How to assess their need for care.

Many of us will be travelling to visit our parents this Christmas. For some it will be the first occasion of seeing them for many months, perhaps even this year. Seeing changes in them is inevitable and is more marked if you have not seen them recently. This is the ideal opportunity to assess how they are coping and if there is a need to get help involved in their care. But how do you know what is normal aging or when there are signs that they are not managing very well? The best tool for assessing anyone is simple conversation.  Beware of slipping into ‘interrogation mode’ as this can cause offense and close down potential communications. Talk, listen and observe.

All these observations and questions must be seen within the context of what is usual for that individual, with allowances for normal changes and variations, but here are some areas to be aware of when visiting elderly relatives.

1. Physical health

Margaret Wilson - Supported MovesPhysical condition is often the most obvious area that changes as we age. Long-term conditions such as diabetes can accelerate or bring on new complications, or new conditions such as high blood pressure can emerge. How are physical changes being handled? Has your parent been to the doctor recently? Are medication regimes understood and are they being followed? Are aids such as hearing aids being used correctly and are they functioning as they should? Have they had appropriate eye tests and denture checks in the recent past? Are there any symptoms that they complain about, but seem reluctant to seek help for? While it is common for any of us to put off making a doctor’s appointment for a niggling worry, an aging person may have undue fears or anxieties that prevent them from seeking a diagnosis and getting the help they need to manage a condition.

2 . Mental health/mental capacity

Most people fear a deterioration in their mental state but conversely, it is often the area that we are not aware of in ourselves. Everyone’s memory gets a little patchy as we age, (remembering details from long ago, but struggling to recall what we did yesterday) but attention should be paid if this is happening to an extent that threatens a person’s safety. Try the shopping list test:  are they able to identify items that are needed for a meal or around the house; are they are able to write out a shopping list, with appropriate items on it; can they remember that they have made a list and why certain items are on it? Ask about television programmes they have watched recently or items in the news. Be alert for changes in habits – if your parent has always keenly followed current events, but appears to have lost interest, find out why. Subtly check their orientation to time and place: at holiday time it is possible for any of us to lose track of the day, but are they able to figure it out? Are they able to follow the conversation or is there a change in their ability to communicate?

3. Food issues

While it can be said that none of us eat as usual during the Christmas holiday, it is important to try to assess if your parent is looking after themselves when you are not there to stock up the fridge! Is there evidence of meal preparation or can your parent tell you about meals they have made recently? Is there a reasonable amount of food in the cupboards: check for sell by dates, general quality of the food and how they are storing left-over food. How do they get their shopping in? Does it look as if your parent has lost or gained weight: are they interested in meals or eating inappropriate food at the wrong time? Drinking enough fluids is one of the most important factors in staying well as we age, as dehydration can cause confusion and be a factor in infection. Is there evidence of alcohol consumption which is out of the ordinary for your parent, or is there cause for concern about the amount they are drinking? Depression and isolation can lead to a dangerous increase in drinking at any age.

4.  Personal hygiene

A difficult subject but often one of the first areas to deteriorate in an older person. Observe whether the clothes your parent is wearing are clean, in reasonable condition and appropriate for the weather and occasion. Are clothes being washed regularly; are there difficulties in using the washing machine; are there bundles of dirty clothes secreted about the house? Is your parent having regular baths/showers or is there a reason why they are avoiding bathing; for instance, a person living alone may be afraid of slipping in the bath, so may be making do with a wash. Are excuses made as to why they are not going to have a bath/shower while you are there? Do they look and smell clean?

5. Financial situation

Concerns about finances and how they are going to manage is now recognised as one of the biggest areas of worry for lots of pensioners.  It may also be a part of your parent’s life that you have never been involved in, so assessing how they are managing will require some delicate sleuthing. In conversation, do they express any worries about their finances? Is this a change for them or is it there any basis for their worry? Try to assess how your parent is managing with day-to-day matters: have they got a suitable routine established for collecting their pension; are bills being paid correctly; are there unopened bills hidden in piles of papers; do they have an appropriate amount of cash on hand or the means to get more if they need it? How are they with handling money: are they giving over the correct amount of cash in a shop or do they seem not to know the  price of common goods within reason?  There may be an opening to have a direct conversation about financial matters: if so, cease the moment and remember that there are many ways to get help and guidance, from financial advisors, charities or on-line.

6.Home safety and security

Much can be gleaned from simple observations around your parent’s home. You should be trying to assess if they are safe and comfortable: is the home warm enough or is it over-heated? Taking into account personal preference, do they seem aware of the temperature around them or is it out of the ordinary for them? Can they manage to control their environment or are they avoiding changing the temperature because they can’t remember how the heating system works? How is the general up-keep of the property: are there simple maintenance jobs that have not been done and why? Is the level of cleanliness acceptable and usual for them? Are areas being over-looked because of failing sight and mobility? How does the home smell? Safety for elderly people is very important: are they aware of locking their doors and do they exercise appropriate safety with strangers at the door? Safety within the home is important too: are there loose rugs which present a tripping hazard; have they reported any falls or is there evidence of bruising which may have resulted from a trip or fall? Observe for trailing flexes and overloaded electrical adaptors: can these be changed or up-dated while you are visiting? Is the home cluttered to an extent that it is dangerous: this can be especially true if mobility is changed, for instance if they are now using a walker or wheelchair and needs to be addressed.

7. Social situation/relationships

Be aware of changes to their routines: are they still going to their normal social outings (church, bingo, shops, clubs or groups) or can they give a reasonable explanation why they have stopped going out? Have there been any significant changes to their social circles, such as the death of close friends or relatives? Much as this is an unfortunate fact in later life, it can have an impact on social routines and can lead to isolation and depression. How are their relationships with others around them: can unexpected feuds or complaints about the neighbours be checked out? If appropriate, it is a good idea to have a little chat with the neighbours as they may be able to shed light on how things are generally or highlight areas they are worried about.  How are relationships between partners: are they getting along as usual or are there difficulties? Is it possible to have a separate chat with each partner, to give them a chance to verbalise any worried they have?