1. Fall hazards. Do you notice things like unsafe indoor or outdoor stairs (especially without railings or poor lighting), throw rugs, clutter or a laundry room that forces your loved one to carry laundry baskets up and down stairs? Is he using unsafe stepladders or stools to access items? Does the bathroom present a scary obstacle course for him? Has his vision changed, or is he feeling dizzy? If your loved one has had one fall, he is more likely to have another. It's time to evaluate all fall hazards.
What to do: A certified aging in place specialist (CAPS), an aging life care specialist, or a physical or occupational therapist can help evaluate your loved one's needs, abilities and the home environment. An expert can also make recommendations for home modifications or exercises for balance and strength. Contact the local area agency on aging or Veterans Affairs to find out if funds are available to help defray costs.
Consider ramps, handrails on both sides of stairs, grab bars in the bathroom or a walk-in shower. Check with your loved one's optometrist or ophthalmologist, doctors and pharmacist about glasses or cataracts, medication adjustments, or mobility aids such as a walker or wheelchair. More fall prevention tips are in this article and my video here.
2. Unfinished business. If you see stacks of unopened mail and unpaid bills, or key financial, home or legal documents that haven't been dealt with, your loved one may be cognitively, physically or emotionally unable to handle them. (Unpaid or unexplained bills, as well as things like missing checks, are also red flags for financial abuse.) When my dad's Alzheimer's disease began progressing, he used to put sticky notes marked "Amy?" on stacks of letters and bills because he couldn't understand them.
What to do: Assess the depth of the problem. Is it a temporary issue or ongoing? A solution may be as simple as help sorting the mail and prioritizing. You may also need to help your loved one simplify her affairs or engage a financial manager.
Offer to help with the more complicated matters while he continues handling day-to-day household and personal finances. When Dad started struggling with multiple health care matters, I helped him open another checking account that he could use for cash and basic needs, and I paid the bills from his primary account. Gradual changes are often better than taking over everything at once.
Be sure your loved one has her advanced directives and other legal documents in place so you are able to help manage her affairs in an emergency.
3. Car accidents and tickets. When you see multiple accidents — no matter how small — or a number of warnings or citations, scrapes or dents on the car, it's time to have a talk about driving.
What to do: Ride along and observe. Is he having close calls? Does there appear to be a health issue causing problems such as vision, hearing or cognitive changes? It's a good idea to get a thorough medical evaluation and recommendations from his doctor. There may be an easy fix, such as new glasses or a car that fits him better.
Suggest that he refresh his driving skills by taking a driver safety course (which may also entitle him to a discount on insurance). If it's time to hang up the keys, be sure to offer other viable transportation options.
4. Isolation. Does your loved one seem disconnected from friends, family and community? If her support system seems to be deteriorating, her physical and mental well-being are at risk.
What to do: Find out with whom she interacts on a regular basis. Ask if she feels lonely. Seek out potential activities she would enjoy, such as a senior or community center, a program where she can volunteer, faith-based programs, arts and music events, adult day care, friendly visitors or a regular gathering of friends for a meal or coffee — and help make arrangements for ongoing participation and transportation (the area agency on aging can help with transportation).
Regular phone calls can help her connect, as well as using technology, including video chat, online communities and social media such as Facebook. Also check for health issues such as untreated hearing impairment, which can discourage communication.
5. Change in appearance. If you notice your loved one has gained or lost excessive weight; is wearing the same clothes every day, or dirty clothes that need mending; is not bathing; has dirty hair; has a flat affect; appears sad, anxious and distressed; or has experienced disturbed sleep patterns — something is off-kilter.
What to do: Suggest a thorough medical and psychological evaluation to determine what is normal for him — there may be multiple causes for these changes. Depression or anxiety may need treatment. Or you may find that changes in vision, sense of smell or mobility are impeding his ability to care for himself.
Review his medication list with a pharmacist and look for negative interactions or reactions, and determine if he is consistently taking medications as directed. Set up a pill organizer for him.
Is he drinking excessive amounts of alcohol? If so, consult with a treatment counselor who specializes in older adults.
Find out how he is making or receiving meals and whether he is adhering to a special diet. If appropriate, arrange for home-delivered meals, housekeeping, medication management and laundry assistance.
Approach conversations about these and other issues with love, concern and a supportive attitude. Be clear that you are not trying to take over your loved one's life or make decisions for her. Your goal is to help her be as independent as possible for as long as possible.