If you regularly visit a friend or relative, you may see changes in mental and physical capabilities. You may notice changes in behavior, or you might see signs of a physical problem. For example, depression, a common condition for many older people, can appear as a physical problem (e.g., tiredness or insomnia), a cognitive problem (e.g., forgetfulness), or both. Remember, if an older adult seems forgetful or takes longer to do some tasks, it may be a normal part of the aging process. Paying a bill a week later is not the same as forgetting to pay bills for three consecutive months. The most important consideration is whether the changes you see pose a threat to your loved one’s medical or physical safety. Some changes that may signal the need for help are:

Behavior changes

• Changes in personal hygiene
• Change in tidiness or cleanliness of the home or yard
• Laundry piled up
• Mail and bills unopened or unpaid
• Odors (e.g., from spoiling food)
• Missed appointments
• Getting lost in familiar places
• Evidence of safety risks (e.g., burned pots in cabinet)
• Evidence that medications are not being taken properly

Physical symptoms

• Weight gain or loss
• Unsteadiness when walking or getting up/down from chair
• Evidence of incontinence (e.g., odor of urine in the home)
• Unusual thirst
• Unusual fatigue

Symptoms of depression

• Darkened house with the shades drawn when you arrive
• Decreased contact with family and friends
• More withdrawn, less conversational

When you have a concern, it may be tempting to rush to intercede. It’s better, however, to avoid taking over. If your loved one is able to participate, don’t make unilateral decisions and don’t go over his or her head. Instead, discuss the issues that you’ve noticed and, if you have difficulty resolving problems, consider involving the professional community—a primary care physician, a gerontologist, or a senior care specialist. They are likely to ask you about your loved one’s behavior. They may also ask about his or her cognitive status. Questions you are likely to hear include:

• Is there difficulty with Activities of Daily Living (ADL) tasks such as bathing, dressing, toileting, eating, and transferring from place to place (e.g., bed to chair)?
• Are support tasks such as shopping, laundry, meal preparation, managing finances, housekeeping, and transportation being adequately managed?
• Are you noticing significant changes in memory, judgment, or ability to make decisions?

The objective is to jointly determine the cause of the problem(s) and decide on possible interventions. If an older person has an acute event, such as an illness or accident requiring hospitalization, the social worker or discharge planner may offer helpful guidance. You can begin to develop a care plan based on insights and considerations from your loved one, the medical community, friends, and relatives.