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Our hair turns white (or falls out).  We need glasses.  We don't move as quickly as we once did.  Others comment that the TV is too loud. 

We expect to change as we age, even if we don't welcome all of those changes.  We see age-related changes in ourselves and in our parents and other relatives.  Sometimes the difference is dramatic, such as after a major illness or stroke.  Sometimes it just appears to be dramatic, like when we visit our distant relatives on the holidays and are surprised at how different they look. 

For most people, skills and capacities diminish gradually, and most people will need a little help every once in awhile as they get older. 

The challenge is to know which of the changes are part of the normal patterns of aging and which are indicators that something is wrong and that some intervention is needed because your parent cannot manage on his or her own without some regular assistance.  Here are some signs to look for:

DETERIORATING HYGIENE OR APPEARANCE.  Occasional uncombed hair or going to the grocery store without make-up isn't something to worry about.  A persistent pattern of neglected teeth, dirty clothing, not bathing - these are some of the signals that your relative may need some help. 

ERRATIC OR INAPPROPRIATE BEHAVIOUR CHANGES.  If your loved one starts acting differently, or inappropriately, you may need to take action, especially if that behaviour lasts more than a few weeks. 

CONFUSION OR DISORIENTATION.  This may take the form of garbled answers to questions or an inability to concentrate or not understanding a normal conversation.  It may also take the form of memory loss.  Some memory loss is normal - all of us forget where we put our car keys, for example.  That kind of occasional lapse isn't cause for concern, and forgetfulness tends to increase with age.  On the other hand, forgetting what a car key is for, or failure to remember significant people or getting lost in familiar surroundings may be early signs of Alzheimer's disease or dementia.  Because of our fear of Alzheimer's disease, we tend to notice the memory lapses of older people, but we shouldn't jump to conclusions without a medical diagnosis. 

EMOTIONAL PROBLEMS, DEPRESSION OR STRESS.  Stress, sadness and grief are often a part of seniors' lives, just as they are a part of the lives of younger people.  They become a cause of concern if they linger and persist for more than several weeks. 

SIGNS OF INSUFFICIENT NUTRITION, DEHYDRATION, WEIGHT LOSS.  If your relative is not getting enough to eat or drink, their health is in jeopardy and it may be a sign of depression, or that they are no longer able to prepare meals for themselves.  The obvious sign is if your loved one is losing weight.  Check the refrigerator and pantry to see that they're eating regularly. 

INABILITY TO MANAGE MONEY.  If you notice that the bills are stacking up, or that the bank account is being depleted when there should be enough money, it's time to step in and help your parent manage the finances. 

FRIENDS OR NEIGHBOURS EXPRESS CONCERN.  Your relative's friends may be the first to notice when something's wrong.  They may be hesitant to let you know because they don't want to appear meddlesome, they don't want to "go around" your relative, or, most often, because they simply don't know who or where to call.  It's a good idea to give them your phone number and ask that they call you if they ever have concerns. 

INABILITY TO MANAGE MEDICATIONS.  It seems like the number of little plastic bottles of pills in the medicine cabinet increases with every year that we age.  By the time they're in their seventies or eighties, people may be taking a full handful of pills, three or more times a day.  It can be difficult to remember which pills to take when.  If they cannot remember if they took their medication, or how much they took, you can set up a schedule or monitoring system to help ensure that the right pills are taken at the right time. 

UNCLEAN OR UNSAFE LIVING ENVIRONMENT.  At some point, the normal maintenance of the house may just become more than an older person can handle.  The lawn never gets mowed and paint is peeling.  These are indications that some housekeeping services are needed.  Other signs may indicate that physical or mental impairments have deteriorated such that your relative simply cannot continue to live independently without assistance.  If they leave the stove burners on or cannot safely make it from one room to another, or consistently leave dirty dishes piled in the sink, it's time to get some help. 

FALLING, LACK OF MOBILITY, WANDERING OR SIGNIFICANT VISION OR HEARING DIFFICULTIES.  Because bones fracture easier and heal more slowly with age, falling is always dangerous for older.  Likewise, if your relative can no longer physically get around the house, or becomes reclusive or isolated, or if they cannot see well or cannot hear the doorbell or telephone, it's a potentially dangerous situation and it's necessary that you step in. 

What do you do if you believe that something's wrong?  Try to verify your impressions with others.  Certainly talk to your parents about your concerns.  They may be quite aware of their own limitations, but aren't mentioning it because they don't want to upset you.  Talk to your siblings and see if they share your concerns.  Get a medical evaluation and a geriatric assessment.  The problem may be temporary or treatable.  If you ultimately conclude that your parents do indeed need assistance with daily living, there are many options available to you, and very often you can arrange for assistance in the home rather than having to move your relatives to a retirement or nursing home.

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