The Signs of Changing Needs


How to tell when an aging relative might need extra help.

Aging relatives, particularly those who live alone, increasingly face medical and mobility issues, and questions relating to their physical, social and psychological well-being arise. So how do you know if a relative’s needs have changed and more care is necessary?

Healthy aging and signs to expect

The aging process will slow down even healthy adults to some degree, though how much and to what extent depends on the individual. As we age, we won’t be as quick and our energy reserves won’t be what they were when we were teenagers.  Even with normal aging, a parent may not be able to get through the day without some help. That said, the aging process should not necessarily cause problems in basic functioning. Outside of slowing down physically, people should still be able to balance their checkbook, maintain personal hygiene, and conduct routine tasks. If these activities of daily living are being successfully accomplished, you probably don’t need to worry too much.

dementiaHealthy aging and signs that need evaluation

If you see signs beyond some general slowing of physical function, it’s important to take an aging parent to a doctor – if possible, a geriatric medicine specialist – for an evaluation. Any number of illnesses could be behind worrisome symptoms. Increased fatigue and reduced energy may not seem like urgent health issues, but they should still be evaluated. For instance, fatigue and weakness can be caused by anemia, common in older adults, and can be treated. Weakness and shortness of breath can be signs of heart disease, even if you parent isn’t complaining of chest pain. A normal condition in aging adults is having a less steady gait, a common result of the loss in muscle mass that naturally occurs with age. But that unsteadiness can lead to falls, which can be dangerous for aging adults who may easily break a bone or suffer a head injury. Signs of instability should be evaluated by a doctor, and the aging parent’s home environment should be carefully checked for hazards that could cause trips and falls. See our Home Safety Checklist.

The challenges of recognizing health problems

It can be difficult to know when aging parents are experiencing health problems. Part of the problem is that aging parents often won’t admit that something might be wrong. They are afraid of being “put somewhere”, or perhaps of being a burden to anyone. An adult child might miss the signs of health problems if she sees a parent all the time. If you live close by and visit often, health problems may be tough to spot because some conditions such as dementia can occur slowly over time. It’s a good idea to ask regularly about current events going on in the world. Also, take notice and appropriate action if the response is uncharacteristic. Adult children who do not see their aging parents often will be more likely to observe problems right away. Some family members may talk on the phone regularly, but then when they come to visit for the holidays they realize that all is not okay. Confusion or memory problems can be caused by medications. Many aging adults can have trouble keeping track of the many prescriptions and an overdose can easily lead to mental and physiological problems.

Following are some clear warning signs that some type of intervention is needed:

Mail and bills are left to pile up. The simple act of opening and filing mail can become overwhelming. Paying bills on time and managing a checking account can also become too much for a parent to handle, or can be a sign that they are not thinking clearly. The house is cluttered or unkempt. Lack of interest. This should be of special concern if the parent has always been neat and orderly. Losing weight. This can happen especially after the death of a spouse. Shopping, preparing food and cooking become too much trouble. Food in the refrigerator is uneaten or spoiled. Shopping, cooking, and cleaning become too much trouble A parent might eat just enough to get by, but suffer nutritionally. Losing weight can be another sign that a parent is not eating a nutritious diet. Signs of scorching on the bottoms of pots and pans. A result of short-term memory loss, this is a dangerous sign that parents are forgetting about pots left on the stove, causing a fire hazard, and threatening both the individual and the surrounding neighbors’ safety. Look for other signs of confusion in the kitchen such as water stains and mildew under the sink and in other places because water was left on and forgotten about, dishes that are unwashed for long periods, food left out, etc. Declining personal hygiene as indicated by unkempt hair, dirty or lengthy nails, poor oral hygiene, body or urine odor, unshaven, and wearing same clothes over and over or wearing night clothes during the day. Especially common when the washing machine is in the basement. Or there may be a fear of falling in the tub or shower. Missed doctor’s appointments. Sometimes this is simply a product of not having transportation and not knowing how to access ride options. Getting up and down stairs and in and out of home becoming difficult. Walking unsteady on level ground and/or complaining of dizziness. Falls are likely or have already occurred. Forgetting to take medication. A sign of short-term memory loss or depression, this is not just a quality of life issue, but a real risk factor. Inappropriate behavior, clothing or speech. You may hear about this from a neighbor, someone who has noticed that your parent is not dressing appropriately for the weather, for instance. That’s a sign that he or she might be confused. Not recognizing need for, arranging, or scheduling necessary household repairs and maintenance. Lawn not mowed, trash not disposed of, and mail retrieved with irregularity. Just acting strangely or out of character. Odd conversations, signs of paranoia, accidentally taking too much medication, phone calls at odd hours, unusual fears and nervousness, all of these things may be signs that a parent needs help.

Now what?

If you see any of these signs in your parents, discuss it with them. Share your concerns and see what they say. Try to get them in to the doctor, but if you can’t, make an appointment with the doctor or a geriatric care manager yourself and discuss your concerns. The professional can point you to various agencies that can help.


Legal Considerations


While you’re in the process of organizing long term care for your loved one, it’s a good idea to look into some legal considerations that are specific to seniors. Addressing these issues now will help reduce stress when critical life decisions need to be made and will ensure that a senior’s wishes are met.

Wills and Trusts

Wills – Enable a person to specify who gets his or her personal possessions when they die. They are useful in preventing potential family conflicts. In the absence of a will, the law will determine how personal property is distributed.

Trusts – A trust is a legal arrangement where one person (called the “trustee”) holds and manages property for the benefit of someone else (the “beneficiary”). The trust “property” can be cash, CDs, stocks, or real estate. The terms of the trust document control what the trustee may do with the trust property. It will set forth specific instructions for how the property can be invested as well as who can receive distributions from the trust and under what circumstances.

Some estate planners say it’s possible to use trusts to reduce your assets in order to qualify for Medicaid. Others say trusts can disqualify you for Medicaid. It’s important to seek the help of a good and experienced elder law attorney in the patient’s state when structuring your estate to meet specific goals.

Advance Health Care Directives

In the event that an individual is unable to make decisions due to illness or incapacity, Advance Health Care Directives are legal documents through which someone expresses their preferences for medical intervention and long-term care.

The 2 types of advance directives are:

Living Will – Provides instructions for the types of health care treatment that should be provided.

Durable Power of Attorney for Health Care – Appoints a person to make decisions on the individuals’ behalf when the individual is incapacitated.

Both forms of advance directives are advisable. To ensure they are followed, you should discuss them with everyone involved and give copies to responsible family members, a personal physician, and other trusted individuals. Advance Directives are recognized nationwide, but the detail in them may vary from state to state. Check with an experienced elder law attorney in your state.

Spouses do not have legal authority. Just because you are married does not mean you have legal authority over the property and person of your spouse. It’s important to give your spouse or someone you trust Power of Attorney. If your spouse becomes incapacitated and you don’t hold his or her power of attorney, you cannot sell the home you own jointly, cannot make withdrawals from your spouse’s IRA or other retirement plan, and cannot act for your spouse in any other legal capacity. If you don’t have a power of attorney, the only other alternative is a court appointed guardian.

Guardians and Conservators

If an individual becomes incapacitated without having completed a durable power of attorney to specify who he/she wants to act on his/her behalf, a court can appoint a guardian or conservator. Terminology varies from state to state and sometimes the terms are interchangeable. In Pennsylvania, the court procedure is termed a “guardianship”.

Guardian – An individual appointed to make health care, personal and financial decisions for someone in the event that person becomes physically or mentally incapacitated. A guardian would have the legal right to decide where the person will live and the medical treatment they would receive.

Conservator – Someone appointed to oversee the financial affairs of someone unable to do so themselves. The conservator takes control of the person’s assets and must handle them for the welfare of the protected person. Once a conservator is appointed, a dependent person may not liquidate his own assets or determine how the money will be invested without the consent of the conservator.

The court appoints a guardian/conservator after hearing evidence that a person is incapacitated and deciding that there is a need for a guardian. The law requires due process for the proposed ward. The proposed ward, or alleged incapacitated person, must be given formal legal notice of the proceeding, has a right to be present at the hearing, and has the right to be represented by a lawyer.

Court appointed guardianship can be very expensive and can take a considerable amount of time to get. Making a power of attorney is much less expensive and much less stressful than the court-appointed guardian process.

Starting the Conversation


Conversations about the effects of aging and plans for the future of an aging loved one can be tricky. Here are some suggestions for tackling such issues as long term senior care, finances, driving, household safety, and end-of-life choices.

Some things to consider before you begin:

Don’t think of your changing relationship with your parent as “role reversal”, think of it more as becoming a peer or friend. Chances are, if you become the “parent” by ceasing control, they’ll become the “child” and rebel.

Don’t think of it as “The Big Talk”, but rather as a series of conversations. It’ll be easier to get started if there’s not a huge list of things to accomplish. And it’ll be easier for your parent not to feel overwhelmed. Be sensitive to their level of comfort and stamina.

Sooner is better – talk before a crisis occurs and when your parent’s health allows them to fully participate.

Remember that while most kids assume their parents will resist having this conversation, the fact is that many parents want to share their thoughts but think their kids don’t want to hear it!

Try to ask questions and then listen carefully. You’re trying to find out what your parent wants. DO NOT give ideas, suggestions or input unless asked. If you jump in with a bunch of plans and solutions before asking what they want, you’ll likely meet with resistance. Ask what, where, who, how and when… but avoid asking “why”. If you do you’ll likely meet an emotional and defensive response.

Pick a time for the conversation that’s not rushed. And don’t do it during family occasions such as holidays or birthday celebrations.

Educate yourself before you start. It’s important to know what needs to be discussed, ie, living arrangements, outside help, power of attorney, when to stop driving, etc. Understand the options available. The more you know the better you’ll be able to ask the right questions.

It’s possible you’ll get some resistance. Remember that resistance is usually the response to fear. You can reassure them that the reason you’d like to discuss things is so you can help them live the life they want, even if in the future they can’t do certain things for themselves.

Remember that decisions made today can be changed tomorrow. Especially after having had the time to think about them more and from various perspectives.

Try to keep it light, involve only immediate family, don’t make it an intervention, and limit your initial expectations.

Some conversation starters

Hopefully one of the following examples will give you an idea:

Use an experience you’ve had or that of a friend. For example, “My friend’s mom broke a hip and is in the hospital. My friend has to make decisions for her and is unsure what to do. It got me thinking that I should know what you’d want me to do if that happened to you. Can we talk about it?”

“I read an article about how seniors often lose control as they age because others’ have to make decisions for them. I want to make sure you never feel that way. Can we talk so I’m clear about how to help if you need it?”

You can share an experience such as your own retirement or estate planning as a way to gracefully transition into a conversation about your parents’ thoughts regarding the future.

If you are unsure what sort of documents you might need, see the Legal Considerations section.

Ask about records and documents. Explain that you want to be prepared to help them when needed. Ask where they keep important documents such as insurance policies, wills, trust documents, investment and banking records, tax returns, living wills and durable powers of attorney. This approach could also serve as a way of finding out what plans he or she have already made and what needs to be done.

Some signs of a looming problem might be if you notice damage to an older driver’s car, or if you notice that they’re reducing driving at night due to vision problems. “Let’s figure out a plan for how you can get around town if you no longer feel safe driving.”

If the house is a mess… “Mom, I have some extra cash. What do you say we find someone to help you with the heavy stuff?”

Even if the house isn’t a mess, you can help open the discussion by inquiring whether there are any responsibilities – such as home maintenance, yard work or bill paying – that they’d like some help with to make life easier.

If you see medication bottles everywhere… “How the heck do you keep all these pills straight, Dad?” There might be good reasons such as, some are in the kitchen because he takes them with food. Some are on the nightstand because he takes them before bed. On the other hand, if the response is something like, “I don’t know. I do my best. I’m not even sure what some of them are”, then the situation probably needs more attention. A pill organizer might help, or perhaps a trip to the doctor or pharmacist together to get it sorted out.

Household clutter is a little-known cause of senior stress. Perhaps offering to help a parent sort through a cluttered home will give you the time together to broach a tougher subject and busy hands to make it seem less onerous.

If you notice bruising… Pay special attention. It could simply be a result of certain medication (though if extreme the doctor should be consulted), but it could also be due to falls, malnutrition, or elder abuse. “Mom, that’s a nasty bruise, where did you get it?” If she tries to pawn you off with a generic response such as “I’m just clumsy”, dig further. “Sure Mom, our whole family is clumsy but we aren’t all walking around with big bruises on our arms. So how did it happen?” If you notice empty cupboards or spoiling food in the fridge… “Boy, there’s not much food around the place – what are you guys eating?”

Involve third parties. If your parent resists your efforts to begin the discussion, he or she may be more open to the guidance of a respected non-family member. Doctors, clergymen, geriatric care managers or trusted friends who have already helped a loved one in a similar situation might be possible resources.

Approaching a parent about giving up the car keys

We typically consider driving a significant part of independent living, but the fact is that the ability to drive safely decreases with age. Response times slow, manual dexterity decreases, peripheral vision and depth perception decline, concentration ability declines, hearing loss, and decreased flexibility to look around for problems are just a few. Many people are able to drive safely into their 70s and even their 80s, but people age differently. Knowing the risk factors and warning signs of an older loved one who has become unable to safely operate a vehicle will help you gauge when it’s time to hang up the keys.

According to the National Institute on Aging, there are several critical indications that a senior may be losing the judgment or ability to drive:

  • Incompetent driving at night, even if competent during the day.
  • Drastically reduced peripheral vision, even if 20/20 with corrective lenses.
  • Struggling to drive at high speed even if he or she drives well locally at slow speeds.
  • Erratic driving, such as abrupt lane changes, braking or acceleration, hitting curbs, missing turns or scaring pedestrians.
  • Getting lost frequently, even while driving on familiar roads.
  • Trouble reading street signs or navigating directions.
  • Frequently startled, claiming that cars or pedestrians seem to appear out of nowhere.
  • At-fault accidents or more frequent near-crashes or scrapes on the car or mailboxes, garage doors, and curbs.
  • Failing to use turn signals or keeping them on without changing lanes.
  • Drifting into other lanes or driving on the wrong side of the road.
  • Range-of-motion issues, such as failing to look over the shoulder, trouble shifting gears or confusing pedals.
  • Increased traffic tickets or “warnings” by traffic or law enforcement officers.

Talking to a relative about his or her need to stop driving is one of the most difficult discussions you may ever face. However, it’s better if it comes in the form of advice from you or someone he or she knows rather than by an order from a judge or the DMV. One of the main reasons seniors are reluctant to give up driving is that it is one of the few ways they can continue to feel self-sufficient. The discussion becomes even more difficult when the person still maintains most of his or her faculties, just not those that enable safe driving.

Be empathetic. Imagine how you would feel if you were in your parent’s place. Ask others to join in the meeting. It helps to involve other family members in the discussion to help, but not to confront.

Keep the conversation non-accusatory, honest and between “adults,” not “child and parent.” Say things like, “We’re concerned,” “We care” or “We don’t want you to get hurt or to hurt others.” Once you’ve both come to an agreement, you can continue to support your loved one in ways beyond just offering rides.

Help the senior make a schedule. He or she can plan activities and combine trips on days when a caregiver can drive.

If all else fails, they might have to hear the news from a doctor.

Fall Prevention Checklist


General Precautions

  • Is there an emergency plan in place?
  • Are working smoke detectors installed?
  • Is there a “ready-to-use” fire extinguisher(s) on the premises?
  • Are inside halls and stairways free of clutter/debris?
  • Are throw rugs removed?
  • Are there sturdy handrails or banisters by all steps and stairs?
  • Are electrical cords unfrayed and placed to avoid tripping?
  • Are electric outlets/switches overloaded (e.g. warm to the touch)?
  • Are rugs secured around the edges?
  • Are hazardous products labeled and kept in a secure place?
  • Is there a need for a stool to reach high shelves/cupboards?
  • Is smoking paraphernalia handled safely (e.g. cigarettes put out)?
  • Does anybody smoke in homes where oxygen is in use?
  • Are all animals, on site, controlled?
  • Is the home free from bugs, mice and/or animal waste?
  • Are materials stored safely and at a proper height?
  • Does the occupant wear an emergency response necklace/bracelet?


Entrance to Home

  • Are there outside lights covering the sidewalks and entrance ways?
  • Are the steps & sidewalks in good repair and free from debris/material?
  • Are the railings on the steps secured?
  • Is there a functional peephole in the front door?
  • Does the door have a deadbolt lock that does not require a key to open it from the inside (unless there is a tendency to wander


Living Areas

  • Are doorways wide enough to carry loads through and get a wheelchair/walker through?
  • Are light switches accessible so they can be turned on/off without walking across a dark room?
  • Are sofas & chairs high and firm enough for easy sitting and rising?
  • Is there a telephone in the room that is easily accessible?
  • Is a list of emergency telephone numbers by the telephone?
  • Do telephone cords/electronic wires run across walking areas?
  • Are there castors or wheels on furniture?
  • Does sitting furniture have armrests which are strong enough for getting in and out?



  • Are there glass doors on the bathtub/shower?
  • Is there a non-skid surface/mat in the bathtub/shower?
  • Are there grab-bars on the bathtub/shower and adjacent to the toilet?
  • Is there a raised toilet seat (if trouble getting on/off toilet)?
  • Is the water temperature below scalding (e.g. below 120°)?
  • Does the bathroom have a night light?
  • Is there a shower bench/bath seat with a hand-held shower wand available?



  • Is the floor waxed or otherwise slippery?
  • Are there any flammable items near the heat source?
  • Do the “ON” buttons work on all appliances?
  • Are items used the most stored between eye and knee level?
  • Is there an uncluttered work space near the cooking area (to avoid having to carry items)?



  • Is there adequate lighting in all stairways and hallways?
  • Is there a light switch at both the top and bottom of stairs?
  • Is there a light switch by the doorway of each room?


Medical and Medication

  • Are used needles placed in a sharps container?
  • Is oxygen tubing kept off the walking path?
  • Is medical equipment properly stored?