Holiday Visit Checklist: What to Look for in an Aging Parent

On a holiday visit, look past the dinner table: notice how your parent is thinking, moving, eating and coping, and check the places that show it, like the fridge, the mail pile, the pill organizer and the car. One odd moment means little. A pattern, or a clear change since your last visit, is worth a calm conversation and a doctor's appointment. Before you leave, find the important papers and make sure someone nearby has a key.

Why changes can stand out after time apart

If you see your parent every week, slow changes can be easy to miss. Dr. Gregory Jicha of the University of Kentucky's Sanders-Brown Center on Aging said in a UK HealthCare blog post that if you haven't seen a relative in a while, you might be more likely to notice changes in their memory and behavior. Jill Horner, executive director of the Alzheimer's Association's Western New York chapter, said in a WKBW News story that "the realization that something is 'off' can be quite startling, especially after being apart for an extended period of time."

Two cautions. Holidays scramble anyone's routine. And many symptoms have more than one cause: the Alzheimer's Association's guide to approaching memory concerns in others names urinary tract infections, diabetes, depression and family stress among them. You're collecting observations, not making a diagnosis.

How to look without inspecting

Nobody wants to be audited over pie. Pick up jobs that put you where the clues are:

• Offer to cook or clean up, and you'll see the fridge, pantry, stove and pots.
• Take their car to fill the tank. You'll see every panel and the dashboard lights.
• Ride along when they drive to church or the store.
• Help with holiday cards, which puts the mail pile on the table.

Memory and thinking

The Alzheimer's Association's 10 warning signs pair each sign with a normal age-related change. The easiest to spot on a visit:

The full list adds trouble with visual images and spatial relationships, and withdrawal from work or social activities. If you notice any, the association says to schedule a doctor's appointment.

Mood

Sadness after a loss is expected. Depression is different, and the CDC is clear that depression is not a normal part of growing older; it's a treatable medical condition. Signs from the CDC's list you can notice on a visit:

• No interest in things that used to be fun
• Weight or appetite changes
• Sleeping far more, or awake at all hours
• Irritable, restless or tired all the time
• Talk of feeling worthless or guilty
• Trouble concentrating, remembering or deciding

Depression often gets missed. MedlinePlus notes that fatigue, appetite loss and poor sleep can be confused with aging or physical illness, and that severe depression can resemble dementia. The CDC suggests encouraging your parent to get help and offering to go along to the appointment.

Mobility and fall risk

Watch your parent cross a room and get up from the couch. The CDC's STEADI fall-prevention program has a self-check in its Stay Independent brochure. Several items you can simply observe or ask about:

• Fell in the past year (ask directly)
• Steadies themselves on furniture while walking at home
• Pushes up with their hands to stand from a chair
• Has trouble stepping up onto a curb
• Rushes to the bathroom, especially at night
• Takes medicine that makes them light-headed or tired, or medicine for sleep or mood

The brochure notes that people who have fallen once are likely to fall again. The CDC's caregiver brochure says to tell a health care provider right away if your parent has fallen, worries about falling, or seems unsteady. If that's already happening, read what to do when an elderly parent keeps falling.

The home

The house often says more than your parent will:

• Unopened mail, late notices, piles of sweepstakes and charity letters
• Shutoff warnings, or the same bill paid twice
• New clutter on counters, stairs and spare beds; blocked walkways
• A kitchen or bathroom kept differently from how they've always kept it
• Burned-out bulbs, especially on stairs
• Scorched pot bottoms, melted handles, burn marks on the counter
• A smoke alarm with the battery pulled

The stove deserves a real look. The U.S. Fire Administration says cooking is the leading cause of home fires and home fire injuries, and that "the leading factor contributing to ignition in nonconfined home cooking fires was unattended equipment (37%)." One burned pan is a bad night. Several, plus a silenced smoke alarm, is a pattern. Also look for scorch marks near space heaters, and for candles left burning in empty rooms, a real fire risk.

The National Adult Protective Services Association's when-to-report checklist includes living in hazardous conditions such as hoarding and failing to take prescribed medicines. For those, it says to contact your local Adult Protective Services agency, and to dial 911 in a life-threatening situation. For a full room-by-room pass, use the home safety checklist for an elderly parent.

The fridge and the car

The fridge. The American Geriatrics Society's long-distance caregiving tip sheet notes that an older adult may not be aware when food has spoiled. Look for moldy or long-expired food, the same item bought three times, or nothing fresh, which can mean trouble shopping, cooking or eating.

The car. Walk around it in daylight. AAA's traffic safety team lists minor dents and scratches, getting lost on familiar routes, and two or more tickets or warnings, or two or more crashes or near misses, in the past two years as red flags.

Medicines

Look at the pill organizer, the cabinet and the counter:

• Earlier days in the organizer still full (missed doses)
• Two bottles that may be the same medicine under different names, or from two pharmacies
• Expired bottles mixed in with current ones
• Bottles from a medicine the doctor stopped
• Your parent unsure what each pill is for

Photograph every label, and leave current medicines exactly as they are: don't toss, swap or rearrange anything your parent takes. Show the photos to their pharmacist or doctor and let them sort it out. Once your parent and their pharmacist or doctor agree a bottle is expired or no longer needed, the FDA recommends a drug take-back program or mail-back envelope. Those photos are also most of a medication list for your elderly parent.

Driving

The CDC says age-related changes in vision, physical functioning, and the ability to reason and remember, along with diseases and medications, might affect some older adults' driving. On a ride-along, AAA suggests watching for trouble with the pedals, missed stop signs, drifting across lanes, frequent honks from other drivers, and getting disoriented in familiar places. It also flags needing a passenger as copilot. Several of these call for a conversation and an evaluation, not grabbing the keys on December 26. The process is in when an elderly parent should stop driving.

Money and scam signs

The UK HealthCare piece lists giving lots of money to telemarketers or charities as a sign of poor judgment. Notice:

• Stacks of prize, sweepstakes or charity mail
• New "friends" who call often, or requests for loans
• Gift cards bought in bulk, or wire transfer receipts
• A cryptocurrency "opportunity" or a romance with someone they've never met
• Secrecy or embarrassment about money

The CFPB and FTC warn that scammers demand payment by wire transfer, gift cards and cryptocurrency because the money moves fast and is hard to recover. If money is already gone, see what to do if a parent lost money to a scam. If not, explain the grandparent scam and agree on a family safe word while everyone's in one room.

Personal care and weight

Hug your parent. A hug can tell you about weight loss that a baggy sweater hides. MedlinePlus defines unintentional weight loss as 10 pounds or 5% of normal body weight over 6 to 12 months or less without a known reason, and says to see a provider.

Compare grooming to your parent's own normal: unwashed hair, the same outfit for days, or summer clothes in a cold house. The Aging Life Care Association blog offers a good example. Dad in light clothes in winter might be confused about the season, or his arthritis might make sweater buttons hard, or the winter clothes might be on a shelf he can't reach. Ask before you assume.

How to raise it without a fight

Aim for one calm conversation that keeps the door open. From the Alzheimer's Association's 10-step guide:

1. Check what you saw against what a sibling, neighbor or friend has noticed.
2. Talk one-on-one if you can, so your parent doesn't feel cornered by a group.
3. Pick a time and place where your parent will feel comfortable, not dinner with eleven people listening.
4. Use specific openers: "I've noticed [change] in you, and I'm concerned. Have you noticed it?" or "How have you been feeling lately? You haven't seemed like yourself."
5. Offer to go to the doctor together. One line from the guide works well: "There are lots of things that could be causing this, and dementia may or may not be one of them."
6. Expect more than one conversation.

With siblings, the Family Caregiver Alliance's family meeting advice holds: say "I need" rather than "You should." If your parent says "I'm fine" and changes the subject, that's normal; our guide to an elderly parent who refuses help covers how to shrink the ask.

Before you leave

1. Book a doctor visit, with your parent's permission. Medicare's yearly Wellness visit includes a cognitive assessment to look for signs of dementia. Dated notes help more than "Mom seems off."
2. Get permission to talk to the doctors. A signed HIPAA authorization lets the office speak with you.
3. Update the contacts. Who has a spare key? Which neighbor would notice closed curtains? Write numbers by the phone.
4. Find the important documents. Just know they exist and where they live: will, powers of attorney, advance directive, insurance cards. See important documents for aging parents.
5. Ask a few big questions while there's time. Our list of questions to ask aging parents starts with the gentle ones.
6. Set up the emergency binder: medicines, doctors, conditions, allergies, contacts and where the papers are, in one place at the house.
7. Write down your baseline. Next visit, you'll compare against notes instead of memory.

If memory is the worry, see planning after early memory loss; from far away, the long-distance caregiving checklist.

When a sign is urgent

Sudden confusion. Confusion that appears over hours or days is not slow memory loss. MedlinePlus describes delirium as sudden severe confusion that is often caused by illness and usually reversible, and advises contacting a provider for a rapid change in mental status. If the confusion comes with any stroke sign below, call 911. See sudden confusion in an elderly parent.

Stroke signs. The CDC's stroke signs include sudden numbness or weakness in the face, arm or leg, especially on one side; sudden confusion or trouble speaking; sudden trouble seeing or walking; and a sudden severe headache with no known cause. Call 911 right away; the CDC says not to drive them to the hospital yourself. More in stroke signs in an elderly parent.

Holiday visit checklist to fill in

You can build all of this yourself with this checklist. Or Emergency Binder Now can turn about 25 minutes of guided questions into a printable binder for your parent, with a one-page sheet for paramedics and a list of what's still missing. See a sample binder first.

Frequently asked questions

What are signs an elderly parent can no longer live alone?

No single sign decides it. Signs that add up include repeated falls, spoiled food and weight loss, missed medicines, shutoff notices, scorched pans, getting lost, and new trouble with hygiene. Bring what you saw to their doctor.

How do you tell normal aging from dementia?

Per the Alzheimer's Association, forgetting a name or appointment and remembering it later is typical. Memory loss that disrupts daily life, like asking the same question over and over, is a warning sign worth a doctor visit. So is new trouble keeping track of monthly bills.

Should I bring it up during the holiday?

If it isn't urgent, pick a quiet moment, maybe the morning after. Keep it short and specific, and plan on more than one talk.