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Aging at home: How to assess if an older adult needs extra help at home

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(Image credit: Shutterstock)

No one likes to admit that they can no longer care for themselves. Due to a mixture of shame, denial and the fear of losing their independence many older adults who are in need of help will continue to pretend that everything is fine, even when it is not. Many will become angry or upset at the mention of in-home care, making this a very difficult topic to broach. 

We all also find it easy to ignore those small signs that your older loved ones are declining to the point where they can no longer look after themselves. Dismiss it just a bad day or "senior moment." We hate to think of our parents or even grandparents declining to the stage they can no longer wash themselves or dress properly. 

If you are struggling with this and have trouble deciding whether your parents or grandparents need extra help, AgingCare.com has provided helpful guidance that can help you decide. We've also compiled a small assessment of signs to look for, questions to ask and possible solutions to help you make that difficult choice. 

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Are they displaying physical difficulties?

One of the most common signs that older adults may be in need of assistance around the house is whether they have any physical difficulties. Conditions like arthritis get increasing more common and may have an impact on the daily tasks they can undertake. Assess their mobility against the home design. 

Questions to ask:

  • Do they display any joint difficulties?
  • Are they having difficulties standing up?
  • Do you think they can manage the stairs in a timely fashion?
  • Can they lift their feet high enough to avoid wires or rug edges?
  • How easy is it for them to get in and out of the shower?
  • Do they have trouble getting off the toilet?

Possible ways to help

When it comes to mobility there can be easy fixes that may help them stay independent for longer. A stairlift can help them navigate narrow stairs, handrails on the walls can help them keep balanced when leaving the shower or standing from the toilet. 

Removing the clutter from rooms to create a wider space between chairs and furniture to make the space easier to navigate. Building a downstairs toilet can also be a big help for seniors with mobility issues. Even building ramps or small garages for electric scooters can increase their mobility. 

Are they having more instances of forgetfulness?

Forgetfulness is a possible sign that an older adult may have difficulties living independently. This is particularly troubling if they take any medication that has strict dosage guidelines like Warfarin, where missing one dose can have chaotic effects on blood pressure or cause instances of atrial fibrillation. 

One thing to take into account is their previous level of forgetfulness. If they were always a little absent-minded, you might not need to worry. 

Questions to ask

  • How often are they repeating themselves?
  • Are they forgetting appointments or bill payments?
  • Do they lose important items regularly, only for you to find them in weird places later?
  • Are they taking their medicine?
  • Do they remember to collect the prescription on time? 

Possible ways to help:

These symptoms could indicate early signs of dementia. The best thing to do is consult with a doctor and have a medical and cognitive evaluation if you are worried.

There are a few simple ways to help them remember things you could try. Set alarms to remind them to take medicine, organize their medicine in pill boxes so they don't get confused with the number of pills or the milligrams doses and have visible checklists they can use. This just ensures they don't take their medicine and then wonder if they have taken it or not. 

Dementia and Alzheimer's charities provide great resources for support and developing coping strategies. 

Dementia - forgetting at a wall calendar

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Have their hygiene levels decreased?

A decline in hygiene standards is a sign that your parents or grandparents are struggling to manage. This doesn't necessarily mean they can't care for themselves as there may be other factors at work. You will need to assess why the decline in hygiene has occurred. Is it due to the physical demands of washing, is it forgetfulness, is shopping too demanding or are they struggling financially? All are possible causes of poor hygiene.

Questions to ask:

  • Is their hair clean and brushed? 
  • Do they still clean their teeth? 
  • Do they smell? 
  • Are they visiting the hairdresser regularly?
  • How long are their fingernails?
  • How frequently do they change their clothes?
  • Do their clothes look old and worn out ? 
  • Are the clothes appropriate? 

Possible ways to help

The first step is to find the cause of the hygiene problems. The easiest way to do this is talk to the person about the change. If it is money issues or transport problems, this can be easily fixed through home deliveries that you pick up the bill for. If it is due to problems of physical access then maybe a shower with easier access and handrails would help. If the clothing is inappropriate and they are forgetful, it might be a sign of dementia and a cognitive assessment is advisable.  

Do they display any personality changes?

Changes in personality can be a warning sign that they are suffering from a mental health illness. The two big illnesses that produce a lot of personality and behavior changes are Alzheimer's and dementia. The range of changes differs depending on the person, but there will be increased displays of paranoia, aggressive behavior, needing to check on things, restlessness and wandering, hoarding and hiding things like keys and bank cards. 

You should also be aware of sundowning or evening confusion. During the evening, people suffering from memory impairments usually display increased personality changes like confusion, aggression, and anxiety. 

Depression is also something that affects the more senior members of society, and may cause them to be more withdrawn and less social.

Questions to ask:

  • Is there a change in their personality? Is this more evident in the evening?
  • Are they talking uncharacteristically loudly or softly?
  • Are they paranoid that someone has done or will do something to them? 
  • Do they display odd behavior? 
  • Are they still socially active or withdrawn and listless? 
  • Are they aggressive? 

Possible ways to help:

With big personality changes, it is always best to consult a doctor. They will be able to diagnose any mental health issues. They can also provide you with the help and support you need. 

If they are suffering from depression or social isolation look for a way to enable them to be more social. There could local age-related groups on Facebook that get together for shopping trips or meals. Some local age charities might also provide group transport to shops that will give them an easy way to socialize. 

Are there signs they have less appetite?

When you get older, cooking can be more of a chore. A lot of older people suffer with joint problems that make standing in front of the stove difficult, and muscle weakness that makes lifting heavy pans hard work. 

You need to assess why they are eating less or have lost weight. Has the physical stress of cooking made them eat less cooked meals, are they forgetting to eat or drink? It could also be a problem of getting to the shop, or lack of money. 

Questions to ask:

  • Do they look like they've lost weight?
  • Are they drinking enough?
  • How much food is in the fridge?
  • Are they living off ready meals? 
  • Is standing or operating utensils a problem for them?
  • Can they read recipes easily? 
  • Does their fridge have a lot of out-of-date food? 
  • How often are they going to the shop? 

Possible ways to help:

An easy way to provide support to an older adult who is struggling to prepare food is to arrange domestic care or the delivery of meals. This just ensures that they are eating healthy with a minimal impact on their independence. 

If the problems are more cognitive and forgetful it might be a sign of dementia. 

Elderly woman with appetite loss

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Do they have unexplained scratches, bruises and burns?

Unexplained bruises, burns and scratches could be a sign that an older adult is struggling to cope physically. These could be signs of falls, or even them dropping hot objects when cooking. 

Questions to ask:

  • Do they have unexplained bruises? 
  • Are they having difficulty stepping over the edge of rugs? 
  • Are they unsteady on their feet when they stand? 
  • Do they look steady on their feet? 
  • Are they struggling to lift objects? And manipulate utensils?

Possible ways to help

One way to help is to remove clutter from the home, provide them with clear walk ways with plenty of space. Pick up any rugs or furniture that they may trip over. Hiring a housekeeper, or having meals delivered is a great way to ease their daily routine and keep them off their feet for long periods. There are also devices that can help if they do fall, like fall detection devices and medical alert systems that can provide peace or mind and help with their independence. 

Do they suffer from any illnesses or physical difficulties?

As we get older illnesses tend to get progressively worse, or we get less able to cope and adapt to the challenges they provide. If an older loved one suffers from an impairment or illness, it is important to factor this into any plan to help them living independently. Make sure their eyesight is clear and their hands are still steady enough for insulin injections. Assess their need in line with their disabilities. 

Questions to ask:

  • Do they have advanced diabetes?
  • Are they visually impaired? 
  • Do they suffer from Parkinson's?
  • Do they have joint or muscle problems? 
  • Have they suffered a stroke or recurrent strokes? 
  • Are they hard of hearing? 

Possible ways to help

Seek medical advice from doctors and charities on how to provide support for the senior, have a carer touch base with them for a period each day, and hire a housekeeper to help them with those little tasks. 

Ultimately, the difficult decision of how much help the senior needs, and how it should be provided is your decision. By asking these questions you should get a good idea of the help the elderly people in your life need, and make an assessment of the in-home care they need. 

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