Home for the holidays: Tips for evaluating your parents' well-being
Over Thanksgiving, Eliza Kendall visited her parents at her childhood home in Darien, Connecticut. They had both lost weight since she last saw them, her mother most noticeably. And when Kendall looked inside their oven, she found an uneaten pizza.
"Reality hits you right in the face when you go home," says Kendall, 54, of Harwich, Massachusetts.
There were other worrisome signs. Kendall's mother, 81, was repeating herself.
"Dad was having trouble with very simple tasks, like doing his bills,” she says. “He'd stopped doing his crossword puzzles."
Going home for the holidays often brings great joy, as well as great stress. And for adult children who may not have seen their aging parents in a few months, these visits provide an important opportunity to observe their parents’ physical and mental state to determine whether they're thriving on their own or may require additional help.
But just because your mom overcooked the turkey this year or your dad can’t remember where each grandchild goes to college, it doesn’t necessarily mean they’re in a precarious state of decline.
“Holiday stress can definitely exacerbate things,” says Iris Waichler, a licensed clinical social worker and author of “Role Reversal, How to Take Care of Yourself and Your Aging Parents.”
The pressure of cooking and hosting or the activity and noise of lots of children in the house can throw anyone off. So think of this as a time to reconnect, observe and get an update on how your parents are doing. But while you are enjoying that pumpkin pie and laughing at old family stories, keep your eye out for the following.
What to check for
The state of their home: If the lawn is a little overgrown or the handles on the kitchen cabinets need replacing, no immediate need to worry. You can hire a handyman to fix them — or roll up your sleeves and do the work yourself while you’re visiting. But if you notice smelly garbage piling up, spoiled food in the fridge or cupboard or piles of dirty laundry all over the floor, those are signs that your parents may be having trouble caring for themselves, says Waichler.
Physical frailty: Even if your mom was an avid tennis player or your dad loved to take epic walks around the neighborhood, at some point they’re going to slow down. But if you notice a steep drop in their physical mobility — difficulty going up and down stairs, an unbalanced gait while walking or a tendency to sit in one spot for hours and then wince in pain when they get up — or you notice a significant change in their weight, those could be signs of concern, requiring a doctor’s attention and modifications to their home, more help or even a move to a more accessible living situation.
Cognitive changes: Everyone forgets the name of that actor who was in that movie or misplaces the keys once in awhile, but if your parent forgets the names of a family member or long-time friend or seems confused about how to actually use her keys, that could be a sign of the onset of Alzheimer’s disease or other forms of dementia, says George Perry, Ph.D., a professor of neurology at the University of Texas at San Antonio and member of Medical, Scientific & Memory Screening Advisory Board of the Alzheimer’s Foundation of America. Other things to look for: Frequent confusion, getting lost while driving or walking to familiar places, difficulty reading a book or following a conversation, spending large sums of money unwisely, leaving mail unopened and bills unpaid.
Behavioral changes: If your sweet and doting mom has an uncharacteristic meltdown because the children are playing loudly in the den, or your normally cheerful dad seems quiet and blue over the holidays, that may also be an early sign of dementia, says Perry.
“Some of the earliest signs of Alzheimer’s disease are behavioral changes,” he says. “If you see your parent is quicker to anger, or seems more down than usual, those are cause for concern.”
How to assist seniors in need
If you suspect your parent is in imminent danger (wandering outside of the home, being aggressive or leaving the stove on, for example), then you need to jump in right away with a medical evaluation and safety precautions, says Perry.
But if you are noticing small signs of gradual decline, there’s no need to have a heavy talk during the holidays, says Barbara Silverstone, co-author of “You & Your Aging Parent.” If your relationship with your parents is fairly good, she adds, issues may come up naturally in conversation. Instead, enjoy the time together with family (pitching in with cooking, cleaning and driving as much as you can), and then follow these steps.
1. Note any changes and plan to follow up
“If you see that your parents are forgetting things or seem confused, it may not be the easiest thing to judge in just one snapshot,” says Perry. “But you should be concerned about watching the pattern of their behavior.”
Make plans to check in on them frequently, seeing how they’re faring day by day in lower-stress situations.
2. Make modifications to keep their home safer
Perry points out that keeping seniors in their home as long as possible can be crucial to their well-being, and there are many simple ways you can modify their home to make it safer if they are showing cognitive or physical challenges: Get rid of clutter, move cords out of the way, remove rugs, put railings in the bath and on stairs, put in clocks with large type that also tell the day of the week.
3. Share your concerns with your siblings, neighbors and friends
Your brothers and sisters may have noticed additional problems or have a different perspective on how to approach the situation.
“It’s a good idea to divide up tasks based on each sibling’s skiIl set,” says Waichler.
One sibling may be handy enough to fix up the home while another may want to look over mom and dad’s health insurance policies and be the point person for doctor’s appointments. It may also be valuable to chat with your parents' neighbors, friends and other members of their community like priests or rabbis to see if they’ve noticed any decline. While at home, take a walk and introduce yourself to their neighbors, leaving your phone number and email address behind. Ask them to contact you if they become concerned.
4. Open up the conversation
Wait until all the holiday guests have left and the hubbub has died down, and sit down to talk with your parents about the future.
“Come from a place of collaboration, not confrontation,” says Waichler. “You can say, ‘It’s been great spending time with you, and I want to talk about what you’d like moving forward. Do you want to stay living at home, or perhaps move somewhere where you don’t have to worry about cooking or cleaning the house? It’s good for us to know so we can help you have the best quality of life based on what you want to do.”
Even if your parent says, “I don’t want to talk about this right now,” you’ve planted a seed and opened the door for future conversations.
If you don’t know how to bring up the topic, Waichler recommends you wait until after the holidays, then tell your parent, “My New Year’s resolution is to help figure out how I can best help you to make your life as wonderful as possible.”
If your relationship with your parent is a difficult one, however, you may benefit from hiring a senior care adviser to help you through the process.
5. Make sure they are up to date with doctor’s appointments
If you’re concerned about either physical or cognitive changes, bring your parent for a checkup with their general practitioner.
Silverstone says that you might be able to alert a doctor to a health concern they were not aware of, and it can be sorted out, says Silverstone.
You can also get a sense of whether their physician is competent and knowledgeable about geriatrics. Depending on their symptoms, the doctor may refer them to a neurologist, neuropsychologist or psychiatrist. Be sure to follow up on those appointments, driving your parent if needed or arranging transportation to get them there.
6. Investigate resources in your parent's community
There are many services that can help your parents with challenges as they age, such as adult day programs and in-home care. Contact your parent's local area agency on aging at N4A.org for more information. Understanding the available care options will be extremely helpful in conversations you have with your parents. If you and your siblings don’t live close enough to get there quickly in an emergency or keep an eye on things, you might consider hiring a geriatric care manager who can be the point person for coordinating care and guiding your parent through any crises.
7. Hire help as needed
Whether you hire a driver to help your parents run errands, a companion to visit a few times a week or a home health aide to assist with activities such as bathing, preparing food and managing medication, getting the proper team in place can help keep your parents safe and secure in their home for as long as possible.
“It’s important for them to have social interaction, physical exercise and sensory input,” says Perry. “The more you can keep them a part of your family and a part of the world, the better.”
Eliza Kendall's sisters agreed that their parents needed more assistance. They decided to divide the responsibilities. Eliza, a businesswoman, has power of attorney and handles all the finances. One sister, a social worker, takes care of health-related matters. A the third helps the other two.
"We meet once a month for dinner for an update and to decide if any care changes need to be made," says Kendall.
By using your holiday visit as a time to evaluate how your parents are doing and checking on the level of help they need to keep thriving, you’re doing your best to make sure they will be happy and thriving for future holidays.
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