How to assess if aging parents need more help and support

Whether you are having a physical visit with your parents or grandparents over the holiday season, or a virtual one, it is an opportunity and common time to assess how they are doing.  You may have noticed signs of their aging last time you got together and want to see how they are managing now.  Even if you aren’t physically with them, there are ways to use your virtual visits to assess if aging parents may need (more) help and support.

The COVID-19 pandemic has been a challenge for some adult children to physically visit with an aging parent (s). Many have stayed in touch and visited through video chats and phone calls. It’s pretty common to carry some worry about aging parents and grandparents and to have questions about whether they need extra help or support to manage at home.

Worries about aging parents

• “I chit chat with Mom on a regular basis without seeing her and she “sounds” fine. She doesn’t want to do a video chat and this worries me.”
• “My parent’s neighbour checks in with Dad for a few minutes every other day while social distancing. But what do they see? I worry they may overlook what is really going on with Dad. The visits are short– changes are so gradual and may even go unnoticed.”
• “Mom and Dad are true snowbirds, I’m thankful they’re both safe and staying home. I’m concerned about them socially isolating and getting lonely and depressed. We were supposed to see them at Christmas before they went South. Now we now are not coming and they are not going away. Double whammy!”
• “Love our video call with Grams every Thursday. Lately she has been missing our Zoom dates. When I phone her about it, she tells me everything is fine and she’s just having a “senior moment “. Should I be getting worried?”

What follows is a list of things you can look for and listen for during your visits, that suggest more help and support may be needed. These suggestions are in the context of a virtual visit, but what you are assessing for is literally the same, whether virtual or in person.

Cautionary note: don’t turn your visits into interrogations.

When greeting Mom or Dad

• How do they look? Noticeably heavier or thinner? Has their general appearance changed in unexpected ways? For example, Dad has always been clean shaven and now has significant stubble or Mom’s hair has always been immaculate and now is unruly.
• Pay attention to the clothes they are wearing. Is their outfit creased or clothing mismatched when they used to be very neat and carefully coordinated? Are there stains or rips or buttons missing?
• Check for adaptive devices. Are they wearing their glasses or hearing aids or falls detection bracelet/necklace?

Household cleanliness

If the visit is virtual, you can gauge the household cleanliness by asking your parent to show you parts of the home where you would usually gather (e.g. the kitchen or living room).  It will be abundantly clear to you if you are doing a physical visit.

• Is there a significant change from the way the home’s been kept in the past? Does the home appear to have more clutter? Are there piles of newspaper or magazines that weren’t there before? Are there dishes piling up on the kitchen counter? Unopened stacks of mail?

Mobility

Lack of exercise can result in the loss of muscle tone, flexibility, balance and endurance. To test their mobility, ask your parent to slowly model what they are wearing or ask them to show you something like a cherished photo.

• Did they show any difficulty in standing up? Observe how they walked. Were they out of breath? Were there any signs of stumbling? Did they use their walking aid, such as a cane or walker?

Mental Health and Memory

Most older adults take the COVID-19 precautions seriously and have limited their socializing. There is strong evidence that many adults aged 50 and older who are socially isolated or lonely, are at increased risk for cognitive decline or depression.

It’s also wise to educate yourself on the early warning signs of dementia.

• During your video call, update your parent about the family, talk about current events then bring those topics up later in the call to see if they remember what you said. Did you notice any repeated questioning or out-of-place comments? When casually asked, was Dad able to share the month, day and year?
• To further measure the impact of spending time alone, it’s perfectly OK to be frank and ask your parent about whether they are feeling down or have been depressed.

In assessing your parent, your observations and answers to questions may provide clues to how well your parent or grandparent is holding up in their home.

Following up if you have concerns

Talk to your parent/grandparent about your concerns but position yourself as an ally. Talk to them with an open mind and heart. Tell them you want to do everything possible to help them be as independent, safe and as well as possible.

Ask them directly whether they think they need help to manage, and what would be most helpful to them? Ask them if they are willing to hear what you have noticed and your suggestions. If it is a matter of hiring someone to help around the house (like cooking, cleaning) or purchasing services (like meal delivery), address the issue of payment.

If your concerns are medical in nature, you may want to suggest a virtual care appointment with their family doctor. Or you can use a private service like Maple.  You may want to ask if you can also attend this appointment.

Be patient. Try to understand reasons why parents are sometimes  reluctant or refuse to accept help. In other words, it isn’t about stubbornness.  Even if your parent says, “I don’t want to talk about this right now,” or refuses your support, you’ve planted a seed and hopefully opened the door for future discussions.

Host a family meeting

A video chat or conference call can make it easier for families to join in, share, and discuss concerns about a parent. The initial meeting may serve to gather information about changes observed with an aging parent. Email a safety and well-being  checklist  prior to  the family meeting for review. The checklist may later be used as reference to build consensus and even to sketch out ways to support your parent. While it can be difficult, open conversations make it possible to be better prepared for the challenges that may come.

While it isn’t the same as an in-person visit, it is still possible to use your virtual visit to also assess how your parent(s) is doing and what help and support they may need.

Do you closely watch and listen to your aging parents when you see or talk to them?