What is Functional Decline?

Functional decline is the impairment in skills necessary for independent living.

The first signs of functional decline in an elderly person aren’t always obvious. They can be innocuous, like misplacing a purse or pills. The signs can also be obvious, such as placing raw meat in the cupboard instead of the fridge. As a family member or caregiver, it is important to know the signs so that you can act when necessary to protect the elder.

What are ADLs (Activities of Daily Living)?

Signs of functional decline are indicators that an individual can no longer take care of his Activities of Daily Living (ADLs). These ADLs are generally divided into basic or complex activities.

Here are some examples of basic ADLs, which are skills that we could not function without:

• Ability to feed yourself
• Independence in the bathroom
• Personal hygiene
• Dressing yourself

Complex ADLs are the tasks that allow us to live independently, on top of the basic ADLs. Some examples of complex ADLs are:

• Managing money
• Cooking
• Shopping
• Communication
• Managing medications

Some of the first signs that an ill or elderly person needs help involve struggles with complex ADLs. Loss of basic ADLs usually comes later.

What are some signs of functional decline?

Here are some common signs of functional decline in ill or elderly individuals, set out more specifically than above in the discussion of basic and complex ADLs. Just because someone displays one of these signs, doesn’t mean that decline is occurring. But if you see more than a few of these signs, you should investigate.

• Unpaid bills and unopened letters/mail, especially if the bills or the mail is placed some place unusual
• Urine or feces stains on the elder’s clothing, on the furniture, or even on the floor (including unexplained wet spots on furniture and the bed)
• Other signs in decline of personal cleanliness (shaving, body odor, makeup, clothing)
• Overall decline in cleanliness in the home
• Spoiled food in the fridge or in the pantry
• Improperly stored food
• Repetitive statements or, along with the failure to remember your previous answer
• Struggles to cook meals (charred or blackened pots, setting off fire alarm, burned food, undercooked food, and other cooking disasters
• Tasks started but then abandoned before completion (think moldy clothes in the washing machine)
• Struggles to communicate (inability to spit out a word, confusing conversation, rambling sentences)
• A beloved pet shows signs that she is not being cared for (losing weight, dirty, empty water bowl, disgusting and full litter box, animal poop in the corners of the room
• Strange clothing choices that don’t make sense (shorts in the snow, winter coats to the beach)
• Confusion (lots of confusion)
• Brain farts about how to do familiar tasks (how microwave works, using a key to open a door, open a jar
• Other family friends or neighbors report concerns
• Getting lost away from home, especially if it is at a place that should be familiar
• Struggles with medication (failure to take it, underuse, overuse, loss)

What factors contribute to functional decline?

There are several factors that can contribute to functional decline, and you’ll see them play out differently in each aging individual.

Physical changes in our bodies are a significant component in functional decline. As we get older, we lose muscle control, balance, stamina, and strength. When you lose these abilities, the daily tasks of living become much harder. Balance problems make many normal and common tasks impossible. (Even walking around can be difficult, and driving, going to the grocery store, or even getting the mail….forget it).

Besides age, disease can also also contribute to functional decline, similar to age related decline. Arthritic joints can make it hard to move around and balance. Heart and lung problems can make it hard to have enough strength to accomplish tasks. Undiagnosed or untreated pain can make daily tasks of living just about impossible.

Perception changes that come with age can also contribute to functional decline in the following ways:

• As our vision gets worse with age (usually farsightedness), it becomes much harder to shave, put on makeup, write notes, or use the computer/phone/devices.
• Decreased hearing can cause a person to miss wake up or fire alarms, alerts such as sirens and train horns, telephone calls, and conversation.
• Losses in smell or taste can contribute to problems with cooking or in knowing that food has spoiled.
• Poor circulation or other age related decreased sensitivity to touch can make it easier to burn oneself while cooking or washing dishes. Scrapes or other injuries that break the skin may be overlooked, which can lead to infection.

Cognitive changes can be some of the most devastating causes of functional decline, especially if the elder’s body is otherwise will working well or fairly young. As we get older, we can still process information the way we did in our youth, but the speed at which we do it does slow down. We also struggle to multitask as well as we did in our earlier years.

Everyone declines to some degree in cognition as aging progresses, but Alzheimer’s and other diseases can impact memory, problem solving, language, and ADLs more severely.

Psychological changes are another contributor to functional decline. Disinhibition is a condition where lifelong personality traits become exaggerated. For example, a person who was a leader and take charge sort of fellow in his youth can become argumentative or irritable in old age. A person who relied upon others for advice can become clingy and annoying in her persistent pestering. Most commonly, older people become depressed and/or anxious, which can interfere with their ADLs.

Getting Your Aging Loved One To See a Physician When You Functional Decline

If you are seeing functional decline, it is time to get your loved one to see his physician.

If the person you are worried about (who is showing signs of decline) has a good relationship with his physician, getting them in for a visit should be as simple as scheduling it. If not, you may have to coax, cajole, or persuade them to get there.

One thing to remember is that your loved one is old. Elderly. People who were born 70-80 years ago may have a different association with doctors than you do. In modern times, doctors represent information and answers. In the past, doctors represented expense and death. If you can, talk to your elder one about his objections to going to the doctor, to see if you can reassure him about the purpose of the visit and what will happen.

If you are struggling, ask for help. It may be that there is another family member or friend of your elder who has more influence than you do. Having this person talk to him or even come along on the visit could make a huge difference.

Another thing to consider is that one of the greatest fears for a lot of aging individuals is being “put away.” There is a lot of misinformation about what it is like to be placed in an old-folks home. All your elder might know is that people “go there to die.” He may associate any trips to the doctor to discuss aging as a preparation for a transition to an assisted living facility.

Whatever the Diagnosis, Learn as Much as You Can and Plan Ahead

When you get your elder to the doctor, try and be present for the interview or the exam if possible, even if it is behind the privacy of a curtain. You’ll want to be able to relate to the doctor what you noticed, and keep an eye on what your elder has to say to the doctor, to see if it matches up with what you observed.

It is important to respect the elder at these appointments. Don’t talk over him or speak as though he is not present in the room, as if he were a small child. If it makes sense, step out of the room and ask the nurse if it would be possible to meet with the doctor briefly outside of the hearing of the elder to have a conversation that might otherwise embarrass your loved one.

If the functional decline you observed is a symptom of a significant illness or signs of serious age-related trouble ahead, learn as much as you can. Talk to the doctor and ask for recommendations to resources for you as the caregiver as well as for the elder.

Put together a short term and long term plan–something to get your loved one through the next few weeks or even months, and then use that time to make the long term plan that will carry your loved one through the end of his life. Don’t be afraid to ask for help, and don’t be afraid to take time for yourself. This can be an emotional time for family and friends.