Intervening When Self-Care Slips

Aging and Life Enhancement
By Kathryn Kilpatrick, M.A.

“There is no exercise better for the heart than reaching down and lifting people up.” ~John Holmes

At some point, perhaps you sense something is changing with a friend, family member or neighbor. This person who previously cared about his or her appearance may now seem to be less “put together” or their home seems more cluttered. Perhaps the bathroom isn’t clean or there are dirty dishes and food that should have been refrigerated still on the countertop. If there is no family in town or a close friend is not willing to alert the family, the situation can become more precarious.

When this happened with one of my neighbors, I contacted a family member who was actually aware of some of the things that were changing, including the person’s disposition, but they did not feel they could “interfere” under those circumstances. 

Observations and suggestions were offered to the family that included recommendations, at least initially to visit more often if possible, to just observe, then consider providing her primary care doctor with some details to explore some options.

As a speech-language pathologist for decades in the home health arena, these kinds of   situations were not uncommon when a person lives alone or with someone for whom they may be providing care. The benefit is that often other disciplines are involved (nursing, home health aide, physical and occupational therapy) so observations can be shared and a referral made to the social worker. 

Mobility issues, vision, depression or cognitive decline may be lurking in the background but being proactive and taking baby steps initially can be a good starting place in hopes of averting a major crisis.

“Circumstances change and you have to be proactive about changing with those circumstances.” ~Paul DePodesta

Some Things to Observe:

1. Changes in personal appearance. It may become obvious that there is less interest in getting dressed for the day or the person may repeatedly wear the same clothes. 
2. Neglected laundry. Piles of dirty clothes may appear, or laundry may not be folded or put away.
3. Dirty dishes in the sink or scattered around the kitchen. Food left out or spoiled food and outdated items in the refrigerator.
4. Different outfits. If this person was always well-dressed, wearing mismatched outfits could be a clue that something has changed.
5. Stained, dirty or ripped clothing. Keep an eye out for clothes that are stained or in need of repair. 
6. Poor hygiene. Perhaps increased body odor from possible decreases in bathing or hair washing. Also, keep a close watch out for poor oral care.
7. If the person is still driving, check the car inside and out for any red flags.
8. If there are stairs, make sure there are not items stored there to be taken up or down at a later time. This is an accident waiting to happen.

There are four areas that could lead to self-neglect or issues of concern. Unless there is an unsafe situation that requires immediate attention, it is important to choose your words very carefully. Think about how you would want someone to handle this IF YOU were in a similar situation.

1. Depression: Depression can lead to a significant decline in personal self care. If you think your loved one is suffering from depression, start with an appointment with their physician. For example, one  gentleman had several losses including some of his family members within a year and was urged to attend hospice support  groups. When he finally agreed, his children took turns going with him. By going out for coffee and dessert after these meetings, he was able to open up about his loss of interest in living. Gradually, things started to turn around as he got involved in some activities with others. The family noticed that his personal care habits began to improve significantly once he started getting together with his new acquaintances.
2. Limited mobility and pain: Poor mobility, pain and other limitations can make it much harder to do the laundry or put the clothes away. Fear of falling might also be an underlying reason for taking fewer showers or refusing to get into the tub. One woman prided herself in keeping a neat house but caring for her husband after his stroke meant a lot more laundry than she was used to. She was having trouble assisting him with bathing since he was paralyzed on one side but did not want to bother anyone or hire a caregiver. This couple wanted to stay in their home and family members took turns helping out until they were able to convince them to finally hire some additional help twice a week to clean, do laundry and assist with bathing.
3. Visual problems: Visual problems can mean it is harder to see the missing buttons on shirts or notice clothes are stained. Instead of raising a fuss about what’s occurring initially, it’s better to offer to help in small way. Doing so allows family members to discover if a loved one is dealing with bigger issues.
4. Cognitive decline: Cognitive decline can make the whole process of organizing tasks and following through a challenge. For example, one woman with dementia started wearing the same clothes every day. She still lived alone, but her family checked in regularly. In one of my sessions, she shared she had lost weight and her clothes did not fit so she did not want to attend church. She did not want to bother her sons and did not feel she should waste money on new clothes. Her problem-solving skills were not what they used to be, and she did not realize there were several appropriate outfits in her closet. Once her sons got her several  new pairs of pants that fit and matched them with her tops, she can now more easily pick out something to wear.

Respecting a person’s ability to make choices is important but it is equally important to know when something significant may be interfering with those choices, impacting their safety and quality of life. Step in when you can.

   “One of the most important things you can do on this earth is to let people
    know they are not alone.” ~Shannon L. Alder