In the elder law field, we are often asked to help families navigate difficult conversations. One of the most difficult conversations is whether or not it’s safe for their loved ones to live independently or manage their finances, or whether they are at risk of injury or exploitation.
We often see an increase in calls from concerned family members after a major holiday. They’ve been visiting with older family members, who they haven’t seen in person for several weeks or months, and they’re alarmed by changes that they’ve noticed. There are certainly obvious cues that there may be a problem – there are major dents and scrapes to the car doors and bumpers, the food in the refrigerator is spoiled, the normally tidy house is in disarray, personal hygiene has declined, or the same question is posed multiple times within a very short time span.
There are also more subtle indicators. Because some conditions impair your sense of taste and smell, you might hear a complaint that “nothing tastes good”, or see an eating pattern that focuses on sweeter foods to the exclusion of more savory foods. Because some conditions impair your gross motor skills, you might see someone walking in a very stilted fashion. Because some conditions impair your ability to process language, you might see someone who is listening to the television or the radio at an inexplicably high volume, or someone who once read voraciously lose interest in reading. Because some conditions impair your judgment, you might see someone who suddenly has “new friends” who are out of character with their normal associations. Because some conditions impair your ability to process numbers, you might see someone who is suddenly very focused on whether or not they have enough money (or who are suddenly no longer concerned at all with living within their means.)
If you are concerned about apparent confusion and memory loss, we always recommend that you begin with the assumption that your loved one is not suffering from dementia. Many people are unaware that, for an older man or woman, something as simple as a urinary tract infection can result in profound confusion – which can be completely remedied with a course of basic antibiotics. For this reason, we counsel families to begin with a basic visit to the doctor to rule out and treat any physical ailments. Some issues that a primary care doctor can diagnose include dehydration, poor nutrition habits, urinary tract infections, poor kidney function, poor thyroid function, and hearing loss. The patient should also be screened to rule out depression and anxiety, and to determine whether they are taking the proper dosage of any prescribed medications.
However, if the doctor’s examination reveals possible cognitive impairments, your loved one should sit down soon with an elder law attorney to evaluate whether creating a general durable power of attorney, advance medical directive, or trust would be in their best interests. And if the doctor finds that your loved one is definitively impaired, you should sit down soon with an elder law attorney to evaluate how you can help your loved one live as independently as possible while still ensuring their personal and financial safety.