Caregiving: When Does Your Loved One Need Extra Support?
Aging is a fact of life. There are many benefits to aging: realizing self-determination, collecting experiences, gaining wisdom, and sharing expertise. But there are also some inevitable challenges including slowing down and, for many, requiring additional support.
But when is this additional help needed? Sometimes it is obvious; they are unusually forgetful, confused by instructions, or leave a pot boiling for entirely too long causing a fire. But more often, the cognitive decline is gradual, with behaviors chocked up to forgetfulness or a bad day.
There are key areas of daily living that caregivers and family members can look at – perhaps with a geriatric professional who can provide an assessment – to determine if your loved one needs extra assistance to remain safely independent.
Falls and Trip Hazards
According to the Centers for Disease Control and Prevention, each year, more than 1 in 4 older adults will have a fall. Falls can lead to broken bones, torn ligaments, head, and brain trauma, and greater health issues down the road.
Steps to Take: Ensure the living space is clear of clutter, slippery throw rugs and mats, prominent electrical cords, and other trip hazards. If your loved one needs to use a step stool to reach items, make sure it is in good working condition, steady, and unlikely to move when standing on it. Replace shoes with worn and uneven soles and poor traction.
Mobility
Pay particularly close attention to how well your loved one is getting around. A lack of mobility not only takes a physical toll, it can also have psychological repercussions. If mobility is reduced, it is likely the person’s living space will shrink because it becomes too hard to access items outside of the area. When individuals are limited in living space, feelings of isolation and depression may increase.
Steps to Take: Take note of your loved one’s gait – the speed and relative steadiness. Are they lifting their feet when walking or shuffling or dragging a foot? Test the balance. If your loved one is having trouble walking or maintaining balance, consider making modifications to the home including handrails, grab bars, walk-in tubs, showers with a seat, higher toilets, and additional ramps. You can also opt to move daily-use items to lower cabinets or sliding shelves for easier access. Use AARP’s Free HomeFit Guide and room-by-room checklists for more than 100 tips for a safer, more comfortable home. Contact aging-in-place specialists or occupational therapists for additional ideas.
Mental Health
Depression can be tricky to spot in older adults. It's normal for an older person to feel down every once in a while — perhaps frustrated by health problems or worried about money. Despite the stereotype, there isn’t necessarily a mood change. When engaging with an older adult, are you noticing a change in energy levels, an increase in irritability or anger, difficulty sleeping or sleeping more than usual, change in eating patterns, or thoughts of death or suicide?
Depression and dementia often share symptoms. Dementia is more than memory loss or loss in the ability to handle daily living activities. It also includes poor judgment, such as leaving the bathtub running while going to watch a movie. While depression is treatable, dementia is not.
Steps to Take: Check in often with your loved one to see if they are sad or anxious about something, listen and provide emotional support. Develop a group of friends or family to look in on the older adult frequently to provide support. Talk with your loved one’s doctor or geriatric psychiatrist about treatment options including talk therapy and pharmaceuticals. Also, confirm that current medication combinations are not contributing to depression.
Fiscally Speaking
When you visit, are you seeing stacks of unopened mail and unpaid bills? Are checks going uncashed or are multiple checks sent to family members for holidays and celebrations? Are insurance policies or other important home or legal documents being ignored? Are you noticing unusual transactions or amounts of money going to charities – both real and fake? As loved ones age, many tend to become overly generous and susceptible to financial scams.
Steps to Take: Start by helping sort the mail and prioritizing important items. Offer to provide support when dealing with more complicated financial matters while your loved one handles the daily finances such as shopping and paying utility bills. Try setting up automatic payments and suggest getting online access to the bank accounts to make sure everything is proceeding as it should. Finally, make sure they have legal documents in place, so you are able to help manage affairs in an emergency.
Driving
By 2030, there will be more than 70 million people age 65 and older, and about 85 percent will be licensed to drive. In fact, seniors are outliving their ability to drive safely by an average of seven to 10 years, according to AAA. If you’re starting to see an increase in tickets, “fender benders,” or unexplained dents and scratches, you may want to have a conversation.
Steps to Take: Tag along for a ride and keep your eyes peeled for close calls, vision difficulties, and getting lost on familiar roads. Vision issues may be fixed with a new prescription. Bigger issues may require a driver’s course refresh such as the AARP Smart Driver course. If it is time to hang up the keys, identify other options to help your loved one remain independent. Investigate ride-share options such as Lyft and Uber or senior shuttles in your community.
Changes in Appearance
Has your loved one's appearance changed? Have they gained or lost a significant amount of weight? Are they ignoring basic hygiene regimens such as bathing, shaving, brushing/combing hair, etc.? If they have unexplained bruises — where they can't remember when or how they got them — point to concerns with daily activities and cognitive issues.
Steps to Take: While these issues can signal cognitive decline, they could also be explained by changes in mobility – for instance, shoulder arthritis leading to the inability to lift the arm to brush hair or fear of getting in and out of a shower or bathtub – are hindering their abilities. These issues can be addressed with modifications. Should your loved one be dealing with depression or cognitive decline, it is important to contact their doctor.
The Next Step
Noticing more than a few red flags? It may be time to get a trained professional to conduct a more in-depth geriatric assessment about the degree of impairment and what is causing the impairment, as well as to offer recommendations — as part of a team — about what can be done. The best person to go to initially is the primary care physician, who knows your loved one's history, or a geriatrician. Your doctor can send a visiting nurse, social worker or physical therapist to assess the situation, recommend changes and get them help.
Family members and caregivers can also hire an individual geriatric care manager or aging life care professional to conduct assessments in the home over time to see how loved ones are functioning on a day-to-day basis. The manager provides and discusses the results, and refers you to other resources for additional support.
Download or request mailed copies of these free AARP resources:
Tips for Having “The Talk” With Your Loved One
- Don't put off the talk. Having the conversation ahead of time and in a theoretical sense will give your loved one the opportunity to provide direction on what they want to happen and where they would want help. If you wait until issues build up, it will be more threatening for your loved one.
- Ease into it and treat it like a yearly check-up. If help is needed down the road, introduce it bit by bit. For example, start by offering to hire someone for a task your relative doesn't like, such as cleaning the house.
- Don't command. Include your loved one in any decisions. They may have a disability, but they also have years of wisdom and preferences. Don’t treat them as children. Ask what they would like and listen to them. Start a conversation with, “When you look at your future, what do you hope for? What is important to you? What worries you?”
- Reframe their thinking. This is about being proactive and trying to preserve independence as much as possible.
- Are the caregiver or family members experiencing increased stress? If so, you may need to make a change. Assure your loved one that accepting help provides an opportunity to remain as independent as possible and eliminates and burden that may be placed on you.
