Every year, starting in late November, the phone calls to memory care homes change. Families who haven't been worried suddenly are. They spent three days in their mother's house for the first time since last Christmas, and something was wrong that a weekly phone call had hidden.
If you are heading into the holidays with an aging parent, it's worth knowing what to look for before you arrive, and what to do with what you find.
Why the holidays reveal what phone calls hide
People with early cognitive decline are often very good on the phone. A ten-minute call is a performance they can still manage: the social scripts are intact, the voice sounds the same, and nobody can see the kitchen. A three-day visit is different. You see the mail. You see the refrigerator. You see what happens at four in the afternoon when the energy runs out.
Clinicians call the phone version “showtiming,” and it is not deception. It is a person using every resource they have to seem like themselves. It just means the family member who lives farthest away usually has the least accurate picture.
A ten-minute phone call is a performance most people with early decline can still manage. Three days in the house is not.
What to notice
None of these alone means dementia. Several together, especially if they're new since last year, mean it's time to involve a doctor.
In the house
- Unopened mail, unpaid bills, or notices from utilities
- Expired food, or multiples of the same item bought repeatedly
- Scorched pans, burners left on, a smoke detector with the battery removed
- A house that is noticeably less clean than it used to be
- Medications in disarray, or pill organizers that don't match the day
In your parent
- Weight loss, or clothes that are suddenly loose
- Repeating the same question or story within the same hour
- Trouble following a group conversation at the table
- Getting lost driving to a familiar place, or dents on the car that nobody can explain
- Withdrawing from the activities they used to organize
- Irritability or suspicion that is out of character
- A sharp decline in the late afternoon and evening
In the routine
- Missed appointments, or appointments they don't remember making
- Friends who mention they haven't heard from your parent
- A pet that is thinner or less cared for
What not to do on the visit
Don't confront. The temptation, once you've seen the stack of mail, is to sit your parent down and lay out the evidence. This almost never goes well. It puts them on the defensive at the moment they are most frightened, and it can poison the relationship you'll need for the harder conversations ahead. We've written about why parents refuse help and what to say instead.
Don't quietly fix everything either. Paying the bills and cleaning the kitchen feels helpful, but it also erases the evidence before anyone else in the family sees it, and it resets the problem for another year.
Do take notes. Dates, specifics, photos if appropriate. A doctor will ask what you observed, and “she seemed off” is much less useful than “she asked me what day it was four times at dinner.”
What to do in January
Get a medical evaluation. Sudden change can have treatable causes: thyroid problems, vitamin deficiencies, medication interactions, depression, or an infection. We wrote about why sudden confusion is not always dementia. Ask the primary care provider for a cognitive screening and a full medication review.
Talk to your siblings before you talk to your parent. Get everyone looking at the same facts. The holidays are the one time of year most families are in the same room, and sibling disagreement usually comes from different information rather than different values.
Find out what the paperwork says. Is there a healthcare power of attorney? A financial one? Advance directives? If not, this is the year to do them, while your parent can still participate fully in the decision.
Start learning the options. You don't have to act on them. But knowing what in-home care, assisted living, and memory care actually involve, and what they cost, means that when a crisis comes you're choosing rather than scrambling.
The bottom line
The holidays reveal what the rest of the year hides. If you see changes, resist the urge to confront or to quietly tidy them away. Write down what you noticed, get everyone in the family looking at the same facts, and book a medical evaluation in January.
Most families who call us in the new year say the same thing: they wish they'd started the conversation a year earlier. Starting it this year is enough.