As your parent ages, you may notice some signs of decline. These could include things like poor hygiene, struggling to manage finances or their home, or unexplained injuries. It’s important to note, however, that signs of decline look different for each person. No one knows your parent like you do — something unusual for them may be the norm for another person. Still, it’s helpful to learn the common warning signs that may signal the need for assistance. Niki Gewirtz, with 20 years of experience in the senior living industry, shares her expertise.
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Many seniors take multiple medications, which can cause harm if seniors don’t take them as directed. The more medications your loved one takes, the higher their risk for error. A third of adults in their 60s and 70s take five or more prescriptions on a regular basis.[01] Niki Gewirtz, a former executive director of senior living communities who now trains Senior Living Advisors at A Place for Mom, notes that many of the families she’s helped had concerns about medication adherence. It’s something that she has personal experience with as well.
“It [medication management] started becoming an issue for my grandmother,” Gewirtz recalls. “My mom would visit and find her blood pressure meds on the floor where she had dropped them and didn’t know it. She ended up in the hospital several times because of not taking her meds appropriately.”
Certain medications, like blood thinners, can be life-threatening when not taken correctly. Seniors taking blood thinners have their blood checked frequently to make sure the medication is working properly and adjust the dosage if needed. Because of this, seniors on blood thinners may have multiple prescriptions of the same medication at varying dosages in the house. Gewirtz notes that family members are often concerned because the risks of taking blood thinners incorrectly are quite serious. Medication mismanagement here may result in blood clots, stroke, or heart attack.
Seniors with Parkinson’s disease may also struggle to manage their medications. Gewirtz notes that seniors often need to take these medicines at a particular time of day, and people with Parkinson’s are at an increased risk of developing dementia. This may make it difficult to remember to take the medicine correctly, which can affect the senior’s mobility, cognitive ability, and ability to communicate.
Some red flags that your parent isn’t taking their medicines correctly include:
Poor hygiene has many noticeable signs, such as body odor, piles of dirty clothing, or bad breath. Neglecting self-care could be a sign that your parent isn’t able to complete these tasks on their own anymore. It could also be a sign of declining mobility, depression, or early dementia. Regardless of the cause, poor hygiene carries health risks.
Poor hygiene after toileting and not bathing often enough can lead to infections.
“When a senior isn’t managing incontinence hygiene, it can lead to UTIs and skin breakdown. Not showering regularly can also trigger skin issues,” says Gewirtz.
Not all neglected hygiene is obvious, though. Gewirtz notes that seniors often overlook foot care, including toenail trimming. This can lead to discomfort and even injury when walking. Gewirtz recommends seeing a podiatrist or a nurse with specialized training, especially if your parent has diabetes. An accidental cut or scratch can lead to infection and much larger health problems.
The condition of your parent’s home can often be a good indicator of how they’re doing, both physically and mentally. Always finding dirty dishes in the sink, unclean bathrooms, and mold are all cause for concern.
“I’ve heard from many nurses who go to a senior’s home to do an intake assessment that it’s beneficial to see the senior in their own environment. It gives a much clearer picture into how the senior is taking care of themselves,” says Gewirtz.
You can use this strategy yourself the next time you visit your parent. Gewirtz has a few examples of things to keep an eye out for:
Try to look for patterns that can help you devise solutions for your parent. For instance, if most of your concerns relate to cleanliness, homemaking services may allow them to live independently in a cleaner and safer environment.
On the other hand, if you’re consistently noticing things that indicate forgetfulness, such as not bringing in the mail or neglecting to take out the trash, you may want to take your parent to their doctor. Forgetfulness could indicate early stages of dementia or other underlying medical conditions.
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Forgetting to pay bills or regularly overdrawing accounts can be a sign that your parent needs help managing their money. Gewirtz suggests helping your parent if this is something they struggle with physically. For instance, if your parent has limited mobility, you could take the checks to the mail for them. If your loved one has arthritis, you can set up online payments or write checks if they’re no longer able to.
However, if your parent is forgetting to pay their bills, this could be a sign of dementia. In this case, someone may need to take a more active role in helping to manage their finances.
Having a [financial] power of attorney (POA) in place is important, especially if there is any concern about memory loss. Once a dementia diagnosis is in place, the senior is not legally able to sign a POA, so conservatorship or guardianship would have to be established, which is a much longer process.
If you’ve noticed bills piling up, bounced checks, or calls from collections agencies, ask your parent how you can help. Money can be a sensitive topic for many people, and your parent may not want to admit that they need assistance managing their finances.
Even though it may be awkward to discuss, it’s worth working through the discomfort.
“Being able to make sure bills are paid can mean the difference between keeping the power on or not,” Gewirtz says.
The state of your parent’s car can give you a good deal of insight into their driving abilities. New dents or scratches on the car could be signs that your parent isn’t able to drive safely. Gewirtz notes that this is a common concern for families. Seniors want to keep their independence, and no family member wants to be the person who takes away the keys.
If your loved one is experiencing symptoms of dementia, Gewirtz says that families can tell their loved one that the car had to go in for a tune up, or something similar. This may be easier for someone with dementia to accept.
In other cases, you may be able to reason with your loved one.
“My grandmother was losing her reflexes, so driving was becoming dangerous. She wanted to hold on to the car, as it meant in her mind that she was still independent,” says Gewirtz. “My mom was able to convince her to let go of it when she showed her how much she was paying to keep it insured and registered, plus the parking fee at the community. Money was the deciding factor for her!”
If this doesn’t work, Gewirtz advises families to share these concerns with their parent’s doctor. After an evaluation, the doctor may be able to submit a form to the DMV stating that the senior is no longer safe to drive, or advise you on the next steps in your state.
Nutrition is important at any age, and especially so for seniors. Gewirtz notes the following red flags that may signal your loved one isn’t getting the nutrition they need:
Any of these signs can lead to malnutrition and other health issues, Gewirtz says.
You may have additional concerns if your loved one already has health problems such as high blood pressure or diabetes. Seniors on a low- or no-salt diet may struggle if they’re not cooking or eating fresh food, as processed foods are typically higher in sodium. Diabetics may have trouble controlling their blood sugar levels if they’re not getting the nutrition they need regularly.
A grocery or meal delivery service can make it easier for your loved one to access healthy food. Meals are often a social experience, too. Having shared mealtimes, like those in senior living communities, may help if your parent has experienced a loss of appetite.
Mood swings in seniors can have medical causes, so you shouldn’t ignore them. An abrupt change in mood or personality could be a symptom of a treatable condition, such as an infection or a reaction to a medication.
“It could be related to medications, especially if there is a new med that has been introduced, so letting the doctor know of any new symptoms is important. It also could be a medical issue, like a UTI or blood sugar swings. Always let the doctor know if this is unusual behavior, as it could be something serious, and could easily be managed if caught early,” says Gewirtz.
Another common reason for changes in mood and personality is Alzheimer’s or another form of dementia.
If you’ve noticed changes in your parent’s behavior, schedule an appointment with their doctor. If you’re concerned that these changes are due to medications or an infection, you may want to take them to the emergency room.
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As we’ve mentioned throughout this article, forgetfulness or confusion can show up in many different ways. Noticing this once or twice may not be a big deal. But seeing a consistent pattern, whether it’s forgetting to bathe or take medicine, is a sign for concern.
“Things like forgetting appointments, repeating themselves, taking longer to complete simple tasks, and getting lost in familiar areas are indicators that the senior may be experiencing early stages of dementia, which would need to be checked out by a physician,” says Gewirtz.
If you suspect your parent may have dementia, make a list of the behaviors that concern you. You can share this with your parent’s doctor and ask if they can do a cognitive assessment.
Mobility is an important consideration for almost every task seniors do throughout the day. Something as simple as poor balance could make it more difficult to get dressed or stand up from a chair.
Gewirtz says some of the first signs of declining mobility include things like:
If any of these signs describe your loved one, check for and remove safety hazards in and around their home. For example, Gewirtz recommends removing rugs that they could trip over. A physical therapist may be able to help your loved one improve their mobility and recommend solutions to support their safety and independence.
Unexplainable bruising or other injuries should be a red flag when it comes to your loved one’s safety. Gewirtz notes that falling is her first concern when this arises.
“Many seniors don’t like to admit when they fall, so skin tears should be taken seriously,” Gewirtz says.
Unfortunately, elder abuse is another possible reason for bruising. If you suspect that your loved one is in an abusive situation, you can help by reporting it. Search for your local adult protective services information through the Department of Health and Human Services site.
It can be difficult to know when signs of decline mean that your parent needs more support. Senior care is not one-size-fits-all, and you have many options.
It’s important to discuss your parent’s wishes and check that they have important documents in place if you haven’t already. Consulting with a geriatric care manager, elder law attorney, or financial planner can help you prepare for the future and determine next steps. This may help ensure you’re on the same page and make current and future care decisions easier for the whole family.
If your parent wishes to age in place, Gewirtz suggests having an occupational therapist evaluate their home. Modifications like adding grab bars in the bathroom, for instance, may be enough to help your parent feel more comfortable showering regularly again. If, however, they have to step into a bathtub, home care a few times a week could be a better solution.
As you evaluate your options, Gewirtz emphasizes that quality of life is something families should keep in mind.
“It’s important for caregivers to look at the quality of their life, their loved one’s life, and the quality of that relationship when evaluating options,” Gewirtz says. “If a family member has to take a lot of time off from work or from family obligations to take care of a senior loved one, that becomes an issue. If there’s a concern about a senior wandering out of the house, getting lost, or other unsafe behaviors, that is unsustainable and needs to be addressed as soon as possible.”
She stresses that it’s OK to seek outside help for your parent. The Senior Living Advisors at A Place for Mom can help you find solutions for your loved one. Options include:
You can get help caring for an elderly parent from many sources. Try consulting your parent’s doctor for recommendations. You might also consider respite care, getting an in-home caregiver, hiring a geriatric care manager, or moving your parent to an assisted living community.
You can deal with an aging parent who refuses help by involving them in their care plan, respecting their autonomy, and giving them time to make a decision. It’s also important for you to have an outlet for your stress during this time and ask for help when you need it.
It might be your responsibility to take care of your mother or father. Some states have filial responsibility laws that dictate who is financially responsible for an older adult’s care. If you’re concerned about the laws in your state, you can consult an elder law attorney.
You can only legally control an elderly parent’s finances if they’ve signed a financial power of attorney , or if you have a guardianship or a conservatorship in place. This lets you make financial decisions on their behalf as long as it’s in their best interest.
Hales, C. M., Servais, J., Martin, C. B., & Kohen, D. (2019, August). Prescription drug use among adults aged 40-79 in the United States and Canada. National Center for Health Statistics.
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