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Assessment: What Help Does Mom or Dad Really Need?

     Take a step back. There are times when that's the first move you need to make when trying to determine how your parent is doing. Look at the situation the way a concerned but objective outsider would.

     "Mom used to be so active . . . ."

     "Dad's just rattling around that big, old house . . . ."

     "My parents are eating less than what I feed my preschooler . . . ."

     What do you need to be looking for when you're trying to determine how your parent is doing? How your parent is really doing?

     The bottom line is this: Is your parent safe in his or her present situation and able to do the things he or she wants to do, and if not, what steps need to be taken to make that happen?

     "To do the things he or she wants to do" brings up the issue of quality of life. You need to remember it's your parent— not you, not your siblings, not your parent's siblings, not a concerned neighbor—who determines what that life will be.

     Wait a minute here! If Dad refuses to go to the senior center anymore and prefers to stay home and watch "The Young and the Restless," "All My Children" and "General Hospital" every day, don't you need to step in—for his own good—and . . . .

     Maybe. Maybe not. That's what assessing is all about. It's looking carefully at each piece of the jigsaw puzzle to get the complete picture, and not simply focusing on one or two pieces. The complete picture needs to include information from basic areas: physical, mental, emotional or social, and spiritual.

     What can make the task even more difficult is trying to look at each area objectively. It can be hard to put aside emotions, and there's always the temptation to gloss over some area or need because the truth can hurt so much. ("Well, yes, Mom doesn't seem to hear everything that's said but . . . .")

     And you need to base your assessment on what you see your parent doing or not doing now. ("I know Dad's always been able to . . . .")

     Also, you can't dismiss an apparent problem with a handy excuse. ("If he weren't tired today, I'm sure he could . . . .")

     It's best to begin any assessment with reviewing some good, basic information on the aging process to get an idea of what's normal. For example:

     ● Dad says he seems to be forgetting things lately. Should I worry?

     ● Mom says her feet have gone numb. Is that typical?

     ● Dad has trouble reading the newspaper. He's just sure the print has gotten smaller. What's that mean?

     ● Mom used to get up at the crack of dawn. Now she's sleeping in till 8:00 or so. Is that bad?

     Your parent's doctor is a good resource for getting that type of basic information. So is the Area Agency on Aging. It can be contacted through Senior Information and Assistance.

     If your parent has been diagnosed with a particular illness or disease and you want information of a more specific nature, visit the web site for the national association that focuses on it. Often there’s also a toll-free number. Or call information (1-800-555-1212) and ask for any listing under that particular topic. For example, "Parkinson's Disease" or "stroke." 

     Once you have a basic idea of the aging process and any diagnosed conditions you can better look at the major areas of assessment.

Physical

     Your parent needs to see a doctor for a complete physical examination, and you both need to listen to what the physician recommends.

     You need a good—meaning clear—diagnosis. Hearing "It might be this or it might be that or it might be something else" isn't going to help. You may not get an exact answer the first time. Keep asking, report any changes in symptoms and be persistent. You also need to ask about the prognosis. The diagnosis is the identification of the disease from tests and symptoms. The prognosis is a forecast of what's going to happen because of that particular problem. For example, how long will this symptom last? Will other complications and problems follow? How soon? Will there be a rapid deterioration in health or a gradual one? And so on.

     Your parent's hearing and vision also need to be tested.

     And take a look at your parent's daily routine. How is Mom sleeping? Has she lost weight recently? Is she smoking? Has she been drinking more? Should she be drinking at all with the current medication she's taking?

     What medications is Dad on now? If he has more than one doctor prescribing more than one medication, does each doctor know what the other has given him?

     What about mobility? Can Mom get up from a chair and walk around? Does she need some adaptive equipment, such as a walker or cane?

     Is there a problem with incontinence, the loss of bowel, or more commonly, bladder control? This is difficult to talk about. Although there are many television ads praising the benefits of adult protective wear, the subject is still taboo in many households. Yes, it can be extremely embarrassing to have to ask or answer questions about incontinence but it needs to be done. And done respectfully.

     And finally, listen when your parent tells you his or her symptoms. It may be that day after day, week after week, it seems to be the same litany of minor aches and pains or of problems already being addressed, but there could be something new in there. Something that needs immediate attention.

Mental

     How is your parent's memory, both long- and short-term? Does Dad seem confused? Can he remember Christmas 1955 but forget to eat? Can he still handle his own finances? Can he make and stick to a decision or does he seem able to say yes and no in the same sentence and mean both?

     Is Mom showing poor judgment? Did she leave the front door wide open all night—in a very unsafe neighborhood—because it was hot out?

     Does she know what day it is? What time of day?

     Can she follow a conversation? Does she seem to have trouble with her receptive language ability? (Her ability to understand the words you use and follow the general train of thought in everyday conversations.) Is there a problem with her expressive language? (Does she use the wrong word or seem unable to come up with a word for which she's searching?)

     Is she using "suicidal phrases"? Does she say things like "Life's not worth living anymore." "I don't want to be here." "What's the point?" "I hope it's over soon." "It would be better if I just died."

     Is she aware of her mistakes, and does that make her feel frightened and angry or is she oblivious to them?

     Is there evidence of dementia—cognitive loss—a deterioration in mental ability? Do you need to arrange for a professional assessment?

Emotional and Social

     Again, what do you see? Is Mom depressed quite a bit of the time? Does she not want to get up in the morning? Does she complain of having no energy? Does she burst into tears?

     Is she grieving? Has she recently suffered a major loss? (The death of a spouse, failing health, an amputation and so on.) Does she seem angry all the time? Frustrated? Resistant to any help?

     Is she frightened most of the time? Is she generally anxious or agitated? Is she afraid to stay alone at night or does she panic when you say you have to leave?

     Has her mood been taking wide swings, from extremely angry to completely passive?

     What about socially?

     Does it seem that Dad is becoming more and more isolated from the rest of the world? Does he get out and see other people as much as he wants to? Have telephone calls and letter-writing replaced visits, and is he content with that?

     How does he spend his leisure time? Does he just sit in front of the television during most of the day? Does he have any hobbies? Does he have a pet?

     Is he just not interested in anything anymore or has he adjusted his interests to match his abilities? (For example, he used to love gardening and now he reads gardening magazines and watches gardening shows on TV.)

     Does Dad know what he needs and if so, can he get it for himself? If he wants to go some place, can he figure out how to get there—by walking or driving, by taking a bus or taxi, or by arranging to have someone drive him? Is he still involved at his parish? If he can't make it to Mass, can he arrange for someone from his parish to stop by the house? Does he stay for "donuts and coffee" and visit with fellow parishioners.

Spiritual

     How about Mom’s spiritual life? Does she practice her Faith the same as in the past or has it faded away?

     Does she continue to attend Sunday Mass? Has she faithfully attended daily Mass, but now can’t or doesn’t want to?

     Does Dad have access to the Sacraments? If he can’t go to Mass, does he have a Eucharistic minister come each week?

     Is his parish community involved in his life? Is he on the list of the sick in the parish for the "Prayers of the Faithful" at Sunday Mass? Does he still attend his monthly Knights of Columbus meetings?

     Has he talked to a priest lately? Would he like to arrange an appointment for your parish priest to stop by for a visit?

     Does he have a Bible near-by for reading? Would he like other spiritual reading? Lives of the Saints? Daily devotional?

     Do you and your parent pray together? Would he like to? Would he like to say the Rosary?

     Does he seem at peace with this time in his life or is he frightened, bitter, angry and confused? Does he ever express a desire to improve the spiritual part of his life?

From an evaluator's view

     There may be a major concern in one of the areas that obviously needs to be addressed first. It could be that nothing stands out, but there are a lot of little problems which, added together, may mean a parent needs some kind of help from you.

     To evaluate a senior's living situation considers the individual's "activities of daily living." Without help, can she: eat, walk, use the toilet, take a bath, and get dressed?

     We also need to look at "instrumental activities of daily living." Can he: handle the finances, go shopping, drive the car or take the bus, do the housework and laundry, prepare meals and take the right medication, at the right time, and in the right amount

     Once needs are determined—and sometimes it's best to do this with that outside, more objective help—then you can investigate how those needs can begin to be met by family, friends, neighbors, people from the parish and professionals.

     But keep in mind that those needs may fluctuate. Mom may have to have someone in to help with the cooking and cleaning for a while after her surgery but later she can resume those duties. Dad might have had no trouble writing the bills six months ago, but recently there have been a lot of extra charges for late payments.

     Assessing a parent's need isn't a one-time task. It's a job that needs to be repeated periodically to make sure you're seeing all the little pieces in order to get a clear view of the big picture: your parent's health, safety and quality of life.

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