How well is your aging loved one managing?

By Lisa M. Petsche

It can be a difficult determination to make: is your aging parent or other elderly loved one managing adequately on his or her own, or does he or she (the latter will be used from here on) need some assistance?

No matter how difficult it may to be to look after their day-to-day needs, many older adults are reluctant to ask for or accept help, regarding it as an admission of incompetence or an invasion of privacy. They may also fear being forced into institutional care. As a result, some try to conceal any physical or mental difficulties.

The following are some indicators that your relative is unable to independently handle all the activities of daily living.

Grooming
• Changes in appearance, such as dirty or unkempt hair, ragged fingernails, decaying teeth
• Inappropriate dress or soiled clothing
• Body odor

Nutrition
• Noticeable weight loss
• Complaints of poor appetite, or loose-fitting dentures
• Insufficiently or inappropriately stocked refrigerator and pantry
• Expired or rotting food in refrigerator

Housekeeping
• Dirty dishes or laundry piled up
• Accumulation of garbage
• Excessive dirt or clutter
• Unsanitary conditions, especially in the kitchen or bathroom

Finances
• Accumulation of unopened mail, especially bills
• Major credit card debt or large, inexplicable bank account withdrawals
• Bounced checks
• Inability to perform basic banking transactions, including writing a check

Medication
• Non-compliance with medication regimes - look for prescriptions that haven’t been filled, and unused or expired containers of medicine
• Lack of an organized system for managing medications
• Prescriptions filled by a variety of pharmacies

Mobility
• Difficulty going from a sitting to a standing position
• Poor balance
• Poor walking endurance
• Difficulty negotiating stairs within the home

Safety
• Recent falls— be on the lookout for bruises or limping
• Cluttered walkways or stairwells
• Accidents with household appliances

Energy Level
• Lethargy
• Social withdrawal

Mental Status
• Poor short-term memory
• Confusion
• Inability to carry out familiar routines or follow instructions
• Poor judgment stemming from lack of insight into needs and limitations
• Suspiciousness

Getting help
Here are some ways to help, depending on your relative’s situation:

Arrange for a medical check-up and accompany your relative. Lethargy, forgetfulness and confusion could be caused by reversible conditions such as infection, malnutrition, dehydration or depression. Request a medication review by her primary physician or pharmacist, since side effects, overmedication or drug interactions might be at the root of difficulties. Ask the pharmacist about available aids for organizing and remembering to take medications. Ensure all prescriptions are filled at one pharmacy.

If nutrition is an issue, arrange a dental appointment to have your relative’s teeth or dentures checked; set up a schedule to take her grocery shopping; stock the freezer with heat-and-serve foods; regularly have her over for dinner; and arrange for nutritional supplements if necessary (consult the doctor or a dietitian first).

If vision is a problem, ask the doctor for a referral to an ophthalmologist. If nothing can be done to improve your relative’s vision, get her a magnifier for reading small print, and other adaptive items such as a large-keypad telephone and a clock with oversized numbers. List important phone numbers on a posterboard (use black lettering on white), and place it on the wall by her phone.

If falls are a concern, perform a safety assessment of the home environment to identify potential hazards—for example, clutter, throw rugs that don’t stay in place, poor lighting, lack of proper stair railings—and do what you can to rectify them. Visit a medical supply store and check out the many products that might make daily activities easier and safer.

If financial management is an issue, arrange for direct deposit of pension checks and automatic bill payment from your relative’s bank account. If necessary, have mail redirected to your home. Encourage her to contact a lawyer to assign a durable power of attorney for property to one or more people she trusts.

Investigate available resources in your relative’s community, which might include: personal emergency response systems; telephone reassurance services; grocery delivery services; meals on wheels; volunteer driver programs; accessible transportation; therapeutic day programs; recreational programs; and home health services involving personal care, homemaking, nursing, dietary consultation, physical and occupational therapy and social work. Such information can be obtained from the local office on aging. If your relative needs more help than community programs can provide and the cost of private-pay services is prohibitive, inquire about senior housing and residential care options.

Even if your relative appears to be managing sufficiently at present, it’s a good idea, especially if she has any chronic illnesses, to start learning about resources in the community that might be of future benefit. This can help to avert a crisis, and if one does arise, you’ll be ready to assist her in making informed decisions and necessary arrangements.

Lisa M. Petsche is a clinical social worker and a freelance writer specializing in family life and elder care issues.