Warning Signs to Watch for During a Holiday Visit

Infrequent visits can reveal subtle changes in older adults. How can family members or friends tell if it’s something to be worried about? And is it time for a move?

A holiday visit often gives you a chance to spend time with loved ones you haven’t seen in awhile. These happy occasions can provoke worry if family members notice changes that weren’t there the last time they visited. How does someone tell if it’s normal aging, or the beginning of dementia or even Alzheimer’s? Is it time to contact a care professional?

Many of the early signs of dementia and Alzheimer’s overlap. We’ve provided a list of each, with behaviors that are typical in older adults, countered with behaviors that might be found in someone beginning to show signs of disease.

Early Indications of Dementia

It’s hard to diagnose dementia in the beginning stages, because the signs are subtle and vary from person to person. However, common symptoms are:

• Reduced ability to concentrate. Anyone can struggle with managing finances. Someone with dementia might not understand what numbers mean or how to use them.


• Personality or behavior changes. Anyone can get tired of an activity. Someone with dementia totally loses interest in activities they used to enjoy, or needs prompting to get involved.


• Loss of ability to do everyday tasks. Anyone can get distracted and burn a meal. Someone with dementia has trouble remembering all the steps involved in preparing a meal.


• Increased confusion and disorientation. Anyone can get lost. Someone with dementia may have difficulty finding their way on a familiar route or be confused about where they are.


• Difficulty remembering recent events. Anyone might forget an appointment. Someone with dementia forgets them more often or never remembers making them at all.


• Depression or apathy. Anyone can be down or depressed. Someone with dementia may become confused, suspicious, or apathetic, or have wild mood swings.


• Loss of language ability. Anyone might forget a word occasionally. Someone with dementia may forget simple words and substitute inappropriate ones, making the person hard to understand.


• Poor judgement. Anyone can miscalculate the weather. Someone with dementia can see snow outside without thinking a jacket is needed to go for a walk.


• Misplacing objects. Anyone can misplace the car keys. Someone with dementia might forget what the keys are for.

Be aware that many conditions, some of them temporary, can mimic dementia. Don’t think your loved one has dementia when the warning signs may be due to a stroke, depression, infection, nutritional deficiency, hormonal disorder, long-term alcohol overuse or even a brain tumor. Many of these conditions are treatable. Only a doctor can diagnose dementia. An early diagnosis is critical for treatment, support and making plans.

Is It Alzheimer’s Disease?

No one wants to discover that a loved one has Alzheimer’s, a brain disease that slowly degrades memory, thought and reason. But early diagnosis is crucial for treating the disease to get some relief from symptoms and maintain a longer period of independence. Read on for a list of 10 warning signs and symptoms, adapted from the Alzheimer’s Association’s version. A person may experience these signs at varying levels. If you notice any of the signs in a loved one, have them see a doctor for further evaluation.

Five Warning Signs of Abuse or Neglect As many as 5 million older adults are abused every year, according to the Senate Special Committee on Aging, and yet that abuse remains significantly underreported. Elder abuse often originates with someone in a position of trust, including family members and caregivers. Here are five warning signs to watch out for: Physical abuse. Look for burns, abrasions, pressure marks and bruises. Does your loved one have a history of sprains, dislocations or even broken bones? Sudden hair or tooth loss can also indicate abuse. Beware of odd explanations such as “She ran into a wall.” Does a caregiver or family member hover, not allowing you to visit alone? Is your loved one taken to many different medical facilities for treatment? All are red flags. Neglect. If an older adult needs help due to cognitive or physical impairments, check for dirty clothes, soiled diapers, bedsores and unusual weight loss. Is their living environment neat and clean, or has it deteriorated? Are medical aids such as hearing aids, canes and glasses clean and available, or nowhere to be found? The neglect may be intentional, or it could be passive as the result of an untrained or overly burdened caretaker. Verbal or emotional abuse. Does your loved one seem withdrawn, or exhibit odd behavior like biting or rocking? Are there signs of fear, stress or tension around the caretaker? Does the caretaker snap or yell at the older adult? Is there forced isolation of the older adult by a member of the family or a caretaker? Emotional abuse can be tricky to spot, because it ranges from an insult to an outright verbal attack, and the older adult is often unable to fight back or even recognize the problem. A caregiver may say, “I can’t wait until you die so I get my life back!” or curse. The abuser may also isolate the older adult so no one knows what is happening. Sexual abuse. Age is no armor against a sexual predator, who may see an older adult as easy prey. Look for bruises around breasts or in the genital area, venereal disease, and vaginal or rectal bleeding. Your loved one may have difficulty walking or standing, and exhibit depression or withdrawal. Be suspicious if the caregiver acts flirty or seems to touch the older adult excessively or intimately when it is not warranted. Financial abuse. Are there unpaid bills piling up? Has money “disappeared”? Does a caregiver suddenly have an unexplained purchase that seems beyond their means, such as a new car, cell phone or clothing? Does a caregiver take money to make a purchase that never arrives? Has someone new been added to bank accounts or credit cards? Is credit card use increasing? Are cash withdrawals becoming more frequent? Family members and caregivers have the greatest access to older adults’ accounts, and are often in the position of greatest trust to steal from seniors. If you suspect severe elder abuse, call 911 to report immediate, life-threatening danger. Otherwise, report the abuse to a local adult protective services agency, the police or a long-term care ombudsman. Find a local resource at the National Center on Elder Abuse.

• Memory loss that disrupts daily life. Anyone forgets names or appointments, but remembers them later. Someone with Alzheimer’s forgets important dates or events, asks for the same information again and again, and has difficulty remembering recently learned information.


• Difficulty solving problems or planning. Anyone makes an error now and then balancing a checkbook. Someone with Alzheimer’s has trouble following a familiar recipe or paying bills.


• Confusion of time or place. Anyone might forget what day of the week it is, but be able to figure it out later. People with Alzheimer’s can lose track of seasons or the passing of time, where they are or how they arrived.


• Difficulty with spatial cues and visual images. Anyone might have reduced vision due to cataracts or macular degeneration. Someone with Alzheimer’s has vision problems leading to issues reading, judging distance and seeing color contrast, which might lead to difficulty driving.


• Problems with written or spoken words. Anyone can struggle to find the right word now and then. Someone with Alzheimer’s struggles with vocabulary, and has trouble following or joining a conversation, repeating what was just said or failing to continue the thread.


• Misplacing objects. Anyone can forget where they put something and have to retrace steps to find it. People with Alzheimer’s put things in unusual places, like leaving car keys in the freezer. They may be unable to retrace their steps to relocate an object, or accuse others of stealing it. This behavior typically accelerates over time.


• Poor judgment. Anyone can make a crummy decision once in a while. People with Alzheimer’s may use poor judgment with money, giving large sums to people they meet over the phone. They may quit taking care of their appearance and cleanliness.


• Withdrawing from work or social occasions. Anyone may feel like being alone sometimes. Someone with Alzheimer’s might quit hobbies, social outings, sports or work activities. This could be because they’ve forgotten how to complete the hobby or because of other changes from the disease.


• Mood and personality changes. Anyone can get in a particular pattern and feel irritated when it is disrupted. People with Alzheimer’s can easily be upset at home or work, especially in situations where they don’t feel comfortable. They can become confused, suspicious, fearful, anxious or depressed.

Increasing the Level of Care

Perhaps your concern for your loved one isn’t about cognition at all. You may notice that Grandma prepared a delicious turkey, but she didn’t have the strength to carry it to the table. Maybe her house is dirtier than usual because her eyesight is failing, or she can’t physically sweep like she used to. There are a host of issues you may need to address while you are there or shortly afterward.

Have a conversation with the older adult about what you notice. How does the older adult feel about it? Is Grandma adamant about aging in place, or is she feeling lonely and thinking it might be time for a move to assisted living? Would she like help doing certain tasks around the house, or with errands? Is it time to stop driving?

If you decide to bring in home help, determine if the neighbor down the street would be a good fit, or if you should contact a professional caregiving service that screens and trains all of its employees. Do you simply need a cleaning service, or is your loved one ready for help with meals and shopping? What are her needs likely to be going forward, and is there someone, such as a family member or friend, who can help you assess them? Do you need to talk to her doctor to review medications and recommend changes in Grandma’s home so she can get around more easily?

Homecoming is full of nostalgia. It can be hard to face the point when you realize that your loved ones need your help, especially when they might not be willing to admit it yet. Tread gently and seek their input, then consult with professionals if you need further guidance. Above all, accept the changes with a loving spirit and the most positive attitude you can muster for the challenges ahead.

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Sources

“10 Early Signs and Symptoms of Alzheimer's,” Alzheimer's Association.

“Dementia - early signs,” Department of Health & Human Services, State Government of Victoria, Australia.

“5 Signs of Elder Abuse,” Caring.com.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us