Recognising when a loved one may need help at home

Many families first notice something is wrong during a visit home, a phone call that doesn't sound right, or a comment from a neighbour or church member. It can be hard to know whether a change is a passing phase, part of getting older, or a sign that someone needs more help.

As people get older they are more likely to live with several health conditions at once, and the World Health Organization notes that problems such as falls, incontinence, frailty and sudden confusion often have several causes at the same time. That is one reason why a single sign is rarely the whole story. It's the pattern that matters.

Changes in everyday routines

These are often the first things to slip, because they take energy, memory and steady hands.

• Meals. Little food in the house, food going off, weight loss, or relying on bread and tea instead of proper meals.
• Washing and dressing. Wearing the same clothes for days, a stronger body odour, or hair and nails that are less cared for than usual.
• Using the toilet. Accidents, a smell of urine in the room, or reluctance to go out in case they can't reach a toilet.
• Medicines. Tablets left in the packet, doses doubled by mistake, or repeat prescriptions not collected.
• Sleep. Sleeping much of the day, being up and about at night, or not getting to bed at all.

Changes around the house

The home often tells you what someone won't.

• Rooms that used to be tidy are now cluttered, or the person lives in just one room.
• Post, bills or letters left unopened.
• Burnt pans, a gas cooker left on, or doors left unlocked.
• Bruises, or small injuries they can't explain, which can be signs of falls.
• Rugs, loose wires and dark corridors that they now struggle with. Our guide to everyday home-safety questions goes through the home room by room.

Changes in health, movement and mood

• Moving about. Holding on to furniture, shuffling, taking longer to stand up, or no longer using the stairs.
• Falls. Even a fall without injury is worth taking seriously, especially if it happens more than once.
• Mood. Losing interest in things they enjoyed, withdrawing from friends, family events or their place of worship, or seeming low or anxious.
• Memory and thinking. Repeating questions, getting lost on familiar routes, or confusion about days and times. Gradual memory changes should be discussed with a doctor.
• Drinking enough. In hot weather especially, older people are more at risk of dehydration. Dark urine, dizziness, tiredness and a dry mouth are common signs.

Changes in money and paperwork

• Bills not paid, or paid twice.
• Unusual withdrawals, new "friends" asking for money, or pressure from callers.
• Difficulty using mobile money or a bank card they used without trouble before.

If you're worried about money, it's worth sorting out who can help with bills, and how, before a problem becomes serious. Any help with payments should be agreed in writing and come with receipts, and nobody helping them, including a paid carer, should ever need to know their PIN.

What these signs might mean

None of these are fixed answers. The right support depends on the person, their home, their health and what they want.

Starting the conversation

Talking about help can be difficult, particularly with a parent who has always looked after everyone else. A few approaches that families often find useful:

1. Choose a calm moment. Not straight after a fall or an argument, and not in front of visitors.
2. Start with what they want. "What would make the day easier?" works better than "You can't manage any more."
3. Talk about specific things. "I noticed the kitchen floor is slippery" is easier to hear than "You're not coping."
4. Involve the people they trust. That might be a sibling, a pastor or imam, or a close friend, as well as their doctor.
5. Offer choices. A few hours of help a week is a very different idea from someone moving in. Starting small is often easier to accept.
6. Respect their decision. An adult who can make their own decisions has the right to say no, even if you disagree. Keep the door open and come back to it.

If you live abroad, our guide to arranging care from abroad covers how to have these conversations, and organise support, from a distance.

What to do next

• Write down what you've noticed, with rough dates. It helps the person's doctor and anyone assessing care.
• Ask the person's doctor for a check-up, especially if there have been falls, weight loss, memory changes or new confusion.
• Talk to the rest of the family about who can do what, and what is realistic.
• Find out what support is available. A home care assessment looks at the person's day, their home and their health, and gives you a plan to consider, with no obligation to go ahead.

Sources

1. Ageing and health (fact sheet), World Health Organization (checked Invalid Date).
2. Help at home from a paid carer, NHS (UK) (checked Invalid Date).
3. Sudden confusion (delirium), NHS (UK) (checked Invalid Date).
4. Dehydration, NHS (UK) (checked Invalid Date).

This guide is general information, not medical advice for a particular person. Talk to the person's doctor about their health, treatment and medicines.