It's the first thing you notice when you come home for the holidays: Mom's normally immaculate house is full of clutter. Or Dad's mail has gone unopened for weeks and he looks disheveled.
As families come together, often after months apart, it's not unusual for adult children to discover a parent's health has declined significantly and to suddenly be filled with panic.
"They may find that the house is messy, and there are unfilled prescriptions," said Jean Wood, executive director of the Minnesota Board on Aging. "Or they may find that there's no food in the refrigerator. There are a whole variety of things they find."
Phone calls to the state organization's seven call centers double and sometimes triple between late November and the end of January, Wood said, as children, grandchildren, even nieces and nephews visit their elders.
The shock can touch off a volley of difficult questions, concerns and family conflict.
Aging remains a "taboo subject" in most families, said Gayle Kvenvold, CEO of LeadingAge Minnesota, an association of organizations that serve seniors. Aging is often equated with loss — not being able to drive, being forced to leave one's home or community, losing independence.
It often takes a crisis to force families to swing into action, Kvenvold noted at a recent "Policy and a Pint" event on aging parents, which drew more than a hundred people to downtown St. Paul last month.
Senior housing and assisted-living centers see a "flurry of admissions" around Thanksgiving and Christmas, Kvenvold said, "because people realize something is wrong."
Red flags might include an empty refrigerator, stacks of unopened mail, unwashed clothes or a lack of hygiene. Changes in weight or lack of balance can signal underlying medical conditions. Loss of interest in hobbies may be a sign of depression. Scorched cookware suggests that burners may have been turned on and forgotten.
Experts say even if there are no immediate health or aging concerns, the holidays can be a good time to start talking about finances, health care and living arrangements that keep older family members safe.
"If you're in the beginning phases [of decline], start talking about important things now," said Wood, whose organization offers a brochure on how to hold a family meeting.
"And even start thinking about yourself," she added, "getting papers organized and leaving documentation for your own children. Because you don't know when things will go south for you."
Some situations require taking immediate steps, but not always. Even if adult children are worried about a parent's declining ability, experts caution that bringing up concerns at the dinner table can quickly backfire. It's best to arm yourself with information before diving in, they say.
Here are some tips for managing a holiday visit with aging relatives:
• Don't ignore signs, but don't jump the gun either. There could be a medical reason for a cognitive decline, including depression, skipped prescriptions or even dehydration. Seek medical care before taking drastic steps.
• Engage your parents. No independent adult wants to be bossed around by their children, no matter how well-meaning. Work together on solutions, listen, and give your parents a say in their own life.
• Make simple adjustments. Put an extra handrail on stairs and add grab bars in the shower. Put levered handles on doors, or make sure often-needed food items or toiletries are on lower shelves. Remove small rugs from the kitchen or bathroom or other obstacles in the home that might lead to a fall.
• Consider the caregivers. If nearby siblings are taking on more duties, don't judge their approach. Recognize they are juggling obligations and find ways to support them.
• Plan ahead. Don't bring up emotional issues at the dinner table. Plan a family meeting or conversation at a quieter time, when everyone can be focused and be heard. And define a single purpose — helping your parent remain independent as long as possible or planning for a move.
• Turn to experts. State and local communities have ample experience and resources for family members. You don't have to figure it out on your own.