Dementia is caused by damage to brain cells and affects thinking, behavior and feelings. Symptoms of dementia can vary greatly. For a diagnosis of dementia, at least two of these core mental functions must be significantly impaired:

• Memory.
• Communication and language.
• Ability to focus and pay attention.
• Reasoning and judgment.
• Visual perception.

Dementia is not a specific disease and is not a normal part of aging, although age and genetics are risk factors. A decline in memory and other thinking skills are symptoms that can be caused by depression, medication side effects, excessive use of alcohol, thyroid problems, and vitamin deficiencies. In these cases the decline may be reversed when the underlying condition is treated or addressed.

In our culture, where stigma of aging and dementia is widespread, decline in memory or other thinking skills is a sensitive issue. Often elderly people or their family members hide or simply ignore symptoms, when early diagnosis could enable treatment for conditions that are reversible and enable a higher quality of life for conditions which are not.

The Alzheimer’s Association reports that Alzheimer’s disease is the most common type of dementia, accounting for 60 to 80 percent of reported cases. Vascular dementia related to a stroke is the second most common type.

When observing for signs of dementia that may point to Alzheimer’s, it can be difficult to distinguish warning signs from typical lapses in memory. The following list of warning signs from the Alzheimer’s Association will help.

Making a decision about whether it is time for assisted living can be emotionally unsettling and complex, or it can be an adventure. Of course, assisted living is not the best choice for everyone. Answering these questions in sequence may help you to decide: 

• Is it possible to live safely, happily, and independently at home with minimal care from family and friends?
• Will living at home work with modifications to the living space and/or additional help from home care services?
• Will either of the above options work by moving to share a home with someone else?
• Is it time for assisted living?
• Is it time for assisted living with Alzheimer’s and dementia care?

We trust reading this series of articles, searching additional resources, and consulting health care professionals will give you tools to arrive at a well informed and more rational answer to these questions. We also trust you will arrive at a decision with optimism and hope.

Author and speaker Paula Spenser Scott suggests we look at the kitchen, living areas and overall maintenance for signs it may be time for assisted living. Scott also suggests looking at living things like pets and plants that need regular care. The degree to which property, living space, and belongings are taken care of tells us about the ability to manage self-care.

Signs in Living Areas and Overall Property

Look for the obvious:

• Piles of clutter.
• Cobwebs.
• Spills and grime.
• Neglected maintenance of the house.
• Neglected maintenance of the yard.

Signs in the Kitchen

Some clues in the kitchen relate to safety. Some let us know about the ability to plan meals, shop for food, and prepare meals:

• Perishables past their expiration dates.
• Too many multiples of the same items.
• Frozen TV dinners, meals in a box, snacks and canned goods with no fresh fruits or vegetables.
• Signs of increased takeout foods for someone who has always enjoyed cooking.
• Large or small appliances that don’t work or are broken and need repair.
• Stacks of dirty dishes and evidence that only disposable plates, cups, and flatware are being used.

Ability to Care for Pets and Plants

These signs are especially revealing for pet or plant owners:

• Animals that look underfed and unkempt.
• Litter boxes that haven’t been changed.
• Grimy pet dishes or spoiled pet food.
• Floors or furniture stained with pet urine.
• Plants that are dead or dying.
• Absence of plants in the home of a former plant-lover.

Signs of Past Fire

Give weight to evidence of the risk of fire. According to the U.S. Fire Administration (USFA), the risk of individuals aged 65 and over dying in a fire is 2.6 times greater than that of the general population. By the age of 85 the risk increases to 4.4 times greater. The leading cause of fire deaths in older adults is smoking, and the leading cause of fire injuries in older adults is cooking.

Look for signs especially in the kitchen and, for smokers, in the bedroom:

• Charred stove parts and pan bottoms.
• Potholders and dishtowels with burned edges.
• Burn spots on bedding, floor coverings or furniture.
• Smoke stains on ceilings.
• A discharged fire extinguisher.
• Smoke detectors that are disconnected or disassembled.

For further information, you can download a copy of USFA’s Fire Safety Checklist for Older Adults.

In the final part to this series, we will look at concerns about cognitive impairment.

Even for family members who are caregivers, it is difficult to open discussion about money management and driving. It helps to understand that these issues of privacy and independence are grounded in the more important issues of security and safety. Assessing the ability to take care of daily finances and to drive will help with decisions about assisted living.

Money Management

Basic money management skills include planning and living within a budget, keeping track of income, balancing a checkbook, and paying bills. Because there is usually an increase in the need for healthcare as we age, an additional skill is managing health insurance. This includes shopping for insurance coverage, tracking insurance claims, and following up to see that payment is made to medical providers.

According to the National Center on Elder Abuse, sound money management is not only essential for financial security, it is a protection against elder abuse.

Managing daily finances can be a problem for a variety of reasons:

• Cognitive impairment.
• Arthritis or other conditions that limit the person’s ability to write or use a computer.
• Visual impairment.
• Vulnerability to pressure or undue influence.
• Loss of a spouse, family member or friend who previously handled the person’s finances.
• Limited literacy.
• Lack of familiarity with standard banking, credit, and tax practices.

Often mail can give clues about how well financial matters are being handled. Are there unopened letters from banks, insurers, credit card companies, or collection agencies? Unopened bills? Pledge cards or thank you notes from charities? Personal or solicitation letters from strangers? Unopened benefit checks or investment statements? Bills from magazine subscription services, retail purchase clubs, or online home shopping sites?

Kathleen Michon, an attorney who writes about elder law issues, reminds us that many elderly people can handle daily finances with help. When someone cannot handle daily finances with help or they become susceptible to financial abuse, intervention is necessary. For Michon’s advice about daily money management programs for seniors, see Daily Money Management Programs for Seniors.

Driving

How do we know when it’s time to stop driving? Some conditions that accompany aging can indicate it is no longer safe to drive and it is time to look for alternative transportation:

• Health conditions that affect agility and judgment.
• Medications and side effects.
• Vison impairment.
• Hearing impairment.

According to the Tennessee Department of Transportation (TDOT), these warning signs say it is time to stop driving:

• Nervousness while driving.
• More tickets or warnings.
• Accidents.
• Getting lost or confused.
• Poor driving skills.
• Deteriorating physical condition.

For further help from TDOT in making a decision about driving, see Decisions for Tennessee’s Senior Drivers and Driver Safety for Tennessee Seniors.

In Part 4 we will explore signs around the home that tell us it may be time for assisted living.

Paula Spenser Scott, who writes frequently about health issues related to elder care and is editor of www.caring.com, suggests we start by looking for what she calls “big-picture, up-close and social signs.”

The Big Picture

Certain situations may signal it is time to consider alternate living arrangements:

• Recent accidents or close calls.
• A slow recovery from illness or injury.
• A chronic health condition that is getting worse.
• Difficulty managing the activities of daily living and instrumental activities of daily living. (See Part 1 of this series for a definition of these activities.)

Up Close

Some clues are related to changes in personal appearance, dexterity and strength:

• Obvious weight loss.
• Increased frailty.
• Noticeable weight gain.
• Strange body odor.
• General changes in personal appearance (grooming, makeup or clothes).

Social

Consider these signs with the understanding that social connections decrease as we age:

• Lack of active friendships or participation in groups.
• Dropping out of activities and lack of interest in things once enjoyed.
• Days spent without leaving home.
• No check-in on a regular basis or refusal of a safety alarm system.
• Decrease in interest or ability to discuss plans in the event of an emergency or disaster.

In Part 3 we will take a look at concerns about money management and driving.

What is your fondest childhood memory?

The first thing that pops into my head is birthdays. When it was your birthday, you got to decide what the meal and the cake would be. And usually you got to invite one friend to spend the night. It was special how my mom made birthdays a big celebration for each person. I always enjoyed that.

Name a little-known fact about yourself.

I was a majorette in high school. It’s something I enjoyed, although I didn’t like the outfits.

What do you like to do for fun?

The most fun I have is when all my family is together. We hang out on the porch, talk, watch movies, or sit by the fire. Friday night is movie night at my mom’s.

Any hidden skills or hobbies?

I love to read. I’m a very avid reader. Recently I read Marley and Me, which I liked.

We’re finishing up another holiday season. What is one of your favorite holiday movies?

National Lampoon’s Christmas Vacation. It cracks me up.

Name one person who has made a significant impact on your life, and why.

My mother, because she single-handedly raised four daughters on a CNA salary. She had a very strong work ethic. She worked hard for her kids and didn’t think about herself. Her sheer determination to be a strong rock for her children was a huge impact on my life.

What is your favorite meal?

That’s easy. Spaghetti with cheesy bread, and Mayfield chocolate ice cream for dessert. That is living.

If you were stranded on a deserted island, what three items would you want with you?

I would need my Bible, my body pillow, and hot chocolate. That way I could get my chocolate fix.

Most embarrassing moment.

I can’t think of anything specifically because I embarrass myself all the time. I laugh at myself, so being embarrassed doesn’t bother me. I’m an open book and that lends itself well to being embarrassed.

What is the best way to make you laugh?

I don’t know because I laugh about everything. I find humor in everything. I guess the best way to make me laugh is if you’re laughing. I don’t have to know what you’re laughing about; I’ll just join in.

What accomplishment are you most proud of?

Being a mother of twins. They are my greatest accomplishment. As Mom told me, “God will not bring you to it if He cannot see you through it.” I didn’t know how I could work and parent twins at the same time. But my mom was right.

What is your favorite quote?

“I can do all things through Christ which strengtheneth me” (Philippians 4:13). This is our family quote. My older sister went through breast cancer and this verse stuck with her. And when my other sister was sick with cancer, it became our favorite quote.

What is the best part about working at Wellspring Senior Living?

That has to be the residents. They make every day fun and different. You never know what you’re walking into when you come through the front door. They’re so interesting and they have such a great sense of humor. If you just hang out with them, it helps you see just how unimportant all the trivial things in life are.