Two years ago, Gail Cucksey noticed something different about her mother, Evelyn.
Evelyn, who was 88 at the time, had stopped going to her weekly aerobics class for seniors. She spent more and more time in bed and her appetite had changed.
"She was still walking the dog twice a day, but I could see there was something going on," said Cucksey, 59, of Seattle.
She approached the subject carefully, but her mother insisted there was nothing wrong.
"Did you think you were having any issues living alone?" I asked Evelyn at her West Seattle home last week.
"No," she replied.
Gail decided to force the issue.
"It was very hard," she said. "We've had a great relationship. From mother and daughter we went into friends. She helped me out with my business. But, when I saw things were going so badly I thought, 'We've got to give something a try.'"
That "something" was a caregiver.
A nursing assistant now comes to Evelyn's home during the week. The two exercise together, go on walks and plays card games - Evelyn's favorite.
Gail is glad she got her mother help when she did, and fears the 90-year-old wouldn't have lasted another three months on her own.
For families with elderly loved ones - especially those who rarely visit - the holidays can be a crucial time of the year. For some, Thanksgiving or Christmas can serve as a wake-up call that their senior relative is in desperate need of help.
"I think it is an opportunity that the family can get together and talk about it," said Pete Jelinek, owner of Senior Helpers, which provides nursing assistants to care for the elderly. "People are visiting during the holidays and they can sometimes see that things have changed."
Jelinek offered 10 warning signs that your elderly loved one may be having difficulty on their own:
1) Poor eating habits resulting in weight loss, no appetite, or missed meals.
2) Neglected hygiene - wearing dirty clothes, body odor, neglected nails and teeth.
3) Neglected home - it's not as clean or sanitary as you remember growing up.
4) Inappropriate behavior - acting loud, quiet, paranoid, or making phone calls at all hours.
5) Changed relationship patterns that friends or neighbors have noticed.
6) Burns or injuries resulting from weakness, forgetfulness, or misuse of alcohol or medications.
7) Decreased participation in activities such as attending the senior center, book club, or church.
8) Scorched pots and pans showing forgetfulness for dinner cooking on the stove.
9) Unopened mail, newspaper piles, missed appointments.
10) Mishandled finances such as losing money, paying bills twice, or hiding money.
Jelinek said many seniors will not bring up concerns on their own.
"Maybe they are embarrassed that they can't do some of the things that they used to be able to do on their own," he said. "I think that part of it is just being afraid to ask."
Gail recommends that families approach the issue with sensitively.
Evelyn, who is doing much better than she was two years ago, said simply: "don't be bossy."