It can be hard to tell how your senior parents are really doing at home when you don’t live near them. It’s one thing to talk on the phone or video chat, but going home for the holidays gives you a chance to check-in on their well-being while you catch up with everyone. Pay attention to the following signs when completing an ADLs Assessment to determine if your senior loved ones are in need of assistance.
It can be difficult to determine when your loved one is no longer able to live independently. This can be particularly hard if you don’t live close enough to your parents to drop by often and see how they’re doing. One useful tool for gauging whether or not older adults require assistance or long term care is an ADL assessment. This determines a senior’s functional status based on what basic activities they can or cannot perform.1 If a senior is unable to complete Activities of Daily Living, some accommodations can be made to help your loved one remain safe in their day to day life. This index is also useful for determining if it may be time to consider relocating the individual to an assisted living facility or nursing home.
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What Is an ADL Assessment?
The holidays are a great time to perform an ADL index and reassess your loved one’s functional status. If you plan on attending a family get together or going home for the holidays, it is important to know what to look for when completing ADL functional assessments.
Activities of Daily Living can be split into two categories: Basic ADLs and Instrumental Activities of Daily Living ADLs.2 If your loved one is unable to perform basic ADLs, then care planning is necessary. There are five main categories of basic ADLs:
Daily living IADLs are activities on the ADL assessment checklist that may not be everyday necessities but are still important for independent living.3 IADL scales measure independence in activities including:
Assessing your parents’ ability to complete both ADLs and IADLs can assist you in helping your parents find the best possible living solution. At the very least, it can get them the help they need to live at home comfortably. Here are a few subtle — and not-so-subtle — signs that your parents may need some extra help to stay healthy and safe:
If your folks have always been organized but now you see stacks of unopened bills or letters sitting around, try to find out why. Maybe they’ve just been busy getting ready for the holidays. But unopened mail, especially if it dates back more than a few days, can also be a sign of cognitive impairment, financial problems your folks may not know how to handle, or vision loss.
Possible solutions: If Dad or Mom has trouble reading the mail, an eye exam is in order. If financial or memory issues are to blame, it’s time to talk to your parents about having another family member or a professional daily money manager help them manage their bills and mail.
New dents on their cars or scrapes on the garage walls can be signs that your folks’ driving skills are declining. Try to ride with your parents during your stay to see how they are now driving. Drifting across lanes, driving much more slowly than normal, and not turning to look while backing up are signs that it is no longer safe for them to drive.
No one looks forward to the driving conversation with a parent. However, there are ways to make it less stressful and more productive.
Possible solutions: Research alternate transportation options and discuss their effectiveness with other relatives. You should be prepared to have more than one conversation with your loved one about scaling back or stopping driving altogether.
Your senior parents’ grooming standards should be about the same during this visit as the last time you saw them in person. Cognitive impairment or physical limitations may be the cause of noticeable changes in their appearance. Changes to look for include dirty clothes, dirty hair, and significant weight loss.
Possible solutions: These changes are signs that a visit to the doctor is needed. Memory loss may be causing your parents to forget to bathe, change clothes or eat. Mobility issues like arthritis and neuropathy can make some activities of daily living too painful for your parents to handle on their own. Depending on what their doctor recommends, your parents may need an in-home aide or a move to assisted living.
Pets can be a great source of companionship, but caring for pets can get tougher as we age. Your folks may be having some challenges with pet care if you notice long claws and matted fur on Fido, a birdcage that’s long overdue for a cleaning, or an overflowing litter box. It is probably time to get some help for the sake of your loved one and their pets.
Possible solutions: Dog-walking services, mobile pet groomers and vets who make house calls can take care of the checkups and chores. This leaves your parents free to enjoy their pet’s company.
Your folks don’t have to have a spotless house, especially when they’ve been getting ready to host company. However, if their housekeeping has slipped noticeably since your last visit, they may need some help maintaining their home. Mildew and mold, pantry pests and spoiled food are signs that your folks need another set of hands and eyes to keep their home clean and safe.
Possible solutions: If there’s not a family member nearby who’s able and willing to help out, consider hiring a cleaning service or an in-home aide to clean regularly. Help your parents contact pest control, mold remediation, and other services necessary to make their home a healthy environment to be in.
Does your parents’ refrigerator resemble that of a financially unstable college student who just moved away from home? If so, it’s possible that they are struggling with grocery shopping or putting their meals together. It is also very common for seniors to experience a loss of appetite due to a decrease in activity and resting metabolic rate, medical problems, smell and taste changes, or even depression.4 If you notice your parents have lost a lot of weight or appear fatigued, it is possible they are not maintaining a nutritious diet.
Possible solutions: For parents struggling to make their meals, there are many meal delivery services available to bring healthy, cooked meals straight to your loved one’s door. If your parent seems malnourished, you might need to consult a medical professional to try and determine the cause of any appetite changes. In some cases, prescription appetite stimulants or liquid dietary supplements can help your parents meet their nutritional needs.
While you might feel strange snooping in your parents’ medicine cabinet, it is a good idea to familiarize yourself with their medications and any potential side effects or drug interactions between them. If you notice expired medication, unopened prescription bottles, or past due refills, your parents may be forgetting or choosing to not take their medicine.5
Possible solutions: Take time to sit with your parents and ask how they are doing with taking their medicine. Make a medicine list and review the medicine label with your loved one. Create a medication schedule for your parents. Pillboxes labeled for each day of the week can help them manage multiple prescriptions.
If your parent has scratches or bruises they are unwilling to explain, this can be a cause for concern. It is possible that injuries are due to accidental falls or tripping into furniture. While everyone has moments of clumsiness from time to time, a significant number of injuries can indicate your parent is struggling with mobility. This can be due to aging or may even be a side effect of some medicines.
Possible solutions: Inspect your parents’ home and take note of any potential slipping hazards.6 Work with your parents to make their home more accommodating to their current needs. Non-slip flooring, entry ramps, stair rails, and non-skid mats can help decrease the chance of falling. Ensure there is plenty of lighting to help your parents see at night and help increase accessibility in pantries and closets. Grab bars should be strategically placed in the bathroom. Consider adding a shower chair or bench. Get the help of family members or hire someone to help your parents with tasks that can cause injuries such as changing a light bulb, vacuuming, mopping, and landscaping.
In addition to examining your parent’s physical health, pay attention to your parent’s mood. Do they seem more down than normal or are they detached? Are they cheerful one moment and angry the next? Depression and anxiety are common in seniors, especially during the holiday season. Additionally, mood swings and personality changes can be a sign of dementia.7
Possible solutions: Don’t ignore any concerns you might have about your parent’s mental health. Don’t be afraid to consult a professional, especially if you suspect your parent might be depressed or suicidal. If you are suspecting that your parent has dementia, attend a medical evaluation with your parents and mention any symptoms you’ve noticed. Help your parents connect with a community or center that offers opportunities for socialization and engaging activities they can engage in.
If you notice any of these signs or others that concern you, remember that your family’s holiday gathering is not the best setting to hash out a solution. It may be more productive to talk things over with your parents and other family members when there are fewer distractions and you have more time to research options.
Are you visiting your senior parents this holiday season? What things will you be on the lookout for? We’d like to hear from you in the comments below.
1Fowler, K. (2019, June 19). ADLs and IADLs. Retrieved from https://www.aplaceformom.com/blog/adls-and-iadls/.
2Assessment of Activities of Daily Living, Self-Care, and Independence. (2016, August 30). Retrieved November 14, 2019, from https://academic.oup.com/acn/article/31/6/506/1727834.
3Anderson, J. (2019, June 20). The Ultimate Senior Safety and Well-Being Checklist. Retrieved from https://www.aplaceformom.com/blog/12-5-2013-ultimate-senior-safety-well-being-checklist/.
4Bareuther, C. M. (2010). Dwindling Appetites. Retrieved from https://www.todaysgeriatricmedicine.com/archive/082510p32.shtml.
5Medication management for caregivers. (2019, January 29). Retrieved November 12, 2019, from https://bemedwise.org/medication-safety/elderly-care.
6Important Facts about Falls. (2017, February 10). Retrieved November 12, 2019, from https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.
7Changes in mood. (2017, November 11). Retrieved November 12, 2019, from https://alzheimer.ca/en/bc/Living-with-dementia/Caring-for-someone/Understanding-symptoms/Changes-in-mood.