3 Common Signs of Functional Decline

Everyone changes physically and mentally with age, but there are some changes that can really put a loved one’s safety at risk.  If you think that a loved one may require a transition to assisted living or elderly care, then you must first assess whether they are undergoing a true functional decline.

Functional decline is sometimes difficult to diagnose as individual symptoms often go unnoticed. Below is a list of symptoms of functional decline to be familiar with.

  • Misusing medication (over or under use and deviating from a schedule)
  • Reports of inexplicable behavior from friends, neighbors or family members
  • Poor personal hygiene
  • Unpaid bills
  • Changes in spending patterns
  • inappropriate clothing
  • Stains on clothing or upholstery from urine or feces
  • Forgetting how to use simple tools
  • Poorly cared-for pets
  • Repetitive questioning
  • Difficulty in communicating
  • Confusion
  • Unfinished tasks and chores
  • Spoiled or poorly-prepared food

Studies have documented that functional decline, i.e., the loss of either complex or basic ADL functions is due to changes in one or more of six areas: physical, perceptual, cognitive, visual and hearing, falling and psychological.  Below I will describe the first three areas in more detail and I will discuss the latter three areas in the next blog post.

1. Physical Changes

It’s obvious to anyone: as the human body ages it loses physical strength, stamina, muscle coordination, and balance. Those of us who had aging grandparents or aunts and uncles saw firsthand how the natural aging process affected their abilities to perform commonplace tasks.

2. Perceptual Changes

Here we’re considering all the senses: vision, hearing, sensitivity to touch, taste – even smell. After all, each is important to overall well-being. If you can’t smell smoke, you may lose your life to a house fire; if your sense of touch is diminished by poor circulation, you may be burned by scalding water.

Many medications are responsible for changes in taste perception. When this happens, it’s easier to eat spoiled food, or even choose not to eat at all, as food no longer tastes like it used to. I have noticed that after older people are less able to use the telephone with ease. Warning alarms and buzzers may go unnoticed.

3.  Cognitive Changes

While our thinking may remain clear, the speed at which a human can process information slows considerably as we age. It’s not just the speed at which we perform tasks. It’s also our ability to multitask. Our ability to divide our attention fades as we age.

Those changes are within the range of normal and expected changes; but what of the complications of dementia and Alzheimer’s disease? With dementia and Alzheimer’s loss of memory, language processing skills and inability to solve problems greatly affects your loved one’s level of independence.

Look for these warning signs:

  • Disorientation, fright or confusion when faced with a change of location, such as a doctor’s visit, visiting friends or family, or eating out at a local restaurant.
  • Giving incorrect or evasive answers when asked simple questions. For example, “What day is it?” gets the response, “What, don’t you know?”
  • Aggressive behavior or noticeable personality changes.
  • An inability to concentrate on television programs, tasks or conversations.
  • A gradual (or sudden) loss of memory.
  • Disinterest in routine tasks, such as cooking or housekeeping.
  • A decline in social skills, such as successfully engaging in conversation, or eating a meal with the correct utensil.
  • A decline in judgment skills, or inability to recognize consequences. This could manifest itself in leaving the water running, not shutting off the stove, or leaving the front door unlocked.

There are three more areas to monitor in order to determine whether a loved one is experiencing a real functional decline: hearing and vision loss, frequent falling and negative psychological changes. In the next blog post we’ll discuss symptoms within these three areas and how these problems can lead to a functional decline and loss of independence in aging individuals.

Photo Credit: Flickr user e-MagineArt.com.

Is it Time for Assisted Living?

elder careYou’ve come to this blog for a reason. More than likely, you’ve seen changes in your loved one that have you concerned. They are likely changes that worry you, but have not fully convinced you that your loved one may need additional care. Whether a spouse, or a parent – even an aging sibling, this person has come to an impasse in life’s journey. And it’s at that impasse that you wish to help them overcome.

The first step is getting clarity about what’s going on today, and to temper that clarity with loving compassion and an understanding of what the future may hold. This assessment process can be emotionally challenging. It’s something I’ve learned firsthand.

Take a deep breath, and let’s move on to step one: the assessment of your loved one’s current capabilities and needs.

How is Your Loved One Feeling Today?

Regardless of our age, our bodies are in a continuous state of decline. Whether it is reading glasses, arthritis or a doctor’s warning about your lifestyle, our bodies emit warnings about its decline.

It’s no different with our loved ones, except that while it can be an inconvenience for us, it is a matter of independence for them. Since you are concerned about your loved one, you’ll want to do an assessment.

An assessment looks at four areas where change may have taken a toll on your loved one’s independence: the physical, perceptual, cognitive and psychological manifestations of aging. We’re going to explore those areas with one overriding premise: ensuring their safety, and the safety of those around them.

Physical changes and loss of abilities (to some degree) are natural in the aging process. Your loved one is not the same as they were 10 years ago, or even 5 years ago – any more than you are the same as you were then. With that said, the essential key in the assessment process is to recognize symptoms and actions which fall outside the range of expected and acceptable changes. What defines “acceptable changes”? I would say they are those changes that don’t significantly interfere with the way they’ve lived their daily life.

Many changes are subtle and inconsistent; and many don’t put their lives, or the lives of others, at risk. Truly then, the focus should be on risk management. Continually ask yourself this question: Is my loved one a risk to themselves or others?

The criterion most often used by doctors, social workers, and geriatric care managers is a list of activities of daily living, or ADLs. These are those most common activities, divided into two categories: basic and complex.

The early warning signs are often losses in the realm of complex skills. Usually (but not always) loss of basic ADLs comes later on in the decline in the quality of your loved one’s life. As every person is an individual, so is his or her aging; assessment can only be done on a case-by-case basis.

Basic Skills

  • Ability to feed oneself
  • Ability to use the bathroom appropriately
  • Ability to maintain good personal hygiene
  • Ability to dress appropriately for the season

Complex Skills

  • Cooking
  • Shopping
  • Effective communication
  • Following directions
  • Taking medications appropriately
  • Money management

This list of activities appears rather brief; however you can see that each element listed, whether ‘basic’ or ‘complex’ is essential. Everyone should be able to use the bathroom appropriately, or follow directions.

If your loved one is having difficulties with one or more of these tasks, then they are in a state of functional decline and you should more thoroughly asses the state of their decline and possible solutions. In my next post I will discuss common signs of functional decline in greater detail.

Photo Credit: Flickr user Titoy.

My Experience with Elder Care and Assisted Living

elder careEighty-four percent of Americans over the age of 50 expect an immediate family member to move into a senior living community within the next 10 years, while 24 percent over the age of 65 expect the same for themselves, according to a new national survey of American attitudes on assisted living released today by the Coalition to Protect Choice in Senior Living (CPCSL). The poll found just more than half (51 percent) expect their parents to live in a senior living community within 10 years, with 15 percent expecting the same for their spouse and 10 percent for a sibling.

My Story

I’d like to briefly share the story of the event that started me on this path. I imagine it’s similar to your own in that it begins with an unexpected phone call.

My wife and I had just returned from celebrating our engagement in Greece, and we were sharing stories over bowling with some good friends.

I was the product of a second marriage, and my mom and I had become quite close since my father’s passing while I was in high school. We spoke often, so I wasn’t surprised when my cell phone rang and the caller ID showed it was her.
I was surprised when I answered and it was the paramedics.

Apparently, my mother called 411 asking for my name and phone number as she could not remember it. The operator called 911, and in a matter of minutes, they had arrived, kicked down the door and called me.

My mother had a stroke. I was only 33, and totally unprepared for the depth of emotions, or the complexity of the decisions I was about to face.

That a 73-year old woman had a stroke is not unusual. My mom’s case was unique because of the series of complications that nearly killed her. In the eighteen months following her stroke, she endured major back surgery to remove a staph infection from her spine, a perforated intestine that required stomach surgery, several MRSA infections1 requiring IV antibiotics and a broken hip. She spent several weeks in the surgical intensive care unit recovering from her back surgery. Many of these nights, I feared the worst. But my mom is a fighter.

The medical system these days isn’t designed for long-term recovery. Hospital personnel are highly trained at treating acute problems and dealing with specific injuries and conditions. In fact, we have some of the most skilled doctors in the world.

But when you’re older and recovering from a serious illness, your options are usually to go home, or go to a skilled nursing facility – where staff can provide physical or occupational therapy, administer IVs and perform other functions requiring a registered nurse.

During this time, she spent nearly six months moving back and forth between the hospital and skilled nursing. In January of 2006, I moved Mom from San Diego to Orange County. She graduated from skilled nursing and was on her way to assisted living.

Trust, Hope and Hard Work

When Mom arrived in assisted living, she could not stand or walk and required a 24-hour caregiver. She could not eat or drink on her own and was in a deep state of depression.

While I found much advice on medical conditions and treatment, I found virtually nothing on understanding assisted living. Sure, there were some Websites that taught you the basics, like “make sure a nurse is on duty” or “make sure the kitchen is clean.” But this is my mom and I wanted far better for her. I wasn’t putting her away; I was playing a key role in her recovery.

Because of the lessons I learned – and a lot of hard work on the part of my mother – she is doing very well. In fact, we’ve become very close friends. She walks with a walker; her memories are clear and vibrant. She has a circle of friends and a packed calendar.

She even made it to my wedding. And she looked beautiful. I cried. They say your wedding toast is one of the most important speaking opportunities you’ll ever have. And I consider myself to be a good public speaker, routinely speaking at tradeshows and other events. But when I looked into the crowd and saw my mother smiling, I fell apart.

The joy I felt at seeing her on that special day was overwhelming. So was my commitment to her continued well being. It was my clear intention that she be given every opportunity in her assisted living situation to thrive, to grow, and to be fulfilled.

Recall the statistics at the beginning of the chapter. While I was shocked these numbers were so high, I completely agree. I did some homework. In an informal study of about 40 people, I sensed an almost inevitability about needing assisted living. I also found that financial issues and quality of care topped the list of concerns for both Baby Boomers and their children.

I followed up my informal study with a formal study of nearly 200 families. The Assisted Living Family Attitude and Preparedness Report showed that 75% of respondents believed a friend or family member would soon require assisted living. The report is free to anyone who wants to read it and can be accessed at the link above.

My goal is to share with you some of what I learned through my journey. My hope is that these lessons can make it easier for you and your mom, dad, relative or loved one. I assume you’re reading this blog because you or a loved is considering assisted living. Since you likely haven’t gone through it before, the decisions can be overwhelming. I’ve written this blog to help you make more informed decisions, and to be calm in what is likely to be an emotional storm. I sincerely hope I can help you avoid some of the pitfalls of learning the assisted living ropes.

While a move to assisted living may initially be seen as negative, I know first- hand that with some careful and thoughtful planning, you can make it a huge positive for all concerned. Over the last several years, my relationship with my mother has strengthened. She has become one of my best friends and an integral part of my life.

I hope you enjoy reading this blog and that I’m able to somehow make your journey a bit easier.

Photo Credit: andrewmalone.