are treated at emergency departments each year for fall-related injuries like hip fractures. If you notice changes in a senior’s mobility and coordination, make an appointment with their doctor to discuss options for keeping them safe and mobile, such as pain management, physical therapy, in-home care and mobility aids. If limited mobility is not addressed, fears of falling can cause seniors to withdraw and stop participating in daily activities both inside and outside the home. Be forewarned that minimized activity can actually cause elders to become frailer and even more susceptible to falls.
  3. Fluctuations in Mood and Behavior
    Keep an eye out for changes in your loved one’s moods and behavior. You can’t always gauge someone’s emotional state over the telephone, even if you speak daily. Look for signs of depression and anxiety, including withdrawal from social activities, changes in sleep patterns, loss of interest in hobbies, and changes in basic home maintenance and personal hygiene. The latter can be an indicator of cognitive decline or other physical ailments like dehydration, which often happens to elders in the winter months and can be serious.
  4. Changes in the Home Environment
    Attention must also be paid to a senior’s surroundings. For instance, if your loved one has always been a stickler for tidiness and paying bills promptly, but you discover excess clutter and stacks of unopened mail while visiting, it indicates a problem. Take a walkthrough of their home while you’re visiting to see if they are keeping the house to their usual standards. Be aware that sometimes the signs of trouble are a bit subtler. Scorched cookware could indicate that your loved one has forgotten food on the stove or in the oven. An overflowing hamper could mean they don’t have the strength and/or desire to do laundry. Check the expiration dates on their prescriptions and over-the-counter medications and try to determine if they’re taking their medications as prescribed. You know your loved one and their habits best, so go with your gut if something seems off. Check in the refrigerator for expired dates as well. Often expired food can be the cause of a senior getting sick. Perhaps they can’t see the date, or they have forgotten when they bought the food. Arranging for delivery for them may be an option.
  • Cookware or appliances with noticeable burn marks could indicate food has been left unattended while cooking or reheating
  • Failure to maintain outdoor areas, such as landscaping, snow removal or garbage collection
  • Signs of unsafe driving (e.g., automobile dents and scratches)
  • Unfilled prescriptions

Identify Supportive Resources

A great resource in our community is www.seniorsservingseniors.bc.ca

It may be difficult to get in touch with these offices around the holidays, but it is still worth reaching out, leaving a message and researching the services they offer.

Sit down with your loved one to create a current list of people they interact with on a regular basis. This list should include other family members, friends, neighbors and clergy whom you can trust to keep an eye on your loved one and contact in the event of an emergency. Double check their home addresses, telephone numbers and email addresses, and be sure to share your own contact information with them.

Prepare a To-Do List

If you realize that your loved one is showing signs of needing help at home, now is the time to begin compiling a to-do list to be implemented over a period of future visits. This list consists of three main categories: medical, legal and financial.

You’ll want to develop a complete medical record for your loved one, including their health conditions, current prescriptions, and doctors’ names and contact information. This is extremely helpful for you to have on file, and your loved one can keep a condensed copy on hand for both routine appointments and medical emergencies.

A financial list should contain information pertaining to all a loved one’s property, debts, income, expenses, bank accounts and credit cards. Should you need to assume control of their finances over the short or long term, this list will help minimize confusion and ensure all their bills are paid on time. A legal list would include things like, the Last Will and Testament, Power of Attorney for Finances, a Care Representative Agreement in place. It is important to have all these conversations BEFORE something happens. They are often difficult to have, especially when talking about finances with your parent or loved one, but being prepared is far better than something happening and not knowing where anything is, or what you can do to support at that time.

Hiring Home Care for Aging Parents

If you believe your mom and Dad are exhibiting any of the above warning signs, the next step is to speak with them about their changing abilities and care needs. It’s best to discuss the future sooner rather than later to ensure everyone is on the same page and avoid surprises. Broach the subject respectfully and in such a way that they are able to participate in identifying the underlying problem(s) and coming up with solutions.

Keep in mind that these red flags don’t necessarily mean a move to assisted living or a nursing home is warranted. However, their presence does indicate that some sort of daily supportive care is needed. For many families, hiring home help allows older adults to stay in the comfort of their own houses for as long as safely possible.

Having difficult conversations with our parents as adults can often bring up feelings of anxiety on our part. It is so important for our parents and loved ones know that we are there to support them, and we only want to ensure everything is in place for us to support them when needed. Often, when we express from our hearts how important it is that they are safe and taken care of, they will be more open to discuss the next steps. Keep in mind, the home they are in is often the home they raised you in. So simply saying good-bye to that and the memories it holds can be rather painful. We have to be sensitive and empathetic to their needs, but the conversations have to happen. At the end of the day, the care and love our parents gave us all our lives will translate to the care and love we will provide to them when they need it.

Next Steps:

If you find that your parents are ‘ready’ to start looking, then your research begins again. It is important for everyone to be involved in the decision making, if possible. They need to feel included and they need to know their options and what that will look like for them. Remember, it is a process for them as well as you so take your time and do not rush the process. And Remember……ENJOY YOUR TIME TOGETHER!