Some hospitals and clinics offer evaluation units or geriatric assessment centers where a medical/social team studies all aspects of a person’s life: health, behavior, medications, finances, environmental safety, and personal interests. Independent geriatric care managers, or case managers, function similarly, and these professional assessments take from three hours to several days to complete. Then, depending on the results of the evaluation, the center counsels you and your parent about the level of independence your parent can reasonably, and safely, expect to maintain at that point in the progression of aging and their arthritic condition. They also offer practical assistance, including references to local services and feasible housing options.
The Independent Living Test is a free on-line assessment provided by Philips Lifeline.
You can conduct your own assessment by interviewing your parent and analyzing the same factors that a medical/social team evaluates.
- Caring.com provides an assessment checklist, “What to Do to Determine if Elderly Family Members Can Live independently.”
- A needs assessment worksheet is available through Family Care America. You can also call (804) 342-2337.
- AARP offers a guide entitled, "Helping My Parents: How Do I Know If They Need Help," on their website. Or you can call (800) 424-3410.
A thorough assessment should include a number of factors, and a sampling of potential questions for each area of assessment follows.
- Any chronic diseases besides arthritis? (diabetes, high blood pressure, emphysema)
- Other illnesses? (bowel or bladder problems, stroke, cancer, heart disease)
- Fractures or trauma?
- Balance difficulties?
- Vision problems? (cataracts, use of vision aids)
- Hearing problems?
- Dental problems? (gum disease, ill-fitting dentures, unusually strong breath)
- Weight loss or gain?
- Skin growths or changes in color?
- Recent hospitalizations?
In addition to answering these questions, make a list of health professionals currently being seen, and record your parent’s current vital signs.
- Diagnosed with any psychiatric disorders? (depression, psychosis, anxiety disorder)
- Alzheimer’s or other dementia?
- Unusual symptoms? (mood swings, forgetfulness, wandering off, difficulty remaining alert, confusion, disorientation, loneliness, sadness, decreased interest in activities he/she normally enjoys, lack of communication, no longer maintaining friends)
List all medicines taken (prescription and over-the-counter) with times per day and dose.
Difficulty handling proper medicine use? (forgetfulness, expense, understanding of purpose)
Check prescription bottles. Do any older bottles need discarding? Do all current prescriptions have refills available?
Observe your parent going through a normal day and notice his/her appearance on several occasions. Watch for signs of weakness.
- Dressed appropriately, in clean clothes?
- Lack of mobility?
- Need adaptive aids?
- Special dietary needs?
- Able to handle personal care and hygiene? (brush teeth, dress, wash and comb hair, trim nails, shave, bathe, use a toilet, get out of bed, get up from a chair)
- Able to handle daily chores? (use the phone, prepare meals, shop, do routine housework and yard work)
Home and Community Safety
- Able to handle house and yard maintenance? Are repairs being neglected?
- Any home safety hazards?
- Safety measures in place and up-to-date? (smoke alarm, fire extinguisher, grab bars, method of getting emergency help)
- Able to avoid telephone and door-to-door fraud?
- Able to hear the telephone ring or a knock on the door?
Examine your parent’s home to see how well it supports his/her daily needs and activities with both safety and comfort in mind:
- Check the refrigerator for food expiration dates. How old are the items?
- Are there loose throw rugs in potential walking paths?
- Are the staircases and hallways cluttered?
- Is the hot water heater set above 120 degrees?
- Are electrical, phone, and computer cords away from the wall, in walking paths?
- Do cords run under carpeting, causing a fire hazard?
- Is general or specific lighting poor anywhere inside or outside?
- Are there handrails on both sides of stairways?
- Are switches, door knobs, drawer pulls, etc, difficult to maneuver?
- Is the laundry conveniently located, without stairs?
Since side effects from medication and a decline in flexibility, strength, and reflexes (as a result of arthritis and/or aging) can all impair your parent’s ability to drive safely, it is important to observe possible changes in driving skills. Observe your parent’s driving on a number of occasions, under different driving conditions and in a systematic manner. Record your observations and driving dates while looking for a pattern and frequency of warning signs:
- Changing lanes without signaling
- Going through stop signs or red lights
- Reacting slowly
- Problems making turns
- Straying into other lanes
- Going too fast or too slowly
- Making jerky stops and starts
Your assessment should also utilize a list of pertinent questions:
- Any recent accidents, tickets, warnings?
- Frequent “close calls”?
- New dents or scrapes on the car, garage doors, mailbox, etc?
- Getting lost when driving locally?
- Having trouble seeing road signs, pavement markings, or traffic signals?
- Having trouble moving from the gas to the brake pedal, or confusing the two pedals?
- Trouble judging gap-distances between cars?
- Difficulty concentrating while driving?
- How recently has your parent’s vision and hearing been tested?
- Are prescription glasses and hearing aids up-to-date?
- How recently has your parent had a general checkup to assess reflexes and flexibility?
- Is your parent’s vehicle in safe operating condition?
- Can your parent see over the dashboard, use the mirrors, and reach the pedals comfortably?
- Is your parent taking any medications that may impair driving ability?
The Hartford and the MIT AgeLab has developed several worksheets and a series of articles to assist you in the driving-ability assessment process.
For those looking for a formal assessment of driving skills, check with local colleges or universities, occupational therapists, doctors, or the American Automobile Association for possible tests that are administered by specialists.
In addition, tests are sometimes available at rehabilitation centers, hospitals, and Veterans Administration Medical Centers (VA). These tests last several hours and often include a road test. They can cost from $200 to $1,000 and are seldom covered by insurance or Medicare, although the VA may offer free tests for eligible veterans.
If driving is out of the question, is reliable transportation for shopping, medical visits, religious services, and visiting family or friends available?
- What insurance coverage is in place?
- Does insurance cover custodial care?
- Are insurance premiums up-to-date?
- Able to complete and file forms like insurance claims?
- Legal documents prepared? (trusts, living wills, powers of attorney)
- Parent’s total assets?
- How long will the assets last?
- Sources of financial assistance?
- What are the current and future bills?
- Paying bills on time? Do you notice any unopened bills?
- Able to make informed financial decisions?
Your Parent’s Support System
- List names, addresses, and phone numbers of key family members, friends, and neighbors.
- Favorite friends or frequent visitors?
- Other social activities? (organizations, church faith-based groups)
- Live near any family members?