In our modern, fast-paced, world where many family members are separated by geography, we often only spend time with our relatives at the holidays. As our loved ones age, we may see and hear things that make us wonder about their health, safety and well-being.  Sometimes these changes seem to have happened quickly, or are so subtle we miss them entirely.

These changes could be either a new and treatable physical problem, such as a urinary tract infection or pneumonia, or a brain disorder like Alzheimer’s or a stroke. Couples are especially good at “covering” for each other, which can make it difficult to see just how disabled one (or both) has become.

Here are five telltale signs I have noticed when visiting my own family:

1) Mom and Dad always want to eat out

It is not uncommon for seniors to want to eat out when family visits. The whole process of meal preparation can tax their finances and planning abilities, and they may feel it is both cheaper and easier to feed the crowd at a local buffet.

However, if they are dining away from home more often than not, even when no one is visiting, it may be a sign they are unable to plan and carry out a full meal, especially if they are on a fixed income. Ask if there has been a change in their financial situation. Also, ask questions to see if they are able to think about and plan their meals. One visit revealed that Dad was eating out a lot due to Mom’s inability to help with either meal preparation or clean up.

2) You find expired and moldy food in the refrigerator and pantry

Every visit home to my parents involved about a 60-minute refrigerator and pantry purge of moldy, expired and highly questionable looking food! At one meal, Dad was complaining about the salad dressing and Mom kept saying there was nothing wrong with it. However, when we looked on the bottle, the expiration date was three years ago!

This is a big problem for many elders, and the reasons are not always due to changes in thinking.  For example, arthritis and osteoporosis can make it very difficult to bend over and see into the back part of the refrigerator or pantry. Vision changes make it hard to read the expiration dates and changes in the ability to smell can interfere with the detection of spoiled food. Sometimes, too, hoarding makes it difficult for them to throw away what they consider to be perfectly good food. As children of the Great Depression, I have found this particular behavior in my own parents frustrating and dangerous!

3) There is a strong urine smell in the bathroom and bedroom

On one visit, I went into Mom or Dad’s bathroom and in both rooms the smell of urine was overwhelming. I looked around and found that the floor, rugs and walls by the toilet seemed clean thanks to a friend who helps with the cleaning. Upon further investigation, I discover used, urine-soaked menstruation pads in my mom’s waste basket and urine-stained underwear in both her and Dad’s laundry baskets.

Urinary incontinence (or the inability to fully control urine) is NOT a normal part of aging and can be a sign of a urinary tract infection in both women and men. It can also be a symptom of prostate trouble in men, and/or pelvic floor problems in either gender. The point is, don’t accept it and don’t ignore it. Point it out gently to your loved ones and encourage them to ask their medical providers about it.  Urinary incontinence can be a sign of a more severe problem like cancer, or simply be a more benign problem that can be treated.

4) Clothing is very baggy

I was walking behind my Dad one day and realized that his pants were really baggy! His belt was cinched four holes past the old mark and I suddenly realized that he had lost weight – a LOT of weight, and not intentionally. Yikes! What happened?

Unfortunately, as we age we lose muscle mass. However, when weight loss is unintentional and dramatic (noticeable changes in belts, pants and underwear sizes, face and neck), then it can suggest a number of issues. Poor eating and dehydration can be due to a lack of income to buy food, lack or ability to prepare it, or mental ability changes. There might be a problem with swallowing, reflux, digestion or an issue with the bowels that has limited what they are eating to the extent that your loved one is literally malnourished. Not having a partner with whom to eat meals also prevents eating well.

5) They got a brand new car!

Finally, on one visit home, I realized that Dad had a car in the garage I did not recognize. At first I didn’t think much of it as I know he typically gets a new one every three years, and I knew he was about due. But then a friend mentioned something about how good the car looked after “that big accident!” What accident?! Another yikes! I discovered that my father had been at fault in an accident that totaled the other car and the damages to his car were over $10,000! Fortunately, no one was injured, but the airbags had deployed, so it was a pretty bad wreck.

New cars (or other major purchases) can signify several issues: accidents, failing functional abilities, and/or failing cognitive abilities. In my father’s case, his combined eyesight and slower responses caused the accident, and he didn’t want to tell me since he knew I would insist that he stop driving—which I did! A new, major purchase could also suggest failing reasoning capability and it would be a good idea to explore with your loved one what led to the purchase and discuss the impact of this on finances. If your loved one cannot follow this conversation or makes excuses to avoid the discussion, it might suggest they need a trip to the doctor for testing.

The holidays bring many joys (and sometimes frustrations) as we visit family and friends only to find that we have all changed! Be alert to changes in your aging loved ones and avoid dismissing them as “old age.” Advocate for their health, talk with them (not to them or about them), and listen to their concerns.  You may find, as I did, that they are a lot more aware of the issues than you think. Raising my concerns in a gentle and respectful way helped start the conversation that ultimately led to safer, happier and more enjoyable visits! Have a wonderful holiday season!

The Alzheimer’s Association also has a great list of early warning signs that can help distinguish normal changes from those that may indicate a need for further evaluation by a healthcare provider.