By Theresa Klein, OTR/L Dementia Care Consulting – Providing quality education and training dedicated solely to Dementia Care
As the holidays approach many of us are making plans to celebrate with those we love. The holidays are a time to visit and reconnect with family we may not see throughout the year. Going “home for the holidays” is an event that is anticipated all year long. Adult children return home to familiar sights, sounds, and smells to participate in annual family rituals and traditions.
Family gatherings are also a great time to check-in on Grandparents, Mom & Dad, and Aunts & Uncles. As family members age, they may begin to need more help. Annual gatherings can reveal changes our loved ones have experienced over the past year. Changes that we are often not privy to during long distance phone conversations.
Physical changes are often the first noticeable sign. Mom might be losing her balance, Dad may have some swelling in his feet, Grandma may be losing weight, Grandpa may be experiencing shortness of breath. Physical changes are easier to see and therefore often addressed more quickly.
In contrast, changes in cognitive or thinking skills (i.e. reasoning, memory, orientation, judgment, problem recognition/solving, decision-making, impulse control, attention, frustration tolerance, and sequencing) often go unnoticed. These changes do not come to light until a crisis arises, such as a fall, medication error, car accident, or hospitalization.
There are several reasons cognitive changes are often missed. First, in our society, cognitive changes are considered a “taboo” subject and therefore not openly discussed. Aging relatives may notice problems or changes in themselves but do not want to burden family members with their health concerns. Or they may fear if they bring up the subject they will risk losing their independence.
Second, many older adults live alone, therefore family is not involved with day to day tasks where early signs of change are evident (i.e. bill paying, housekeeping, medication management, and transportation).
Third, cognitive changes are hard to see and measure. Changes in Mom’s judgment and decision making skills may not be obvious to the family until she falls victim to a scam (i.e. prepaying a contractor for work that is never done or sending large amounts of money to a 3rd party with promise of a trip that does not exist). Dad’s changes in orientation may not be noticed until he does not return home from his drive to the store that is 10 minutes away. Grandma’s changes in problem-solving may not be evident until she stops taking her heart medicine because it makes her feel nauseated and she ends up in intensive care with heart failure.
Though cognitive changes can be difficult to detect, it is possible to spot them if you know what to look for. Changes in cognitive skills often present themselves during an individual’s execution of their daily tasks. Family may be tempted to explain away changes and limitations due to an individual’s physical needs, age, lack of motivation or personal choices. Though all these things can impact the success of an individual’s day, cognitive changes are often at the root of an individual’s decreased ability to manage their daily tasks.
1. Talk with your family members about their hopes and plans for retirement and beyond. Ask loved ones to plan ahead by creating a healthcare directive and appointing a healthcare agent who can work as an advocate for them should they not be able to care for themselves.
2. Become educated about physical and cognitive changes that can occur as we age.
3. When talking on the phone listen for signs that your family member may be struggling.
• Reports of new physical ailments, dizziness, falls, weight gain or loss, vision changes, excessive medication changes, hospitalizations, etc.)
• Reports of memory loss or confusion
• Reports of driving issues (i.e. getting lost, tickets, accidents)
• Changes in financial status (i.e. decreased funds available, new investments, new purchases, etc.)
• Changes in social outings and commitments (i.e. church, card club, book club)
• Complaints of others mistreating them (i.e. neighbors, friends, etc.)
• Changes in mood and personality
• Repetition of stories or questions
• Frequent calls to you, other family members, and/or 911 at all times of day or night with questions, concerns, needs, etc.
4. Visit regularly or arrange for another family member or friend to make regular visits. There are things that can be seen during an “in person” visit that will not be discovered over the phone. Families may also have a community contact (i.e. neighbor, friend, church member) that they can check-in with for regular updates. When visiting watch for signs that your family member is struggling:
• Changes in cleanliness, maintenance, and organization of house (i.e. odors in house, dirty counters, floors/carpets not swept or vacuumed, dirty dishes, dirty clothes, lawn not mowed, piles of old mail, magazines, etc.)
Author: Theresa Klein, OTR/L
Theresa is an occupational therapist who works as a dementia care consultant. Theresa provides education, training, program and behavior consultation to healthcare professionals, caregivers, families and memory care facilities.