Families and caregivers have spent much of 2020 rightfully concerned about preventing older, higher risk family members from contracting COVID-19, but the social distancing and other safety measures required to keep grandma safe are necessarily isolating and can lead to a decline in mental and physical health.

Parker Adult Day Center, a Middlesex County-based provider of aging services including nursing care, assisted living, memory care, and post-acute rehabilitation, offers a list of eight warning signs to look out for when interacting with elderly relatives this holiday season. They can be indicators of declines in physical and/or mental health.

1. Inability to maintain physical appearances.

You may not think twice about a stain on grandma’s favorite holiday sweater, but it could indicate that there’s a larger issue.

“Often, it’s an indicator that they’re no longer able to maintain their physical appearance,” said Samara Elias, a social worker for Parker Adult Day Center. “They may be struggling to do the laundry or maintain good personal hygiene.

2. Weight loss or weight gain.

Elders can have a well-stocked refrigerator and pantry, but they might not remember to regularly eat their meals. Or, at the other end of the spectrum, they may not recall eating a short while ago and then have another lunch.

“I think it’s probably more common that someone would notice weight loss,” Elias said. “But certainly, if somebody is having some cognitive changes and they don’t remember that they’ve eaten a meal, they could make themselves another one. As people start to have challenges, they gravitate toward the things that they know they can do. They might think I don’t remember if I ate, but it seems like maybe it is time to,’ and so they make another meal.

3. Changes in mood or behavior.

“Look for an unpleasant change in their mood,” Elias said. “If you notice that your loved one is depressed it may be time to speak with their doctor.”

This is a tricky one to spot because these changes can be triggered by something as common as a change in the weather or someone experiencing pain or discomfort. But it could also indicate declining mental health.

4. Unpaid bills.

If last September’s credit card bill is sitting under a stack of mail or if the check for the electric bill was mailed to the cable company, they could be warning signs that someone is struggling with executive functioning.

“It’s an early indication that they’re having a harder time managing everything,” Elias explained. “Maybe they can no longer do such tasks as writing a check or balancing a checkbook. They will need help.”

5. Messy house.

Take a look around their home. If it’s uncharacteristically disorganized with clothes strewn on the bedroom floor or dirty dishes left on the table or outdated food in the refrigerator, those are signs of concern.

6. Damage to the car.

The body of your loved one’s vehicle can tell a story. If there are scrapes, scratches and dents that you haven’t noticed before, it may be time to make the difficult decision to take the keys.

Age-related changes can affect memory and decision-making processes, the ability to see and hear, reaction times and other skills and abilities needed to safely operate a car.

If they are struggling to drive safely, it may indicate that other skills are deteriorating. So it’s something to be mindful of.”

7. Inability to manage their medications.

Americans ages 65 to 69 take an average of 15 different prescriptions per year, and those ages 80-84 take an average of 18, according to a recent study by the American Association of Consultant Pharmacists.

It could be a tall task for anyone to keep track of that many pills. It is important to double check that your family member is taking prescribed medications correctly.

“If it’s somebody who always had a pillbox to keep everything organized, and now there’s bottles around and they’re not using the pillbox, that could be a warning sign,” Elias said. “Or, check to see if they’re using expired medications.”

Not taking medication, or taking it incorrectly, can expedite the deterioration of the body and mind, which is why regular checks in the medicine cabinet are warranted.

8. Inability to follow conversations.

“Are they having a harder time following the dinner conversation?” Elias said. “Is this somebody who always used to be super involved and engaged in conversation and maybe they’re taking a little bit more of a backseat? Are they asking repetitive questions and can’t seem to follow the string of the conversation or hold on to information from the beginning to the end?”

The inability to follow a conversation from beginning to end could indicate a number of issues.

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