Every year at this time, Paula Falk receives an influx of calls from adult children concerned about the decline of their elderly parents. “They visited at the holidays and saw the reality of their parents’ situation, which is much different than what Mom or Dad had been describing on the phone,” says Falk, director of caregiving services at the Friendship Centers in Sarasota, Florida. It’s a nonprofit comprehensive senior center that caters to one of the country’s largest retirement populations.
The phenomenon isn’t limited to regions rich with retirees. America is getting older, with adults 65 or older comprising about 15 percent of the population, according to the U.S. Census Bureau, and 10,000 baby boomers turning 65 every day, according to the Pew Research Center.
But older adults typically prize their independence and may not let on that they need help. “Sometimes you’re shocked when you visit,” says Dr. Michael Perskin, a geriatrician at NYU Langone Health. “You walk into a parent’s house and the bathrooms are dirty or there’s no food in the refrigerator. That represents a change.”
It’s natural for adults to experience age-related health changes. Eyesight and hearingdecline, muscles lose mass, bones lose density, joints become stiff with arthritis and cognitive processing speed slows.
Small health changes may not seem like they would affect a person’s ability to live on his or her own. But the cumulative total can have a major impact.
Take, for example, an older adult with muscle weakness, hand arthritis and poor vision. Individually, each condition is manageable. But when combined, the conditions may make it hard to go shopping, carry groceries, cook, dress or clean a house.
Or consider an older adult with a weak grip and knee pain. Neither condition is life-threatening. But together, they may make it hard for an older adult to hold onto a steering wheel and press a gas pedal. Suddenly, it’s difficult to drive.
Sometimes it takes just one major health issue to put an older adult’s independence in jeopardy. Obviously, someone with dementia won’t be able to manage self-care. But the same can be true for people with many other chronic health conditions, such as Parkinson’s disease, rheumatoid arthritis, chronic obstructive pulmonary disease (a lung condition often called COPD), age-related macular degeneration (which causes central vision loss) or severe depression.
Why Don’t They Ask for Help?
There are many reasons why your parents may not ask for help. It could be that they:
- Don’t realize that their health and safety are in jeopardy, especially if they’re experiencing cognitive changes.
- Are in denial that there’s a problem. “We have explanations for everything. You ran into the mailbox driving to your home, but you tell yourself that was because the neighbor left the garbage can too close to the driveway, so why mention that to your daughter? You’ll just upset her,” Perskin says.
- Worry about being a burden to family members.
- Fear they’ll be hustled out of their home and into a retirement facility.
The onus, then, is often on family members to determine if an older adult is having problems. Consider it a red flag if your older parent:
- Is forgetting things. Is he or she missing appointments or forgetting where the car is parked? This happens to everyone once in a while. If it’s chronic, it could signal cognitive change.
- Has a car that’s dented, dinged or missing side mirrors. These can all indicate trouble driving. “Sometimes it’s due to cognition, but sometimes it’s due to neck arthritis. They can’t turn around,” Perskin explains.
- Isn’t traveling anymore. “Mom might not tell you if she dings the car, but she’ll tell you she doesn’t drive at night or doesn’t go to church anymore. Or if she always comes for your birthday and now she can’t, maybe it’s because traveling alone is too hard,” Perskin says.
- Has loose clothing. “Is the parent eating? Is it due to a medical condition and malnutrition, or did the parent forget to eat?” Perskin asks. “Or maybe the parent can’t grocery shop anymore.”
- Has spoiled food in the fridge. “Maybe there’s a visual problem or mild cognitive impairment or a problem with a sense of smell,” Perskin suggests.
- Is withdrawing from activities. “If normally they attended activities and suddenly they start to isolate more, it indicates they’ve forgotten or they can’t keep up with conversations or successfully do the activities. They may have memory issues,” Falk says. It can also be a sign of hearing loss.
- Has a messy house. “It could be due to poor memory or poor vision, or maybe you can’t do physically what you used to,” Falk says. “Look and see if the level of tidiness or cleanliness changed significantly,” Perskin suggests.
- Has an unkempt appearance. Poor hygiene may be a sign of cognition problems. “People forget to clean themselves. Their hair may not be combed or washed,” Falk says. “But maybe it’s just that it’s physically difficult for someone to get dressed.”
- Holds onto furniture when walking around the house. “That’s a sign of mobility problems,” Falk points out.
- Has unexplained bruising. This is important because bruising can indicate falls due to balance and mobility problems.
- Has unpaid or overpaid bills. It may be due to a loss of executive function from cognition changes. “It’s the loss of executive function that really limits our ability to function as independent adults,” Perskin says.
- Is not taking medications. “Look at the date on the pill bottles, and look inside. Are there too many pills left, or are there not enough?” Falk asks.
“When you recognize even one symptom that a parent is having trouble managing at home, it’s time for you to help,” Falk says.
But it can be a tough subject to bring up. “You’ve probably never talked to your parents about their bodily cleanliness before. It’s hard,” Perskin says.
Falk suggests talking about issues as they come up in conversation, when a parent mentions his or her activities, self-care or home management. “Just ask, ‘How can I help you out, Mom?’ Tell her you want to be her advocate. But don’t save it for one big talk,” Falk advises. “It needs to happen over a period of time.”
Or you could ask your parent’s doctor to intervene. “My patients’ kids sometimes call with a concern, and then I talk to my patient about it at the next appointment,” Perskin explains. “Sometimes it’s easier to hear it from me.”
Sometimes the fix for a problem is simple, such as new pair of eyeglasses, hearing aids, physical therapy, a medication switch or hiring private duty care for daily assistance.
But when the situation is more complicated, you may need more guidance. Try contacting a local senior center (there are 10,000 scattered throughout the U.S.). Or find resources in your area by using the U.S. Administration on Aging’s Eldercare Locator.
Falk and Perskin both advise that you take action sooner than later. “If you wait, then the situation can become a crisis,” Falk points out. “I get a lot of those phone calls, too.”
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