What's Happened to My Mother?

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"Are you my mother?" a lost baby bird asks a dog, a cow and a steam shovel in the beloved classic children's book. Family caregivers often feel just as lost when they ask the very same question: Is this unkempt, confused woman the same person who always insisted I clean my room and wouldn't let me go to school unless the part in my hair was perfectly straight? Unfortunately, the answer is often yes; a woman they've known all their lives is living in a dirty and unsafe place, not eating well (or at all) and failing to take care of her personal hygiene.

• Medications. Some drugs cause mental confusion in older people, and others can lead to fatigue or dizziness. Check with the doctor to determine whether prescription or over-the-counter drugs may be causing problems. Stopping medications suddenly can also cause problems.
• Cognitive impairments. Screening tests can help identify whether dementia or some other cognitive deficit may be a factor.
• Depression. Many older people are depressed, but they don't talk about it or even realize it. Untreated depression can result in physical exhaustion, social withdrawal and loss of interest in self-care.
• Alcohol or drug abuse. Some older people hide their addictions successfully until the side effects become too obvious to ignore.
• Isolation. Studies have shown that many people who do not take care of themselves are socially isolated. Adult day services or other opportunities for meeting people might be helpful.
• Contrariness. Perhaps the most difficult factor to assess. Maybe your family member has always been stubborn, or maybe it has developed with age. If your family member is competent — that is, knows what he or she is doing and understands the consequences — it is hard to intervene.

You can learn to recognize the signs of self-neglect. Any one of the signs can be disturbing, but combined they can be dangerous. Common ones include:

• Not bathing or taking care of hair, skin, fingernails.
• Dirty, disheveled clothing, or clothing that isn't appropriate for the weather.
• Failure to take medications or go to doctor or dentist.
• Garbage and rotting food in refrigerator.
• Unsafe living conditions, such as fire hazards or no heat.
• Hoarding, typically newspapers, clothes, animals.

Getting Help

What do you do about it? Early detection of self-neglect signs is important. Once these behaviors — and your family member's resistance to change — have become entrenched, it is harder to modify them. An experienced professional, such as a nurse, social worker or therapist can help. Your local Area Agency on Aging may be able to guide you.

If action isn't taken early, your family member's living conditions can pose a threat to others. If you don't take steps to control the situation, a neighbor or someone else may call in the local health department or adult protective services, which may limit your options.

As the family caregiver, you need to see this situation for what it is — a combination of mostly unavoidable factors that together place your family member at risk of illness, death and nursing home placement, exactly what he or she is trying to avoid. Other family members may blame you for letting the situation get so bad; even your elderly parent may criticize you for trying to change the way he or she lives.

Although you may feel guilty or ashamed, don't keep the problem hidden. Talk about it with other family members, and enlist their support to find a solution.

Carol Levine, caregiving expert for AARP, develops partnerships between health care professionals and family caregivers as director of the United Hospital Fund's Families and Health Care Project.