"When he thinks of his parents, he remembers them as they were in their early middle age - energetic, strong, and more capable than any other adult he knew."
-D.J. Waldie, from Holy Land: A Suburban Memoir

It may be that your wake-up call that your parent needs help is literally that. The phone rings late at night and you learn that something catastrophic has happened to your mom. She's in the hospital - she's had a stroke, or a heart attack, or she's fallen and broken her hip. As the daughter closest to her geographically or emotionally, you'll find yourself suddenly thrust into the role of primary caregiver. Your eighty-two year old mom, who was doing just fine, suddenly needs help and plenty of it.

But not all losses due to aging are sudden, severe, and crystal-clear. Your wake-up call may ring so faintly you have to strain to hear it. Instead of a catastrophic occurrence, your mom and dad may face a gradual decline that will leave you guessing as to how much help they need and when they need it. Is his afternoon nap an indication that he's not feeling well? She's holding the newspaper closer to her face as she reads—is that a sign of something or does she need a new eyeglass prescription? He stumbled while you walked with him this morning—was there a stone in the road or is he losing his balance because of some neurological disorder?

In their book Parentcare Survival Guide, authors Enid Pritikin and Trudy Reece suggest that when you're not sure if your mom needs help, the best approach is to ask. You may feel hesitant to bring up this sensitive subject, but you may find she appreciates the direct approach and will be relieved to be able to tell you flat out that, yes, she's having trouble and needs a hand. If she is guarded or resentful or denies having trouble, respect her wishes (as long as you don't believe she is in serious danger of hurting herself or others) and keep a close eye on her. Then, when you have another opportunity to bring up the subject, do. At that point she might be ready to talk.

Pritikin and Reece also list some "red flags" — things related to changes in your elderly loved one's behavior or physical condition, that should put you on the alert. These include, but are not limited to:

• Gaining or losing a great deal of weight.
• Drinking a great deal of water.
• Wearing excessive or insufficient clothing.
• Sleeping propped up on several pillows.
• Having difficulty getting up from chairs.
• Speaking too loudly or too softly.
• Swelling feet or legs.
• Making frequent trips to the bathroom.
• Acting nervous or distracted.
• Allowing home or yard to fall into disrepair.

If you notice any of these red flags, and if they indicate changes in behavior or appearance, you should be alert to what they might signal. Watch your mom or dad more closely. Ask about the behavior you've noticed. There might be a reasonable explanation—for instance, your dad may be going to the bathroom a lot because he's on a new medication that you didn't know about, and your mom may have stopped eating much because her dentures don't fit well and they hurt her. But until you sit down and ask about the things you've noticed, you won't know for sure if they need help and how much help they need.