Category: Quick Guide / Caregiving

⚡ Recognizing When Someone May Need More Help

It is not always easy to tell when someone needs additional help. Changes may happen slowly, and the person may become accustomed to struggling or find ways to hide the difficulties they are experiencing.

One forgotten appointment or untidy room does not necessarily mean someone can no longer manage independently. Look for patterns, repeated problems, and changes from what is normal for that person.

Start Here

Ask yourself:

• Is this behavior new?
• Is it happening more often?
• Is it creating a safety risk?
• Is the person struggling with something they previously managed?
• Have other people noticed the same change?
• Is the person’s health, hygiene, nutrition, or home being affected?
• Could a medical condition, medication, or recent life event be contributing?

Write down what you observe, including when it happened. Specific examples will be more useful than saying the person “doesn’t seem right.”

Call 911 If the Person:

• Has sudden weakness or numbness, especially on one side
• Has sudden difficulty speaking or understanding speech
• Has sudden trouble seeing, walking, or maintaining balance
• Has sudden severe confusion
• Is unconscious or cannot be awakened
• Has severe chest pain or difficulty breathing
• Has fallen and may be seriously injured
• May hurt themselves or someone else

Sudden confusion or an abrupt change in behavior can be caused by a serious medical problem and should not automatically be assumed to be dementia or normal aging. Signs of a possible stroke also require an immediate call to 911.

1. Look for Changes in Personal Care

The person may need more help if you notice:

• Bathing less often
• Wearing the same clothes repeatedly
• Wearing clothing that is dirty or inappropriate for the weather
• Difficulty brushing their teeth or caring for dentures
• Unwashed hair or noticeable body odor
• Difficulty shaving, grooming, or using the bathroom
• Unexplained bruises, skin problems, or injuries
• Increased difficulty getting dressed

A change in personal care may result from pain, weakness, depression, memory changes, mobility problems, or difficulty using the bathroom safely.

2. Check Food and Nutrition

Look for signs that the person may be having difficulty shopping, preparing meals, or eating regularly:

• An empty refrigerator
• Spoiled or expired food
• Burned cookware
• The stove being left on
• Skipping meals
• Eating only snacks or convenience foods
• Unexplained weight loss
• Signs of dehydration
• Difficulty opening containers or using kitchen tools
• Forgetting whether they have eaten
• Trouble swallowing or chewing

Ask what they ate that day and whether they have enough food for the next several days.

3. Review Medications

Medication problems can quickly become dangerous.

Watch for:

• Missed doses
• Taking the same dose more than once
• Empty prescriptions that have not been refilled
• Pills mixed together
• Confusion about what each medication is for
• Difficulty opening containers
• Using medications prescribed to someone else
• Unexpected sleepiness, dizziness, weakness, or confusion
• Multiple prescribers who may not know about one another

Do not change or stop medications yourself. Contact the person’s pharmacist or healthcare provider if you are concerned about how medications are being taken.

4. Look Around the Home

Changes in the home can reveal problems that may not be obvious during a telephone call.

Look for:

• Unopened mail
• Unpaid bills or shutoff notices
• Excessive clutter
• Trash that has not been removed
• Laundry piling up
• Dirty dishes or spoiled food
• New stains, burns, or damage
• Broken appliances that have not been addressed
• Pet-care needs being neglected
• Missing smoke or carbon monoxide detectors
• Tripping hazards
• Signs of falls
• Doors or windows left unlocked
• The home being unusually hot or cold

The National Institute on Aging recommends looking at changes in the home, personal care, meal preparation, medication use, finances, and mobility when deciding whether an older adult may need additional support.

5. Notice Changes in Memory and Thinking

Some forgetfulness can happen to anyone. Pay closer attention when memory or thinking problems begin to interfere with everyday life.

Possible signs include:

• Asking the same questions repeatedly
• Missing appointments
• Getting lost in familiar places
• Forgetting familiar people
• Difficulty following a conversation
• Becoming confused about the date or location
• Struggling with familiar tasks
• Making decisions that are very different from usual
• Leaving appliances running
• Difficulty managing money
• Becoming unusually suspicious, fearful, or withdrawn

Gradual changes should be discussed with a healthcare provider. Sudden confusion requires urgent medical attention.

6. Watch for Mobility and Safety Problems

The person may need help if they:

• Have fallen or nearly fallen
• Hold onto furniture while walking
• Have difficulty getting out of a chair or bed
• Avoid stairs they previously used
• Struggle to enter or leave the bathtub
• Stop using certain rooms because they are difficult to reach
• Have unexplained bruises
• Become dizzy when standing
• Use a cane or walker incorrectly
• Have difficulty getting to the bathroom in time

A healthcare provider can help determine whether pain, weakness, medication side effects, vision changes, or another condition is contributing.

7. Pay Attention to Driving

Possible driving concerns include:

• New dents or scratches on the vehicle
• Getting lost on familiar routes
• Confusing the gas and brake pedals
• Driving too slowly or too quickly
• Missing stop signs or traffic signals
• Difficulty staying in the correct lane
• Becoming overwhelmed in traffic
• Receiving tickets or warnings
• Having minor crashes or near misses
• Friends or passengers refusing to ride with the person

One mistake does not automatically mean the person must stop driving. Repeated problems or serious safety incidents should be addressed promptly.

8. Review Financial Changes

Look for:

• Unpaid bills
• Duplicate payments
• Unusual purchases
• Frequent overdraft fees
• Utilities being disconnected
• Money or valuables going missing
• Difficulty understanding routine expenses
• New “friends” asking for money
• Donations or purchases the person does not remember
• Responding to suspicious calls, emails, or messages

Unexpected financial changes may indicate confusion, difficulty managing paperwork, or possible exploitation.

9. Notice Emotional and Social Changes

The person may need support if they:

• Stop participating in activities they previously enjoyed
• Avoid friends or family
• Seem unusually sad, anxious, angry, or fearful
• Sleep much more or less than usual
• Lose interest in eating or caring for themselves
• Express hopelessness
• Become unusually suspicious
• Stop answering calls or opening the door
• Experience the recent loss of a spouse, friend, pet, or important routine

Emotional changes can affect a person’s ability to manage everyday responsibilities and should be taken seriously.

10. Talk With the Person

Choose a calm time and describe what you have noticed without accusing or criticizing.

You might say:

“I noticed that you have missed a few medications this week. Can we talk about what is making them difficult to manage?”

Or:

“You mentioned that cooking has become harder. What part is giving you the most trouble?”

Avoid saying:

• “You cannot take care of yourself.”
• “You are too old to do this.”
• “I’m taking over from now on.”
• “You always forget everything.”

Listen to the person’s explanation. Acknowledge their concerns and ask what kind of help they would accept.

11. Start With the Smallest Helpful Change

The person may not need full-time care. A small amount of targeted support may be enough.

Possible first steps include:

• Setting up medication reminders
• Arranging grocery delivery
• Scheduling a medical appointment
• Installing grab bars or improving lighting
• Hiring help with cleaning
• Providing transportation
• Organizing bills and paperwork
• Preparing several meals in advance
• Checking in by telephone each day
• Asking a neighbor or family member to visit
• Using a shared calendar
• Arranging an in-home assessment

Focus on supporting independence while addressing genuine risks.

Quick Checklist

• Identify what has changed
• Write down specific examples
• Look for repeated problems rather than one isolated incident
• Check personal care, food, medications, and home safety
• Review mobility, driving, finances, and social changes
• Arrange emergency help for sudden or dangerous symptoms
• Discuss gradual changes with a healthcare provider
• Talk with the person calmly and respectfully
• Ask what help they are willing to accept
• Begin with the smallest amount of effective support
• Reassess the situation if problems continue or increase

Remember

Needing help does not mean someone must give up all control or independence.

Pay attention to patterns, take immediate safety concerns seriously, and involve the person in decisions whenever possible. The goal is to provide enough support to help them remain safe, capable, and involved in their own life.

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