Question

"I thought Dad was fine…and then I visited for the holidays. I found a messy house with bed unmade, a sink piled high with dishes, and a laundry hamper full of clothes. The house looked like nothing had been done for weeks. Dad even looked a little bit disheveled. When I asked him about it, he said he’d been busy and not gotten around to it. I’m not buying it. He has absolutely nothing going on.

It’s highly out of character for my father to live in a messy environment. Of my two parents, he was the more exacting one. He was always insisting we complete a whole list of chores. Dad saw to it that we did them even if Mom would look the other way. 

Dad is only 75 years old. Mom passed away three years ago and he has been managing quite well since her death. I visit at least once every six months, and this is the first time I’ve found things in disarray. What do you think might be going on, and what do I do about it?"

Answer

A change as dramatic as the one you describe is a cause for concern. The elderly generally don’t have such a change in behavior unless there’s an underlying cause. People who have cared for themselves and their surroundings their entire adult lives don’t just stop doing so over a short period of time. You might see some decline in function over many years, but not like you describe over only six months, and with guests expected.

It’s time to get close to the situation to see what’s going on. The first thing to do is schedule a medical evaluation. Your father may be depressed, he may have had a minor stroke, he may have an early form of dementia, or he may have another physical aliment that makes it difficult for him to perform the tasks he once did.  

After spending some time with him you might have observed small changes, if you knew what to look for. If not, I recommend that you or a sibling adjusts your schedule to spend a week or so with your father. You will then have a chance to observe his habits, and get a closer look as to how he is functioning.

Here are some things to look for:

• Cognitive abilities – does he recognize familiar people? does he get lost driving familiar routes? does he remember to take his medication? are bills being paid? are appointments kept?
• Mental health – does he look forward to events? does he care about what’s going on? does he drink alcohol more? does he sleep excessively, or does he have trouble sleeping?
• Physical abilities – notice his balance.  is he in pain? has his weight changed? can he put on clothing easily? can he stand for a period of time? can he walk without holding on to furniture? is he short of breath? how do his ankles look? is he having trouble seeing? any trouble swallowing? is his speech clear? are his sentences coherent?

A busy and quick Christmas day dinner with numerous family members is not enough time to figure out what’s changed with your father. You’ll need to spend a bit of time with him to really notice any difference. It’s not unusual to rally for a few hours, or for you to miss subtle physical or mental changes at an event. So, spend a day or two or even more to really observe, and watch carefully. You’ll get a sense of where he struggles. During that time, you can make that appointment to see his health care provider. I recommend you plan to go with him to that appointment, for support if nothing else.

It’s very scary to be alone and struggling. He needs you now to step up and help him. He may be resistant, so you need to be persistent. This is what we do for our parents. I wish you well.