As the holidays approach, one of the highlights (for most of us) is time spent visiting with family.  For me, this is one of two times a year when my entire family comes together - and, it has become customary for my two brothers and me to spend a bulk of our time together comparing observations of our parents' functioning.  This is usually done in in a spirit of good humor, although more and more often the anecdotes are accompanied by nervous laughter.

As there has typically been at least a 3-4 month period between the times that we see each other, any changes in my parents' health or mental status are usually marked and noticeable.  I thought it would be helpful to send out some suggestions for what to look for during holiday visits.  If you are visiting your older family member in their home, here are some areas to observe:

At home:  Walking around the house can be very helpful to assess how your family member is functioning.  Note:  It is important to compare any change with their baseline – or ‘normal’ levels of functioning.  For example, my mother is normally a very neat person, so if things are awry in the home, this would be significant.  If my mother were typically untidy, it would not be as noteworthy.

• Are there stacks of unopened mail (and do there seem to be an unusual number of solicitations from charities or sweepstakes)?
• Have there been changes in the level of cleanliness in the house (for example:  strong odors)?
• Is there an unusual amount of clutter (ex: are walkways or doorways blocked)?
• Does it appear that laundry is being done on a regular basis, or are dirty (or clean) clothes piling up?
• In the kitchen, look for spoiled and/or outdated food, as well as fresh food. Are they overstocking certain foods?
• Are there any burned pots or burn marks around the stove, floors or counters?
• Are there any broken items in the home such as clogged drains, broken fixtures, or burned out light bulbs?
• In the bathroom:  are there new medications?
• Are there any medications that are expired?
• Do medications seem organized so that they are able to take them correctly?

Elsewhere:  There are also many indicators you can observe in any setting.

• If you are having a meal together, observe their appetite or apparent changes in taste or smell (are they only eating certain foods, or picking at their food)?
• Are there any significant weight changes (such as weight loss or weight gain)?
• Do they appear well groomed and appropriately dressed (for example; are they wearing a winter coat if it is cold, do their clothes match, are they clean, do they appear to change clothes regularly or are they wearing the same item over and over again)?
• Do they appear to be bathing regularly?

Changes in social behavior are important to note.

• Are they participating in social activities (which could include church), and enjoying time with friends?

Additionally, look for changes in mental status.

• Does it appear that they seem sad or worried?
• Is there any indication that they have lost interest in things or activities that they once enjoyed?  (these can be social activities, such as attending book club, or individual activities such as reading or gardening).
• Are they repeating stories or questions over and over?  Do they seem to be able to recall events accurately – both short and long term?
• Do they appear to have a regular sleep schedule (and do they seem overly sleepy during the day?)
• Do they seem unusually angry, irritable, or suspicious, (such as complaints about items being missing or stolen)?

If you notice significant changes in any of the above areas, a geriatric evaluation can be very helpful.

All the best and Happy Holidays!