Knowing When to Step in

In the course of a week your widowed sister has a fender bender and receives a shutoff notice from the power company because she has forgotten to pay her bill. After thinking about this, you begin to wonder if she is at a point where she is unable to take care of herself.

You visit your parents on Thanksgiving and notice the house and the yard are unsightly. Both Parents have lost weight and your dad appears very confused.

You have worked with your client to help manage her money and affairs for so many years that she is no longer just a client. She is your friend, someone you care about. The last several meetings with her have been problematic. She is becoming more confused and cannot follow the conversation. You know she has no close relations. You wish you had someone with whom you can share your concerns.

When someone you know and care about shows signs of growing older, it is indeed disturbing. But knowing when to step in and what steps to take can be difficult.

These are some of the many signs indicating when an elder person needs help:

Physical condition
Swollen feet and legs
Bloodshot or discolored eyes
Bruises
Gaining or losing significant weight
Unusual skin growths or poor skin color
Excessive itching or scratching
Limping, or newly stiff joints
Unexplained bandages
Personal care
Uncharacteristic lapses in grooming or dress
Not performing personal hygiene
Bizarre or inappropriate dress
Behavior
Episodes of newly obnoxious behavior
Falling
Episodes of exhaustion
Forgetting to eat
Not taking medication
Eating more, but not gaining weight
Increased thirst for no reason
Talking about hopelessness
Increasing alcohol consumption
Frequent mood swings
Bouts of severe depression
Sudden personality changes
Growing reclusive or antisocial, or suspicious
Losing interest in what was previously enjoyed
Fearful of leaving the house
Talking of long-dead people as if they were alive
Conduct
Getting lost
Unsafe driving, or "dawdling" driving.
Not paying bills or paying bills more than once
Unkempt house, yard, or car
Repeatedly losing glasses, keys, or pocketbooks
Failing to meet medical or social appointments
Onset of careless or unwise money habits
Inviting to door-to-door salespeople into the house
Talking to tele-marketers on the telephone

If you observe any of these signs, it is wise (and calming) to reflect that they are not "faults" but unwanted consequences of aging.

However, just by mentioning one of these signs, you may appear to the elder to be fault-finding or confronting him with a list of his weaknesses. Some aging people feel more pain or fear from aging than others, but all are sensitive to their diminishing faculties.

Older people value their independence and anything suggesting that they surrender their driving license and car keys, or turn over their bill-paying to someone else, may cause anger and hurt feelings.

The best approach is to demonstrate your concern for the older person by participating with him or her in finding solutions. To do so successfully it's usually necessary – before bringing up "solutions"– to first get the elder to recognize that a problem exists.

In the cases where your concern is an issue the elder is frustrated by or is angry with, begin by commiserating with him or her about the issue. Draw out the conversation until the elder expresses his feelings. Listen carefully, and ask questions, to discover how often he is frustrated by the issue. Then, wonder "out loud" about ways to avoid the issue, or the frustration it causes. Mention "brain storming," and do it. Encourage the elder to pose solutions, and to improve upon yours.

If you can move the conversation to things to do you have come more than halfway to a resolution. Suppose that the "problem" (yours), and his issue, is his forgetting to pay bills. Your approach is to suggest that he delegate check writing to someone else, just as long ago he delegated his tax chores to a tax preparer. Whenever you can get the elder to approach such changes as delegating a task rather than relinquishing a privilege or a power, do so. But always head the discussion toward things to do, rather than his failings.

If talking to the elder is difficult for you, you may find coaching to be helpful. A good counselor can coach you on how to best communicate your concerns. Often you can find near-by resources that provide advice and counseling in the care of older adults. You can start your search by clicking Helpful information in the "menu" to the left.

In the event the elder does not acknowledge an issue that concerns you, or is not bothered by it, getting her to recognize that a problem exists is more difficult. In such a case the problem must be defined as how her behavior (neglecting to feed the cat, for instance, or refusing to bathe) makes other people feel, and how those people's reactions will, in turn, affect her. This can often be done, but not in cases when the elder's mental condition has severely eroded (a state termed dementia). If you face such a difficult situation, contacting a Geriatric Care Manager or other suitably experienced counselor will be helpful.

Warning signs should not be ignored.