Recognizing the signs that an evaluation is needed
Before initiating an official evaluation, it is essential to observe your parent for key indicators that their needs are changing. These signs can appear suddenly, such as after an illness, or emerge gradually over time. Documenting these observations will be helpful when you eventually speak with a healthcare professional.
Physical and environmental changes:
- Decline in personal hygiene: Noticeable changes in personal grooming, such as unkempt hair, body odor, or wearing dirty clothes, may indicate difficulty with bathing or dressing.
- Unsafe home environment: Piles of laundry, expired or moldy food in the refrigerator, or a cluttered living space can signal an inability to maintain the household.
- Difficulty with mobility: An unsteady gait, problems navigating stairs, or frequent falls and unexplained bruises can point to physical frailty.
- Poor nutrition or weight loss: Unintentional weight loss or changes in eating habits could suggest that preparing meals has become too difficult.
Mental and behavioral changes:
- Forgetfulness and confusion: While some memory lapses are normal with age, repeatedly forgetting important appointments, getting lost in familiar places, or mismanaging medications can be signs of cognitive decline.
- Changes in mood and personality: A normally social parent may withdraw from activities or friends, or exhibit increased irritability, anxiety, or apathy.
- Financial mismanagement: Unpaid bills, unusual bank activity, or falling for scams can signal a decline in judgment and decision-making abilities.
- Refusing to seek help: Resistance to accepting help or admitting to needing assistance is a common hurdle.
Starting the conversation and seeking professional help
Approaching your parent about an evaluation requires sensitivity and empathy. Frame the conversation around your concern for their well-being and independence, not as an accusation. It's often helpful to involve a trusted family member or a professional from the outset.
How to talk to your parent
- Be empathetic, not critical: Instead of saying, “You forgot to pay this bill again,” try, “I’m worried about you. I noticed you have some unopened mail, and I want to make sure things aren’t getting overwhelming”.
- Focus on safety and quality of life: Emphasize that the goal is to help them maintain their independence for as long as possible, not to take it away. For example, a home safety evaluation can help prevent falls.
- Involve their trusted doctor: If your parent is reluctant to listen to you, suggesting a baseline cognitive screening as part of a routine check-up from their long-term primary care physician or a geriatrician can be more effective.
The process of getting an evaluation
- Initial primary care assessment: Your parent's family doctor or geriatrician is the ideal first point of contact. They can conduct an initial health assessment, review medications, and perform brief cognitive screenings like the Mini-Cog.
- Specialist referral: If the initial assessment suggests more in-depth issues, the primary care physician may refer your parent to specialists. A neuropsychologist can perform detailed cognitive testing, while a geriatric psychiatrist can assess for mental health disorders like depression.
- In-home assessment: For parents who are resistant to leaving the house, a professional in-home assessment by a geriatric care manager (also called an Aging Life Care Professional) can provide a more accurate picture of their daily functioning and safety within their own environment.
Types of professional assessments available
Multiple types of evaluations exist to cover all aspects of an older adult's health and functioning. Your parent may need one or a combination of these assessments.
Comparison of evaluation types
| Evaluation Type | What It Assesses | Who Performs It | Common Findings | Benefits |
|---|---|---|---|---|
| Comprehensive Geriatric Assessment (CGA) | A holistic review of medical, psychological, functional, and socioeconomic factors. | Geriatrician, Multidisciplinary Team. | Identifies risks for falls, cognitive decline, and polypharmacy; creates a coordinated care plan. | Offers a complete picture of health and needs, leading to personalized interventions. |
| Cognitive Assessment | Memory, language, reasoning, and judgment. | Geriatrician, Neurologist, Neuropsychologist. | Detects mild cognitive impairment or dementia and helps identify treatable causes like vitamin deficiency or depression. | Provides a baseline for tracking changes and informs decisions on future care. |
| In-Home Safety Evaluation | Home environment for safety hazards, functional ability within the home. | Occupational Therapist, Geriatric Care Manager. | Identifies risks like tripping hazards or poor lighting, and suggests home modifications. | Enhances safety and helps maintain independence in their own home. |
| Psychiatric Evaluation | Mood disorders, anxiety, and behavioral changes. | Geriatric Psychiatrist, Psychologist. | Diagnoses and develops treatment plans for conditions like depression or anxiety. | Improves mental and emotional well-being, which significantly impacts overall health. |
| Financial/Legal Capacity Assessment | Ability to manage finances and make legal decisions. | Elder Law Attorney, trained Psychologist. | Determines if a financial power of attorney or guardianship is necessary. | Protects your parent from financial abuse or exploitation. |
Navigating the legal aspects of evaluation
While most evaluations are voluntary, a legal route may be necessary if your parent poses a risk to themselves and refuses assessment. It is highly recommended to consult with an elder law attorney to understand your state's laws.
Legal steps for formal evaluation
- Guardianship petition: In cases of severe incapacity, a court-ordered guardianship may be pursued. This requires filing a petition with the probate court and providing medical evidence of your parent's incapacity.
- Court-ordered evaluation: If your parent refuses to cooperate, the court can compel a licensed psychological evaluation.
- Power of attorney: The least restrictive legal option is to have a parent willingly sign a medical power of attorney or financial power of attorney, which empowers you to make decisions on their behalf. This should be done while they still have the mental capacity to consent.
Finding support and creating a care plan
Completing the evaluation is just the first part of a larger care plan. Fortunately, a wealth of resources exists to assist you.
Resources for assistance:
- Eldercare Locator: A free public service of the U.S. Administration on Aging that connects you to local resources.
- Area Agencies on Aging (AAAs): These agencies provide local services like transportation, meal delivery, and caregiver support.
- Geriatric care managers: These professionals specialize in coordinating and managing senior care, and can be found through the Aging Life Care Association.
- Support groups: Organizations like the Family Caregiver Alliance offer online and in-person support groups for caregivers.
Conclusion
Getting your elderly parent evaluated is a loving and responsible step toward protecting their health and safety. By recognizing the signs of change, approaching the conversation with empathy, and utilizing professional and community resources, you can effectively navigate the process. Whether it involves a comprehensive geriatric assessment or a more specific evaluation, the ultimate goal is to create a tailored care plan that optimizes your parent’s quality of life and preserves their independence for as long as possible.
