What signs illustrate a person’s increasing difficulty performing the activities of daily living (ADLs)?
At first they are not obvious. Instead a series of events and behavior changes gradually appear. Observed individually, each change doesn’t seem to represent much, but the trick is to view each observation as a puzzle piece that fits together with other observations and puzzle pieces. The complete picture can also be obscured by confusing resistance with skill difficulties –because the distress of a parent often manifests itself as irritation with others who are around in a living environment. Decisions about driving and assisting with finances -which had already occurred –were easy compared to understanding and acting on the discrete daily activities that made our parent’s daily life increasingly complet.
As much as a year can pass — what it took us — before an adult child puts together enough evidence to conclude that a parent’s ability to handle the activities of daily living is on the decline. In our experience, and that of people with whom we have spoken, an adult child’s lack of familiarity with the skill changes delays the decision to arrange additional support, and this delay appears to hasten a person’s difficulty with the activities of daily living –so things get worse faster. We wish that somewhere we had encountered something similar to the information below to help us understand more clearly what was happening to our parent.
Below we have reconstructed the order of the decline.
Initial ADL Observations
On a continuing basis, clothes were lying around in stacks — trousers here, skirts there — all about the bedroom. At first we thought some of these were bound for the cleaners or a tailor. Then we began to notice lots of empty hangers in mother’s closets and on doorknobs, we realized she was having difficulty rehanging clothes. However, we did not associate the situation with the declining life skills.
The time it took to get dressed for a special activity, originally perhaps half-an-hour, grew longer and longer, sometimes reaching around 90 minutes. Blouse sleeves were rolled up instead of buttoned at the cuff. Multiple outfits were tried and discarded in piles (something that had never happened before). Jewelry was no longer worn.
What used to take half-an hour, lengthened gradually to over an hour, not counting getting dressed. We noticed items on the shower floor that were not picked up.
Crackers and cereal grew stale. Sometimes this was because they had been around a long time, or sometimes it was just too hard to close them up securely. In the refrigerator, more food spoiled and sat around without being removed.
Dining Room Frustrations
Visits to the retirement center’s dining rooms decreased, and more meals were delivered to the condo — only in retrospect did we figure out why. If meals were taken in the dining room, it became harder to look over the entire menu and make selections, and the usual wait for the food to arrive was long and difficult. Food was harder to cut and fell off the fork more often.
Telephone and Television Troubles
Hearing a caller on the telephone grew harder. A new telephone with an amplification button — one small button to master — proved to be too difficult. Finding the few required buttons on the television remote became increasingly daunting so favorite TV shows were skipped. Check out the Tec-Pal remotes.
Organizing medications in the morning and evening became too complex. A medication nurse came weekly to organize the pills into morning and evening pill boxes, but then there was confusion between the morning and evening rows. This evolved into confusion with the daily windows themselves.