This is the fourth in a series of articles about the issues that arise over time for older people who experience mental declines - and how you, as a family member or friend, can help.
Jeanne breathed shallowly and made a point of not recoiling. Her mother smelled bad. Jeanne wasn't sure what the problem was - had Edith not bathed for a while? Had she been wearing the same clothing or forgotten to brush her teeth for a week?
Jeanne went into the kitchen to get a glass of water. The cupboard she opened happened to have coffee cups in it, so she pulled down one of those. And saw that it had brown stains inside - not just at the fill line, the high water mark for a cup of coffee. The whole interior of the cup that used to be white was now brown.
It looked as if it had been put away without being washed first.
Jeanne decided to forget about getting a drink of water.
Her stepfather Dalton greeted her genially, standing up for a hug. Jeanne noticed that his trousers were stained in four or five places. Food stains? Urine stains? She didn't want to know.
You may have heard of "activities of daily living" (ADLs). These are basic skills that we tend to take for granted: bathing, dressing, eating, transferring from one place to another (bed to a chair, for instance), using the toilet and walking.
If your parent can still physically manage these tasks without help, you may talk yourself into believing that everything is okay.
But there is another list of more complex tasks, called "instrumental activities of daily living" (IADLs). IADLs include preparing meals, managing finances, doing laundry, handling correspondence (opening and reading mail and/or email and answering it as needed), taking medicines as scheduled, driving or using other transportation, and so forth.
When a relative starts to have trouble with IADLs, both they and family members often try to downplay the problems:
"I never received the bills," when the credit card bill has gone unpaid for four months.
"I couldn't read the instructions because the lighting is bad," when drugs aren't taken as prescribed.
"I'm too busy to write letters these days," when out-of-town friends comment that correspondence that had been routine for decades has stopped.
Each explanation might be plausible on its own. But when they pile up, it's a hint that managing daily life may have become too hard.
Problems with IADLs often take unexpected turns. Cindy works in accounting in Georgia, and sees her parents in South Carolina four or five times a year. She reported, "I reviewed (my father's) bills and found all sorts of problems. He renewed his anti-virus (software) 11 times because he didn't understand how to utilize the activation code they emailed him."
He had very capably used a computer for many years.
Cindy said, "I think that was my 'aha' moment, when I realized how serious things were."
Camilla is a nurse practitioner whose parents lived three states away. She flew into town every three or four weeks as they declined. She noted that an early sign in her mother's case was "decreased attention to nutrition and hydration - she was a very good and healthy eater ... (but) she began forgetting what nutritious food was. She would buy things, and forget to eat them. She started only eating snack foods or fast foods ... She was an immaculate housekeeper (but) she no longer saw dirt, dust, clutter, spoiled food in the fridge (this is quite dangerous in the elderly ... eating spoiled food)."
People in this stage may resist your attempts to help. For example, Jeanne held power of attorney for Edith and Dalton. She arranged to have the bank mail monthly statements to her. A few months later, Dalton changed the mailing address back to their apartment. And then, the statements were never found.
It may be tempting to gracefully distance yourself ("I offered to help, but Dad wanted to do it himself"). However, it may not be fair to leave an elderly relative on his own when he has the desire but not the ability to manage his own affairs.