Your father was doing okay before he went into the hospital, as far as you could tell. Then he fell off a ladder trying to fix a gutter. Miraculously, after an anxiety-inducing round of treatments including surgery and a few weeks in a rehabilitation facility, he comes home. He can't stop grinning as he sits in his favorite chair in the living room. You cook him his favorite meal.

When he can't remember where the coffee is kept, puts his laundry in the trash can instead of the hamper, and tries to mail letters without stamps - and you find the salt and pepper in the refrigerator - you start to get a little nervous. Then he refers to shampoo as "hair wash," calls the toaster a "bread cooker," and terms an awning a "tent." When you play cards with him, he repeatedly tries to put down the wrong cards - in a game you've been playing with him since he taught it to you when you were 11 years old.

He gets defensive when you point out these odd occurrences, and makes excuses.

Now what?

If you are someone's closest relative - or friend, if no relatives are available - (and assuming a generally genial relationship), you can help by taking the four steps described below even as your loved one denies that anything is wrong.

First, if you haven't been named his healthcare representative, work with him and his lawyer to get this paperwork done. Virtually all lawyers who write wills and doctors with elderly patients endorse naming an agent to act if an individual can't. It doesn't mean that you make all decisions for him. It means that if/when he is unable to comprehend issues and options, you will step in to act in accordance with his wishes (not yours).

Second, start to log incidents that are not normal for your loved one. Record the date, day of the week and time, along with a description of the comment/event. Summarize these in just a couple lines each.

Third, make a list of all his medicines and doses (e.g., Advil, 600 mg, 3x a day). Then do some research. You might start with a reputable site online, such as the Mayo Clinic ( WebMD ( and/or If you find that confusion or similar symptoms are listed as possible side effects of any of his drugs, take your list of drugs and log of unusual incidents to the pharmacist at the drugstore where his prescriptions are filled (along with a copy of the document naming you healthcare representative) and ask the pharmacist to help you understand if any of the drugs or interactions among them might be leading to your loved one's confusion.

Fourth, make an appointment with his doctor. Take the document naming you healthcare representative. Share with the doctor both the log of events showing confusion and the list of medications. Ask the doctor to help you understand what might be causing the mental deterioration, in order to come up with a way to reverse it or at least reduce its impact.

Among the items that the doctor might list - and that you might bring up if she doesn't - are drug side effects and interactions; urinary tract or other infections; thyroid, Vitamin D or B12 deficiencies; anemia; metabolic disturbances such as out-of-range blood sugar levels or electrolyte imbalances; and depression. Agree to a plan with the doctor to assess your loved one for likely possibilities.

Red flags to watch out for include attempts by the doctor to dismiss or minimize your concerns. Comments such as, "He's just getting old," "It's normal for people to get confused as they age," "Wait until you're his age and see how good your memory is," and the like should not deter you. If your loved one has a problem that can be fixed, you can dramatically improve his quality of life if you pursue doing so. If he has a problem that can't be fixed, you may need to prepare for some serious medical, emotional, logistical, financial and legal issues, and knowing as early as possible can help.

Next week's column will discuss some benefits and limits of tests of mental status.