Elderly parents often try to disguise cognitive decline. The Thanksgiving holiday provides an opportunity for families to spot signs of incapacity in aging parents.
Publix has the greatest holiday television commercials, doesn’t it? They evoke love, warmth, family and wonderful meals. You can’t wait to visit home.
This year, get a feel for how your elderly loved ones really are doing. They may be disguising fading capacity behind a cheerful façade. You might not be privy to the results of Mom’s latest neurological exam, but these practical hints can alert you to warning signs that Mom’s mental and physical well-being might not be as strong as she may lead you to believe.
1. The Main Meal. Your Mom may have been holding large family dinners flawlessly your whole life. But this year, perhaps she overlooked a traditional family favorite, or undercooked the turkey, or added salt instead of sugar to the pecan pie batter? Hosting a large meal requires a surprising amount of executive-level brain function. Mom has to plan the menu, travel to the store and purchase the appropriate amount of ingredients, read and follow a recipe, use multiple kitchen appliances, time the food preparation, and get the house ready for company. Bobbling the holiday meal can be one of the first public signs of cognitive decline.
2. The Car. If Dad’s car has scrapes and dents, Dad’s eyesight might need to be checked. He may not be able to judge distances, or see past the hood. He could be suffering from seizures. Limited mobility might hamper him from being able to turn his head to look both ways. Dad may be experiencing regular fender benders, but if he is crafty, he may rush to fix the damage without reporting it to you—or to the insurance company – for fear of losing his driver’s license.
3. The Refrigerator and Pantry. Do you notice spoiled or out-of-date food? Are the shelves bare? Aunt Sally might no longer remember to eat. Perhaps she doesn’t have transportation to the store. Could Aunt Sally lack the money to buy food?
4. Personal Physical Appearance. Is Uncle Henry unclean or disheveled? Is he bruised or cut? Uncle Henry could be losing his sight. Are his clothes too large or too small? Uncle Henry could suffer from an undiagnosed medical condition that is affecting his weight.
5. The Mail. Is the mail piled up or unopened? Are there notices from creditors? Dad may be overwhelmed and unable to handle his financial affairs. Shipments of bizarre items that Dad ordered, or thank you notes from disreputable charitable or religious organizations, or unexplained checks or PayPal deductions shown on the bank statements may mean Dad is being manipulated. No bank statements? Dad may bank or pays bills electronically. Record his passwords – the inability to access digital assets is an ever-increasing problem.
6. The House. How does your parents’ home appear? Is the foliage overgrown? Are the shutters askew, screens torn, windows broken, or is paint peeling? Does the plumbing function? Are all appliances operable? Are there stacks of dirty dishes or garbage in the house? Do you smell anything odd or offensive? Your parents may lack the physical, mental, or financial wherewithal to keep up their home. We all hate to recognize it, but there comes a point as your parents age that they will be unsafe living at home alone. They may need assistance with lawn care, house cleaning, meal preparation, and personal care. They may need to downsize, or move into some form of communal living. This is an incredibly difficult subject to discuss. Start the conversation early and keep the channels of communication open, but don’t be surprised if your parents balk at discussing any plan for their incapacity.
7. The Pets. Are the pets being cared for properly? Are there unexpected pets? Has Cousin Ethel turned into the crazy cat lady, or does Uncle Billy have aggressive and uncontrolled dogs? Are they spending money on the pets to their detriment – is everyone eating dog food because it is all they can afford?
8. Personality Changes. Has your sweet-mannered Dad become aggressive or abusive? Has your outgoing Mom become withdrawn? Do their moods swing? Changes in brain function often manifest in behavioral changes. People don’t talk about it much, because it is shocking to have a parent become violent or depressed –but it happens. A lot. Make sure your parent’s physician is aware of your observations, and push for a neurologist’s evaluation if you feel it is warranted.
9. Companions. Our elders can be lonely, isolated, and vulnerable to predators. Be skeptical of new and suddenly close relationships. Pay attention to the names of the people surrounding your loved ones. If your internal warning system alerts, listen to it.
10. Conversation. Can Mom track the discussion? Are her responses appropriate and timely? Suspect hearing loss if Mom tunes out only when there is background noise, but if Mom regularly loses her train of thought mid-sentence, or answers in non-sequiturs, beware of cognitive decline.
Your elders have pride and desperately want to maintain their dignity and independence. They can become masterful at presenting a wholesome picture of health and happiness because they love you and don’t want you to worry. Look deeper and pay attention to the smallest signs of mental or physical decline, so you will be better equipped to help them. The holidays are an excellent time to assess and enjoy your loved ones, whether your family resembles a Publix commercial or a Jerry Springer episode.