Aging is not a linear, controlled trajectory; it can occur slowly or in spurts. It can be difficult to acknowledge and accept, and people often deny the need for more help or to make adjustments in their lives.
As a nurse with over 14 years of experience, I see things before anyone else does. Quiet warning signs that things are changing. Older adults, their family members, and caregivers can sometimes be in denial as well, and many of these early warning signs go unaddressed until they become so pronounced that they can’t be ignored.
How I Notice the Small Things
Part of being a nurse is noticing the little things, paying attention to details, and looking at the whole picture. When I meet a patient in a clinic room, in their home, or just in passing in a waiting room, I am always scanning for the less obvious signs that someone may be struggling or starting to struggle. Often, family members and/or caregivers make observations without even realizing it. They notice issues but brush them off as a one-time incident or allow the person to explain the concern away. Often, no one wants to talk about these issues because they don’t want to accept change, don’t know how to manage it, or are hoping it will just go away.
A good example is a patient I had who was living with her husband in their own home. Over the course of a year, she started missing appointments, appeared disheveled, and was not refilling her medications on time. I visited their home and noticed several issues that indicated a bigger problem. We talked about how she tracks her appointments. She showed me her calendar, which was full of crossed-out notes. Even when explaining it to me, she became confused about what things were written on which dates. Her husband told me she gets mixed up on her dates, but she just needed a better calendar. When discussing her medications, she had numerous pill bottles kept on her kitchen counter. She was able to read the labels and understand them, but could not tell me when she last took them. Her husband told me she takes them in the morning and at night, but she sometimes falls asleep on the couch, and he’s not sure if she took them. While sitting and discussing the other issues, I also noted that the sink was full of dishes, her hair was unbrushed, and her clothes were rumpled. All of these signs were indicators that she was struggling with her memory and ability to care for herself. Her husband was trying to do more, but could not fully compensate. While he was aware that things were changing, he did not think they were serious enough to seek help. Unfortunately, these patterns can quickly escalate and need to be addressed sooner rather than later. In situations like these, when family members, friends, or caregivers start to notice concerns, it is best to encourage the person to discuss the issues with their healthcare provider and receive support from a social worker or case manager who can help navigate additional resources and supports, along with any medical care or change in living situation they may need.
I have encountered endless situations like these where small issues can add up to bigger problems. To help identify when bigger changes are starting to happen, these are some of the things I see before anyone talks about it:
Excess Trash or Laundry Piles
Early signs of incontinence can show up in unexpected ways. When older adults start to experience subtle bladder changes, they usually use coping mechanisms such as buying incontinence products at the grocery or drug store. This can lead to ill-fitting products or using the wrong product type for their needs. They may avoid talking to others about it because it can be embarrassing, which also prevents them from receiving guidance on managing the condition.
A telltale sign for me that someone is experiencing bladder changes or incontinence is when entering their home, apartment, or room and finding an overflow of wipes, toilet paper, or disposable incontinence products. This often looks like an overflowing trash can in the bathroom or a urine odor from discarded products. They may also have excess laundry piling up due to extra clothing and linen changes.
While people can hide bladder control issues while out in public, how they manage them at home can be more telling. Managing the extra trash and laundry can quickly become overwhelming and is a warning sign that they are not managing their incontinence well on their own. Recognizing incontinence early is important to create a management plan. This usually includes addressing any underlying causes of incontinence, ensuring the correct size and products are being used, and providing education and support for skin hygiene.
Utilizing an incontinence manufacturer, such as LivDry, can provide access to a wide range of products and sizes that offer better absorption and reduce the number of products needed. This helps reduce laundry and cut down on excess trash generated by ill-fitting or poorly performing products.
Changes in Memory
Changes in memory, or a memory decline, often occur slowly and worsen over time. There are some instances where memory can change quickly, such as with a stroke, subdural hematoma, or neurologic conditions. Dementia and Alzheimer’s, as well as age-related cognitive changes, can all show up in similar ways. Some of the issues I first noticed are trouble tracking short-term details, such as appointments and plans with friends. This often shows up as sticky notes or lists scattered around the house. They might misplace their keys or walk from one room to another and forget why they went there. In the early stages of memory loss, people can mask pretty well, meaning they make excuses or cover up for themselves in a way that others may not realize their deficits. Caregiver observations go a long way toward detecting early changes in memory because they notice small, subtle patterns before they become more obvious to others.
Not Changing Clothes
There are many reasons why people may not change their clothes every day, but it is something I notice with older adults when they start to struggle. It could indicate fatigue, which can result from changing clothes, keeping up with laundry, or being unable to buy new ones. It can also be a sign of changes with their memory; they either forget to change them or can no longer complete self-care tasks. Not changing clothes may only be apparent to people who see them every day, or if the clothes appear soiled or have an odor.
Spoiled Food in the Fridge
This is one I have seen over and over again, not only in my professional career but also with my own aging family members. With age, the sense of smell and taste can change. It can lead to a decreased appetite. Preparing meals also becomes physically harder because it requires balance and the ability to stand. It doesn’t end with food prep, as you still have to wash and put away the dishes. A common thing I hear is that people often spend the majority of their lives coming up with meal plans, cooking, and cleaning. They are tired and don’t want to do it anymore, so they start relying on packaged, easy meals or skipping meals. The early warning signs of these food behaviors often include an empty fridge or one with expired or spoiled food. It can also present the opposite: someone is buying or dropping off food, but it isn’t being eaten, so the fridge is stuffed, but the food spoils and accumulates. Eventually, these changes may lead to substantial weight loss, but the patterns at home can be seen before the weight loss is detected.
Medication Issues
One of the first things I do when discussing medications with patients, especially those living at home or managing their own medications in a facility, is ask them to show me where they store their medications and how they track them. I approach it gently, without accusations or statements that they’re doing it wrong. A thing I see when there is an issue is filled medisets with no pills missing, bottles overdue for refills or expired, or multiple different kinds of pills mixed in bottles. All of these issues indicate to me that they are not able or do not want to take their medications as prescribed. It often indicates that their medical provider(s) are unaware that they are not taking their medications or are taking them differently, which can directly impact their care.
Loneliness
Loneliness can show up in many different forms. Some people are outspoken about it, while others do not talk about it or don’t want to make their friends and family feel bad. I notice loneliness in several ways. It can be the patient who appears overly chatty because I’m the only person they connected with that day; it can be the person who shares pictures of their family because they haven’t seen them in a while. It can show up as anger, being withdrawn, or avoidance of social activities. Loneliness is something I see and feel more often than it is something that someone tells me is happening.
Balance Issues
We have a phrase we use often to describe the compensation technique people use when they have trouble staying on their feet or balancing. They start to walk through the house with their hand constantly on something, the wall, the door frame, or the dresser. This is referred to as furniture surfing, and it’s a sign that their balance is being challenged and they may not even be aware they are doing it. Furniture surfing often starts after a fall, and the person becomes fearful of falling again, so they compensate by keeping their hands on objects. The person may not even be aware they’re doing it, but it is something I notice right away, as it can indicate changes in their balance and means they are at greater risk of falls.
The Conversations That Usually Happen Too Late
Family members and caregivers can have a hard time coping with the aging of a loved one. Even when they start to notice subtle changes, they might assume they are temporary or not that significant. Unfortunately, I have seen it time and time again that the important conversations about aging happen too late. Decisions about where they may want to live when they can no longer live at home, what they want regarding healthcare, and life-saving measures are better made before they are in crisis.
Addressing the small, subtle issues as they arise may feel uncomfortable, but it will help avoid bigger issues in the future.
