Relationships can be complicated under the best of circumstances. But when you see someone you love — like an aging parent, grandparent or close friend — struggle to take care of their health, stepping in isn't always so simple.
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About 7 percent of adults age 65 and older need help with personal care from other people, according to data from the 2018 National Health Interview Survey. The problem is, some aging adults don't want to accept any outside help. Other times, they simply don't know they need help.
This can make it hard for people to determine whether their loved one needs care. Still, more often than not, the signs are there, says Faith Atai, MD, an associate professor of geriatrics with McGovern Medical School at UTHealth Houston.
"When I talk to families, a lot of times when they look back, they say the signs were all there, but they were so subtle," she says.
The goal for most aging adults is to be able to live at home — called "aging in place," says Kenneth Koncilja, MD, from the Cleveland Clinic's Center for Geriatric Medicine. That's not always possible, though.
Here are a few signs your aging parent or loved one may need some extra help — ranked from least to most serious — and what to do.
When evaluating your loved one’s health, one important question to ask yourself is, “Is this normal for them?” Some people, for example, might misplace their wallet or keys often — and that’s typical for them. But when a person who is usually organized starts losing things all the time, that’s a sign that they may be struggling in some way.
1. Their Personal Hygiene Is Starting to Slip
If your once-meticulously groomed parent doesn't seem to be bathing (or shaving, or brushing their teeth) regularly, that could be a sign that they need another person to help them. They may find that getting in and out of the bathtub or shower can be difficult; in other instances, they may forget to bathe altogether.
What to Do
Schedule time to visit them two to three times a week for several weeks, to assist them with bathing, laundry and other grooming tasks, and see if that works for you both. Then, if needed, talk to a doctor about hiring a home care aide.
"Some parents are open to a family member assisting them, and some will cooperate better with an outsider, who they may see as more of an authority figure," Dr. Atai says.
2. They Aren't Meeting Up With Friends Anymore
Even if your parent or grandparent wasn't exactly a social butterfly, chances are they still made time to see their family or friends — for example, they may have attended religious services or met a friend for breakfast once a month. This might have changed during the novel coronavirus pandemic, of course, if they've been practicing social distancing in order to avoid the virus. But in general, if they aren't at least making an effort to see their friends or do the social things they once enjoyed, that's a sign something could be wrong at home.
"Sometimes socialization is too stressful for them because they're aware that there are some cognitive or hearing deficits," Dr. Atai says. "Conversations and interactions may have become too complicated."
In other instances, it could be a possible sign of depression or anxiety. This can occur "when people have a friend or family member pass away," Dr. Koncilja says.
If you've noticed that your loved one has stopped calling you as often as they used to, and you have to make all the effort to communicate with them, they may be withdrawing from others, too, he says.
What to Do
Talk to your loved one about scheduling an appointment with an audiologist if you think they may need some extra help in the form of a hearing device. If you suspect instead that they're struggling with a condition like dementia or depression, talk to a doctor about the right next steps.
3. They're Giving a Lot of Money to 'Charities'
Financial abuse is widespread among older adults, according to the National Institute on Aging (NIA). In some instances, a family member, friend or caregiver is to blame — say, for example, by stealing their belongings or forging their checks. Other times, a stranger can be responsible for the exploitation, even subtly.
"People will come to the door and ask for money, and because people are lonely, they'll give it to them, and then it becomes a habit," Dr. Atai says. "Or maybe Mom donates to one charity, and the next minute, the phone is ringing off the hook with one charity after another."
What to Do
If you suspect your loved one is being financially exploited or abused, you can contact the police or Eldercare Locator, a public service program from the U.S. Administration on Aging. Other suggestions from Eldercare Locator: Consider hiring a financial advisor or manager or having an estate plan created.
4. They're Having Trouble Driving
Our reflexes and reaction times often get slower with age. Older adults can also have chronic conditions such as cataracts, which limit their ability to see (especially at night), or arthritis, which can interfere with their ability to steer or push on the pedals.
People with dementia or Alzheimer's may also not be able to make split-second decisions while they're driving — say, if someone runs a stop sign or jumps out in front of their car.
Still, it's probably not going to be easy to take away a loved one's keys, especially because so many people value their autonomy, Dr. Atai says.
If you can't evaluate their abilities — maybe you live far away or they won't let you drive with them — try examining their car for dents or scratches, or asking a neighbor for their input, per the NIA.
"I've had situations where the family has gone to visit [a loved one] and they looked fine," Dr. Atai says. "But then they talked to the neighbors, who said, 'Actually, he drove into the garage door twice in the last six months.'"
What to Do
You can ask your parent or loved one to have their driving skills tested by your state's Department of Motor Vehicles or a driving specialist from the American Occupational Therapy Association. If they can no longer drive safely, they may be able to take alternative transportation services like Uber or arrange for a person from a volunteer organization to pick them up.
5. They've Lost a Lot of Weight
Cooking meals can be time-consuming — and tiring — for anyone. But for an aging loved one, who might have trouble reading labels or chopping ingredients, it can be too much. If your parent looks like they're losing weight or their clothes look too big for them, they may be unable to cook their own meals and subsisting off snack food.
Poor-fitting dentures, too, can cause people to stop eating solid foods. "It's amazing how many times people come to me and say their dentures aren't fitting well, so they switch to soft foods, which tend to be less calorie- and nutrient-dense," Dr. Koncilja says.
Other times, a person may have developed Alzheimer's and keeps forgetting to eat, or may be dealing with an underlying condition such as depression that may be blunting their appetite.
What to Do
If your loved one isn't able to cook anymore, help them sign up for a food delivery service or a meal delivery program such as Meals on Wheels, or hire an in-home aide who can do the cooking.
If they need to be fitted for new dentures — sometimes the shape of the jaw can change over time, Dr. Koncilja says — help them schedule an appointment with their dentist.
However, if they have a condition like Alzheimer's and are forgetting to eat, or can no longer safely use the oven (for example, they're burning food or don't remember to turn off the gas), that's a more serious sign that they may not be able to live alone anymore, according to the NIA.
6. They're Having Trouble Taking — or Remembering to Take — Their Medications
Each year, there are almost 450,000 hospital visits among adults over the age of 65 for injuries due to medication — including accidental overdoses or misusing medication, according to the Centers for Disease Control and Prevention (CDC). Taken incorrectly, certain medications can cause serious symptoms like delirium or heart palpitations.
"I don't think people realize how dangerous medications can be if they're overtaken or undertaken," Dr. Atai says. Still, she says, "a lot of times people come to the clinic with their medication and have no idea what they're taking or whether they've taken it."
What to Do
You may be able to help your loved one organize a pill box, or come to their home to monitor them when they take their medications. A home health aide may also be able to visit them and help administer the medication.
If your loved one needs more help taking their prescriptions, however, they may need more supervised care. An older but still relevant February 2005 review in Drugs & Aging reported that the inability to take medications is a common reason people transition to nursing homes.
7. They've Had a Fall — and No One Was There to Help Them
Falls are among the most serious concerns for someone living alone. They're also fairly common: About 3 million people over the age of 65 are treated in the ER for falls each year, according to the CDC.
Not only could a person break a hip or other bone, but they could be unable to get back up again, sometimes until a neighbor or family member finds them days later.
What to Do
There are a few ways to help prevent falls, and there are devices available, such as Life Alert and GPS trackers, that allow aging adults to press a button to connect with emergency personnel. But when a person is at high-risk for a fall — or they start wandering around at night — that's a sign they may need round-the-clock care, Dr. Atai says.
Unfortunately, she says, some people simply refuse to live anywhere other than their own house. But unless you want to take legal action (for example, by getting power of attorney), you and your loved one may need to find a compromise with what they want and what's best for their health.
"You can't define 'quality of life' for another individual," Dr. Atai says. "I've had patients who will not allow anybody to assist them until things have gone really bad… It takes nothing less than an emergency to convince the person that they need help."
Sometimes, it can be particularly tricky for aging parents to relinquish control to their adult children. But if you're worried about your parent's safety, you "shouldn't be afraid of getting in their business," she says.
"After all is said and done, you want to know that you tried your best," she says. "You don't want to look back and regret that you didn't do something."
- Eldercare Locator
- Eldercare Locator: "Protect Your Pocketbook"
- National Institute on Aging: "Bathing, Dressing, and Grooming: Alzheimer's Caregiving Tips"
- National Institute on Aging: "Older Drivers"
- National Institute on Aging: "Driving Safety and Alzheimer's Disease"
- National Institute on Aging: "Healthy Eating and Alzheimer's Disease"
- Mayo Clinic: "Aging Parents: 8 Warning Signs of Health Problems"
- The New England Journal of Medicine: "Emergency Hospitalizations for Adverse Drug Events in Older Americans"
- Centers for Disease Control and Prevention: "Older Adult Fall Prevention"
- Drugs & Aging: "Assessing Medication Adherence in the Elderly"
- National Institute on Aging: "Elder Abuse"
- Centers for Disease Control and Prevention: "Adverse Drug Events in Adults"