Holiday Worries - Part 1

During your holiday visits with family and friends, did you note any of the following concerns?  If so, stay tuned during January as we rerun our "Holiday Worries" series and tips.

The holidays provide an opportunity to spend time with family and friends whom we don’t see as often as we wish.  While these celebrations may not always be “TV-perfect”, they allow us to check in with those we love and see how they are doing.

Having some time between visits highlights changes in family members.  You may notice that Aunt Mary seems a bit forgetful or that Dad is a little unsteady on his feet.  You may arrive at Grandma’s house after being away for a year or so and are shocked by the messy and not so sanitary condition of her home.  You may give Grandpa a big hug and then take a quick step back as you are forced to wonder when he last bathed.  When you take out the trash after Thanksgiving dinner, you may notice a crunched fender on the front of Mom’s car and some scratches on the side.  You ask yourself, “What’s going on around here?  Are they okay?”

Maybe – maybe not.  Any of these observations could indicate physical or cognitive changes in an aging family member.

If you’re in the home of a family member, what should you look for?

1.   Is your loved one’s home clean?  Maintaining a home becomes more difficult as mobility and endurance decrease over the years.  Someone who has always kept a spotless home may not be physically able to care for the home, particularly if it is large.  Someone forgetful may simply forget to pick things up or take out the trash.  Vision problems make it more difficult to see stains on the carpet or mouse droppings in the pantry.  Tasks that require a lot of bending or lifting don’t get done very often – such as washing windows or cleaning tubs and toilets.

2.   Is the home well maintained?  Maintaining the structure of a home, and the yard, can be even more challenging than keeping up the inside.   A hanging gutter may not be noticed or, even if it is, climbing a ladder to fix it is too dangerous, so the gutter hangs and water problems develop.  Broken or burned out lights don’t get repaired or replaced.  In fact, pretty much anything that requires a ladder is off the home repair list.  Cutting the grass and weeding may require too much bending or stooping or too much muscle to power the lawnmower.  That outdoor work may be too hot as well.  And cleaning snow and ice in the cold, and on shaky legs, can be a recipe for disaster.  Roof leaks may not get fixed because they aren’t noticed or because they are too difficult to try to fix personally and too expensive to call in a professional.  Furnace and air conditioning problems may be beyond the homeowner’s abilities and, again, perhaps it is too expensive to call for help.  An elderly homeowner may forget to repair a broken gate or lock, or may put it off until there is a little more money in the bank, making the home more vulnerable to break-in.

3.   How is the car?  Safety is a major issue for aging drivers.  Are there dings, dents or more evident on the car?  When gently questioned about the car, are the answers given confused (what dent?) or evasive?   Any driver can have an accident on occasion.  Most of us maintain insurance coverage and, if our car is damaged, we get it fixed.  If an older loved one doesn’t remember how the damage got there, that can indicate a memory problem, a head injury from a recent accident, or confusion or disorientation while driving.  If the answer is evasive, defensive or even hostile (acknowledging the dent but refusing to continue the conversation), is the older driver feeling insecure about her driving skills?  Has there been some police intervention or a lawsuit that she doesn’t want to talk about?  Has this happened before?  Was anyone hurt?  Can she not afford the repairs?  Does Mom volunteer that she doesn’t drive at night anymore, or on the freeway, or in the rain?  Self-limiting driving is an acknowledgement of increasing difficulties, but is not always an adequate solution.  And, if driving is a problem, is alternative transportation readily and affordably available to your loved one in his/her current home?

4.   Is mail piling up?  Not keeping up with mail can indicate forgetfulness, an inability to pay bills independently, a financial crisis which makes opening bills or letters upsetting, a visual problem that makes reading mail more difficult or a cognitive problem that makes understanding and responding to the mail challenging.

5.   Is there food in the pantry and refrigerator?  And is that food fresh and reasonably healthy?  Is much of it spoiled or outdated?  Visual problems can lead to keeping expired foods and can result in food-related illnesses.   Cognitive difficulties can do the same.  A lack of food in the home can indicate that finances are really tight, that transportation to and from the store is difficult, that the individual is having trouble planning and preparing meals, or that he/she has a decreased appetite (which could be a sign of illness and/or depression).  Is the food on hand appropriate for your loved one?  Does a diabetic have a cupboard full of cookies, but few vegetables in the house?  Does the diet meet the medical needs?

6.   Is the house safe?  Are there electrical cords stretched across a room just waiting to trip someone?  Are throw rugs a hazard with Grandma’s walker?  Can she safely get up the stairs to her bedroom and bathroom safely?  Is the home well lit?  Are there good locks on the doors?  Does the neighborhood still seem safe?  Do people check on her regularly?  Does she have a personal response system (a call button on a pendant or bracelet that she can push for help)?  Is there room to move safely throughout the house or is it necessary to dodge furniture or clutter with every step?

7.   What are the neighbors or your loved one’s pastor or fellow church members saying?  If you have the opportunity to talk to Grandma’s neighbors while you’re out catching up on her yard work, or if you can stay to take her to church on Sunday, try to find the opportunity to talk with some of her friends and neighbors privately for a moment.  Are they seeing areas of concern for her?  Has she been seen walking down the street in her nightgown?  Is she forgetting their names?  Do they dive for cover when she starts her car?  You might want to provide your name and contact information in case the neighbor or pastor has concerns in the future.

What about your loved one himself?

1.   Is your loved one clean?  Bathing becomes more difficult as we age.  For some seniors, the sense of smell decreases and they aren’t as sensitive to body odor, but no one wants to offend others.  Getting in and out of a traditional bathtub (climbing over the side, sitting down safely and pulling oneself back out safely) becomes very difficult for individuals with diminished strength, joint problems or balance problems.  People fear falling and simply avoid the tub and settle for sponge baths at the sink, which are rarely as thorough.  Someone who has few guests may not see the need for daily bathing and gets out of the habit.  Someone who is forgetful may simply forget to shower or bathe.  Individuals with dementia can find running water, or being covered with bath water, frightening.  Individuals with visual problems (and some dementia patients with depth perception challenges) may have trouble seeing tubs, toilets and sinks, particularly if they are white porcelain against white walls or floors.  Some older individuals may develop problems with incontinence (much of which can be treated medically) and may have trouble keeping themselves clean.  Someone who is depressed may not care about personal appearance.  A change in personal hygiene can have many different causes and is a reason for concern.

2.   What is Mom’s mood?  Does she seem anxious or a bit agitated for no identifiable reason?  Is she frequently tearful?  Do her moods change rapidly and without visible cause?  This could be a sign that she isn’t feeling well, that she is depressed, that she is stressed by your visit home or by her visit to you, that she is worried about a health or financial issue or even that someone has been abusing or attempting to exploit her (verbal or physical abuse, scamming her, stealing money, threatening her in some way).  It could also be a sign of dementia and the paranoia and behavioral changes that often accompany it.

3.   How is Grandma’s memory?  Memory loss can be caused by medications, infections, stroke, physical illness, depression, stress or dementia.  Memory difficulties often affect short-term memory first.  Grandma might not remember who came to dinner yesterday (short-term memory), but she can describe in detail her grade school teachers (long-term memory).  It is easier for individuals to cover up memory loss if they stay on familiar subjects, which is often easy to do when families reminisce over the holidays.  As long as you’re all talking about Christmases past, her memory may be clear as a bell.  If you start asking Grandma what your sister (who was present at dinner yesterday) named the new baby, and if it was a girl or boy, or what time Uncle Joe picked Grandma up for the trip to your home, you may be able to tell if she is able to store and retain new information well.  Continued short or long-term memory lapses are a reason for concern and should be discussed with a doctor.

4.   Does Dad seem a little confused?  Does he have one black sock on and one brown sock?  That could indicate a visual problem or it could be that he is starting to have trouble dressing himself.   If you and Dad decide to try to fix a leaky pipe and you, head already under the sink, ask Dad to bring your red toolbox from your garage workbench, open it up and hand you the wrench, do you actually get the wrench?  Or do you get a hammer, or an old pair of boxing gloves (they were also on your workbench) or does Dad never come back at all?  If he hates home repairs, his failure to return may be deliberate.  If he returns with a hammer, he may be having trouble hearing you clearly.  The greater worry arises if he can’t follow the two or three-step simple commands you gave him; this may indicate cognitive difficulties.  Or when you ask Mom, who loves to cook, how to make her traditional Christmas strudel, does she have trouble remembering the ingredients or explaining the process?  Her difficulty in being able to remember how to do something she has done successfully for many years could be an indicator of cognitive difficulties.

5.   Has Aunt Mary lost a lot of weight since you last saw her?  Does she look pale or gaunt?  If she hasn’t been talking of actively dieting, then a noticeable weight loss (or a gain) may indicate an underlying illness, difficulty in affording groceries, challenges in getting to and from the grocery store, forgetting to eat, physical or cognitive difficulties in planning and preparing meals, loneliness (we all eat better with company), etc.

6.   Is Grandpa keeping busy?  When you chat with him about his activities, does he mention what is happening at the church where he has been a deacon for years?  Does he talk about playing chess with his old friend down the street?  Is he following his favorite sports team and is he knowledgeable about their record this year?  Or is he reluctant to talk about his usual hobbies or friends?  Has he become more isolated?  Isolation can indicate  any number of things.  Grandpa may not be feeling well.  He may be having some memory or cognitive problems he doesn’t want his friends to know about.  He may not be driving much anymore and can’t get out.  Vision or hearing difficulties may make it difficult to follow sports on TV or to enjoy visits with others.  He may be a little depressed and can’t find the energy and enthusiasm to do the things he used to enjoy.

7.   Is Grandma caring for Grandpa?  Does Grandpa have cancer, diabetes or a bad heart and is Grandma his nurse?   Does Grandpa have Alzheimer’s disease and is Grandma determined to keep him at home with her and take care of him?  We feel a duty to care for our loved ones when they become ill, but we almost always need help.  This is particularly true when the caregiver is getting older, and when he/she may well have health problems of his/her own.  It is extremely difficult for anyone to be a caregiver and an elderly loved one should not try to do this on his/her own.  There is help out there, but most seniors are unaware of the resources available to them.  Caregivers often die before their care recipients because of the stress of caregiving and because they are too busy to take care of themselves.  Find help for those family caregivers, no matter their ages.  If you can’t be there personally to be in the home frequently to provide that care, help them arrange care through someone who can.  Don’t ignore the situation.  And if you’re the primary caregiver, get some help for yourself.

8.   What about medications?  Does Dad start sorting through a bakers’ dozen of pill vials every morning?  Does he have a clear idea of what all those drugs are for?  Are any of them duplicates, such as the same drug prescribed by multiple doctors, or a name-brand drug from one doctor and a generic version of the same from a second doctor?  Is he having any trouble remembering to take medications on time or getting them refilled as needed?  Can he afford all his prescribed medications or does he adjust some of the doses (take half a pill, or only half as often as prescribed) to cut back on costs?  Does he know which pills are taken with food and which on an empty stomach?  Do any of those drugs interact with other drugs he is taking (or with herbs or vitamins)?  Are any of the drugs in his collection expired?  Do any need special handling, such as refrigeration?  Many elderly patients are the victims of “polypharmacy”, the state of having been prescribed too many medications, which often occurs when more than one prescribing physician and/or more than one pharmacy is involved in a patient’s care.

Should you be worried?

During this holiday season, we will use a series of articles to discuss the warning signs in the checklist above, some of the related concerns, ways to explore those concerns, and options for helping your loved one.  Your worries or intuition about an older family member or friend, and his/her living situation, may have a sound basis, so don’t ignore your concerns and leave a bad situation alone to grow worse.  We all change over time, but some changes indicate more than simple aging.

If you are worried about immediate medical concerns for your loved one, arrange for him or her to be seen by his/her physician as soon as possible.  If another family member is the person who generally stays on top of your loved one’s medical care, please discuss your concerns with that person and include him/her in scheduling medical appointments.  Ask your parent or grandparent if it is okay for you to attend medical appointments and to be part of the discussions with the physicians or see if another family member can attend.

Don’t rush in and assume that you need to take charge immediately, or that Mom, Dad or Grandpa needs to move right away.  Talk with your loved one and with other family members involved in his/her care and life.  Catch up on what is happening and learn what needs are recognized and what plans are already in place.  Explore what others are doing to help and volunteer to assist.  Let your loved one know you care and treat him/her with respect.

Check back next week for the next article in our “Holiday Worries” series to learn more.