Susan W. and her family live in the Chicago area. Her widowed mother, Alice, lived alone in another state. Susan and her mother spoke on the telephone at least weekly, and Susan visited Alice for a few days at least twice a year.

Alice's telephone calls to her daughter always included a detailed report about her active life. She often joked to Susan that she could never manage without the large daily planning calendar she received for Christmas every year.

Recently, however, Alice's calls began to sound disturbingly similar. Alice told Susan about her week, but she was reluctant to give details. Instead, she tried to change the subject, or became annoyed if Susan asked things like, "Who else was there?" or "What did you have for dinner?"

Susan realized that what she was hearing was an exact re-run of what she had heard the week before… and probably the week before that. Somehow, her mother's voice sounded different, too. Within 24 hours she was on a plane.

Susan was shocked when she arrived without notice. Her always impeccably dressed mother was disheveled, and obviously had not bathed recently. Her house was in disarray. Although the freezer held a good supply of food, there was nothing fresh to eat, and it appeared that Alice was living primarily on peanut butter. Next to the telephone Susan found the telephone "script", which had begun to sound so familiar. The once-so-important calendar was nowhere to be found.

Susan immediately cancelled her return trip. She spent the following week making panicked arrangements for help. Today Susan says, "If I hadn't suddenly realized that my mother was using the same words to talk about the same things, time after time, I would have thought everything was just fine. It's so sad.  She was using such a tremendous amount of energy trying to cover up, and I think she was really so scared…"

Sometimes the signs that an older person may be in need of help are subtle. Sometimes the warning signs are clear and obvious. Use your own good judgment. If you see (or hear) any of the following clues, be ready to take action: 

Confusion: Puts things in inappropriate places (teeth in the microwave, shampoo in the desk). Asks the same questions over and over. Mixes up day and night. Gets lost on familiar territory. 

Personal Care: Wears dirty, mismatched, or seasonally inappropriate clothing (winter coat in mid-summer). Hair and skin are unkempt. Body odor. 

Nutrition: Shows signs of marked weight gain or loss. Spoiled or obviously old food in the refrigerator. Meals uneaten and food left out. Evidence of dangerous kitchen mishaps (burned countertops, etc.). 

Accidents: Bruises or other marks, particularly on arms and legs, may be signs of falls. Unexplained dents and dings on the car or sides of the garage.  
Home management: Neglects regular housework and maintenance, inside and out. Keeps temperature clearly too hot or too cold. Accumulates trash and garbage. Signs of bugs or other pests. 

Finances: Has piles of unopened mail. Bills are past due. Appears to be on mailing lists for numerous sweepstakes. Has not maintained, or can't find, the checkbook. 

Communication: Conversations are vague or rambling, often repetitive. Telephone calls come at odd hours, too frequently, or not as often. Handwriting is getting worse.