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Sometimes an older adult's need for additional help is obvious. It could be that he or she is having a hard time getting to appointments, seems confused by instructions or perhaps isn't paying bills on time. More often, though, the change happens gradually. That's where a professional assessment comes in. This comprehensive review of all aspects of person's mental, physical and environmental condition is one way to determine if your loved one needs assistance. This helps to evaluate his or her ability to remain safely independent and identify risks and ways to reduce them.
A family member or caregiver also has an opportunity to evaluate how a loved one is doing in terms of health, safety and quality of life. “The goal,” says Ardeshir Hashmi, M.D., section chief of the Center for Geriatric Medicine at Cleveland Clinic, “is to pick up clues early, before they start to impact day-to-day life a significant way, so we can do something about them.” Here are red flags to look for, which may signal a loved one needs further evaluation — and possibly more support.
Mobility
According to the Centers for Disease Control and Prevention, each year, more than 1 in 4 older adults will have a fall. To make sure your loved one isn't part of that statistic, evaluate their living space, including potential fall hazards: unsafe indoor or outdoor stairs (especially without railings) or slippery throw rugs. Are they using unsafe stepladders or stools to reach for items on kitchen shelves? Do the soles of their shoes have good traction?
Pay particularly close attention to how well your loved one is getting around. A lack of mobility not only takes a physical toll, it can also have psychological repercussions. Lindsey Yourman, M.D., a geriatrician affiliated with the University of California, San Diego Health-Jacobs Medical Center, points to something known as life space, which is the area that you can walk to safely — meaning the environment that is available to you on a regular basis. “Decreased life space can mean decreased interactions with other people and decreased engagement in activities,” Yourman says, “which can lead to isolation and depression.”
There are some ways to evaluate a person's mobility to see if he or she is steady on their feet. One is the timed up-and-go test: Mark a line about 10 feet from a chair. At the word “go,” ask your loved one to stand up from the chair, walk at a normal pace forward to the line, turn, walk back to the chair and sit down. On average, people who take 12 seconds or more to complete the test are at a high risk of falling. Also, observe them walking across a room and take note of their gait speed and the movement of their feet. Are they shuffling or dragging them? How far apart are their feet when walking? When someone spreads their feet far apart, that tends to indicate difficulty in balance. Other signs that may indicate strength or balance issues: difficulty rising from a chair, using furniture or a wall for support when walking, and difficulty pivoting. “If they walk down the hall and come back, how many steps does it take to turn? More than three steps may indicate a mobility issue,” Yourman says.
What to do: A certified aging-in-place specialist (CAPS) can suggest modifications to make your loved one's home safer. These may include handrails on both sides of stairs, grab bars for getting in or out of the shower or a walk-in bathtub, a higher toilet seat or added ramps. In the kitchen, make it easier to reach everyday items by storing them in lower cabinets. Add inexpensive sliding pantry organizers and shelving to cabinets for easier access. A physical or occupational therapist can also evaluate the person's home environment and mobility. A therapist can also recommend the best aid for your loved one and make sure they use it correctly. Pick-up walkers take a lot of effort, and their use can lead to a decrease in activity for someone with congestive heart failure or COPD who gets winded easily. “With a cane, you want to be sure it's the right height,” Yourman says. “If it's too tall or too low, it can throw off the mechanics of how you're walking.”
Mental health
Depression can be tricky to spot in older adults. It's normal for an older person to feel down every once in a while — perhaps frustrated by health problems or worried about money. What's more, there isn't necessarily a mood component. “We have a stereotype of depression as not getting out of the chair all day, kind of folding inward,” says Luci Draayer, a Denver-based clinical social worker and therapist. “That can be part of it, but there are other symptoms.” Among them: changes in energy levels; irritability or anger; loss of interest in once-enjoyable activities; difficulty sleeping, or sleeping more than usual; eating more or less than usual; and thoughts of death or suicide.
Dementia, meanwhile, is more a memory change or impairment. The common theme is forgetfulness, more than people would expect with normal aging. “Early on, changes and difficulty with what we call instrumental activities — financial management, managing medications and driving — on a daily basis may indicate impairment caused by dementia,” Hashmi says. Another cognitive issue, says Draayer, is “a loss of insight or poor judgment — say, the bathtub was left running and overflows because they left to go watch a movie.”
Depression sometimes gets misdiagnosed as dementia, since an older adult with depression may exhibit dementia-like symptoms. “People who have depression may not concentrate as well, and that may sometimes look like memory loss and dementia — we call that pseudodementia,” says Katherine O'Brien, M.D., an assistant professor of medicine, Division of Internal Medicine and Geriatrics, Northwestern University's Feinberg School of Medicine. Being able to distinguish between the two is important. “Depression is eminently treatable,” Hashmi says. “And when depression is treated early, memory and concentration can also improve."
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