Imagine you are at dinner with your parents...
...and suddenly the realization that they have aged right before your eyes hits you. Much like watching your children grow and asking “where did the time go,” you begin to wonder, when did this happen? Certainly they’ve greyed and slowed a bit. However, you realize that one of your parents can no longer see well enough to drive at night. They’ve become forgetful; can’t recall names or faces. They ask the same questions frequently and tell the same story, over and over. There are signs of aging which may indicate your parents are in need of assistance. Some of these signs are believed to be normal; just part of getting older. However, they may not be normal and can be easily missed while your parents are still able to compensate. The following are subtle signs attributed to aging that should concern you.
1. Difficulty with Routine Tasks
My parents often vacationed at a favorite beach in North Carolina. The last time they made the trek to the beach, our eldest daughter drove them. My mom had been ill and we didn’t want them to drive alone. They stayed with good friends that year; we could not join them. By week’s end we’d received a call from one of the friends, a fellow nurse. She shared her concerns regarding my dad. During lunch one day, he needed help to make a sandwich. He couldn’t find the items to make the sandwich and wasn’t able to assemble them. My dad couldn’t recall how to complete a routine task.
2. Reluctance to Do Things Alone
Our friends also noted another subtle change in my dad’s behavior. He wouldn’t leave the house, even to walk on the beach, without my mom. In previous years he had always gone for early morning walks or runs alone. He’d always been very independent. Now he seemed to rely upon direction. He seemed reluctant to be alone. This surprised and concerned us.
Depression is rather common among the elderly. Unfortunately, depression can lead to poor health outcomes including cognitive impairment. Such impairment may put some elders at risk for dementia. Recognizing depression in our parents and seeking treatment is important yet difficult. Signs of depression can be easily attributed to causes other than dementia. Likewise, depression can mimic signs of cognitive impairment. Trouble sleeping, fatigue, exhaustion, headaches, gastrointestinal problems, muscle pain, agitation and restlessness can all be signs of depression. My dad experienced some of these, particularly gastric issues and agitation. He was fatigued and began to sleep more. Naps became routine.
4. Money Mismanagement
Bounced checks, late payment notices, and collection calls may be among the earliest signs of growing cognitive impairment in the elderly. Alone, this may not be as indicative as other signs particularly if budgeting has not been among your parent’s strengths. However, forgetting to pay the bills and an inability to maintain the checkbook are indications that your parents may need help. Additionally, unusual and unnecessary purchases may warrant attention. My dad once purchased an expensive, unnecessary life insurance policy. Luckily, we were able to cancel the policy without significant losses.
5. Delusions and Distrust
The most concerning behaviors were perhaps the last to be recognized and accepted as part of dad’s cognitive impairment. Delusions and distrust are symptoms generally noted in the middle stage of Alzheimer’s disease. However, there may be subtle signs earlier. Delusions may arise as the senior struggles to understand gaps in memory. They may make up a story, one which makes sense to them, to fill those gaps. My dad had worked well past retirement age and was suddenly fired. He couldn’t explain to us why and seemed hesitant to pursue any action to discover why. He seemed to distrust the former employer. In retrospect, he likely didn’t recall or understand the why. As his disease progressed, so did the delusions and distrust. He once accused my sister, their general power of attorney, of taking their money.
You're Concerned, Now What?
If you’ve noted any of these signs as you’ve interacted with your parents take heart, you are not alone. Help is available in many forms. The first step as you embark on this journey is to have your parent(s) assessed. Start with their primary care provider. They will likely recommend a Geriatrician or Nurse Practitioner who specializes in geriatrics; dementia in particular. A cognitive assessment is used to confirm presence of impairment, assist in diagnosing the cause, and to stage the severity or progression of the disease. Once diagnosed, there are a variety of resources to assist you and your parents. These include Geriatric Care Managers, Senior Advisors, Eldercare Navigators, local support groups, and senior advocacy groups. Nationally recognized resources include the Alzheimer’s Association with local chapters across the country.
In retrospect, we missed some of the subtle signs of aging and thus cognitive impairment in our dad. I often wonder if knowing he had Alzheimer’s sooner would have made the journey easier at the least or prolonged his life at best. We’ll never know. I do know that knowledge is a tool that can give us the power to persevere. Learn what signs to look for and be observant when with your parents. One can never underestimate the power of utilizing available resources for help. Find them and reach out to them. Never be afraid to ask for help.