Unseen Shifts. Warning Signs to Notice When Visiting Aging Parents

The holiday season offers a crucial opportunity for adult children to assess the well-being of their aging parents. With many adult children living far away and travel costs on the rise, in-person visits can be infrequent. While anyone can mask their true feelings during a phone call, being there in person offers a different perspective. Since long-distance phone calls often mask gradual decline, a multi-day holiday stay provides a full, unvarnished look at a parent’s health, lifestyle, and home environment.

Having worked in senior living communities, I have seen this scenario unfold repeatedly, and the emotional toll on the adult child is profound. They are often upset because they didn't realize how severe the decline had become and feel a deep sense of guilt for not intervening sooner.

Looking beyond the holiday cheer, let's explore the critical warning signs that your loved one may be struggling and outline proactive ways to provide essential support.

1. Physical Health and Mobility Clues

How your loved one moves, eats, and looks can be the clearest indication of decline.

• Noticeable Weight Change: Unintended weight loss is a major red flag that could signal underlying disease, depression, or an inability to shop for or prepare nutritious food. Conversely, unexplained weight gain can also signal poor health or medication side effects.

  • Tip: Check how well stocked their cabinets and pantry are during your visit. A lack of fresh groceries is often telling.

• Changes in Balance and Gait: Observe how they move. Are they unsteady, shuffling their feet, or holding onto furniture or walls for support? We refer to this as "furniture walking," and one misstep could easily lead to a fracture or a hospital visit. Difficulty getting up from a low chair or avoiding stairs entirely are strong indicators of an increased fall risk.

  • Tip: If you see this, discuss the option of home health physical therapy (PT), which their doctor can order. PT is often covered under Medicare Part B for multiple weekly in-home visits, helping maintain strength and balance (your objection handler for when they say I cannot afford it).

• Bruises or Unexplained Marks: Discovering new, unexplained bruises or small cuts suggests recent falls or difficulty maneuvering around obstacles. Ask gently about their origin, but be aware that they may downplay the issue.

• Decline in Personal Hygiene: A significant shift in grooming habits—such as uncombed hair, body odor, wearing the same soiled clothes repeatedly, or poor oral care—can signal depression, loss of motivation, or physical difficulty managing bathing/dressing (e.g., fear of slipping in the shower).

  • Tip: See if you can arrange for a companion or caregiver to visit weekly or multi-weekly to assist with activities of daily living. This also provides much-needed companionship and social engagement.

2. Cognitive and Emotional Red Flags

These subtle changes are often the hardest to spot remotely but become obvious during a visit.

• Repetition and Confusion: Do they repeatedly ask the same questions (even minutes later) or tell the same stories? Do they seem confused about the date, time, or location? While mild forgetfulness is normal, consistent repetition is a sign of potential cognitive decline.

• Mood or Personality Shifts: Look for uncharacteristic irritability, agitation, sadness, or a noticeable withdrawal from activities they once loved (like cooking or decorating). Depression and loneliness are common in seniors and require urgent attention.

• Mismanaged Medications: Check their medicine cabinet. Do you see multiple, identical pill bottles, expired prescriptions, or evidence of many missed doses in a pill organizer? Medication non-compliance is a serious health and safety risk.

  • Tip: Setting up a pill organizer and arranging for a medication management service can make a profound difference in their health outcomes.

• Difficulty with Familiar Tasks: Watch them handle routine tasks. Do they struggle to use the TV remote, follow a familiar recipe, manage the phone, or get overwhelmed by the complexity of holiday planning? This signals a loss of executive function.

  • Tip: While in town, make every effort to connect with their primary care doctor. Accompanying them to an appointment is one of the best ways to get back in the loop on their overall health and cognitive status.

3. Home Environment and Safety Clues

The state of the home is a direct reflection of a parent's ability to cope with daily life.

• Hazards and Clutter: Look for clutter blocking walkways, loose throw rugs, poor lighting, or burned-out lightbulbs. These are all immediate fall risks.

  • Tip: Removing all throw rugs and clearing clutter from high-traffic areas are mandatory safety steps.

• Kitchen Concerns: Check the fridge and pantry for expired or spoiled food or a general lack of fresh groceries. Also, look for scorched cookware or smoke detectors with batteries removed, which may indicate forgotten food left cooking on the stove—a severe fire hazard.

  • Tip: If you are noticing these things, exploring options at senior living communities, such as independent living or assisted living, should be a primary consideration.

• Financial and Paperwork Piles: Piles of unopened mail, late notices, or scattered bills are a major warning sign that they are struggling to manage their finances or are overwhelmed by organizational tasks.

  • Tip: Step in and offer to take over or assist with their finances. Seniors who struggle with this are frequently taken advantage of by scam calls and fraudulent donation requests.

• Neglected Maintenance: Is the laundry basket overflowing, the house noticeably dusty or dirty, or are simple repairs (like leaky faucets) left undone? This suggests the physical or mental effort of maintenance is too much.

  • Tip: Setting up a caregiver or companion to visit a minimum of once a week helps avoid this type of neglect. It eases their burden, and the companion provides another set of eyes to call you with concerns.

What to Do If You Spot These Signs

If your visit reveals any combination of these warning signs, don't panic, but don't ignore them.

• Approach with Empathy: Start the conversation by expressing concern, not criticism. Use "I" statements: "I've noticed you seem tired lately, and I just want to make sure you're getting the support you need, especially since we don't live nearby."

• Schedule a Doctor's Visit: The single best next step is to arrange for a comprehensive medical check-up, including a cognitive assessment. Frame it as a proactive wellness check.

• Offer Specific, Small Help: Instead of asking, "Do you need help?" which is often met with "No," offer specific, immediate tasks: "Can I organize your medications while I'm here?" or "I'd like to sign you up for a meal delivery service for a month to try it out."

• Prioritize Physical Therapy (PT): Remember that arranging for PT, ordered by their primary care doctor, will be covered under Medicare Part B. Keeping up their balance and strength is crucial, and multiple weekly in-home visits ensure engagement and safety supervision.

If you are experiencing this with your loved one, first know you are not alone. There are so many professionals who can assist you in navigating this journey. Reach out—we are here for you, near and far.

~ Felicia