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Daughter in law Dorel Shanon, right, of Mt. Airy, helps Fran Bogom, 86, do a strength exercise during rehabilitation session, February 8, 2010, at The Abramson Center for Jewish Life in Horsham, Pennsylvania. When Bogom fell and broke her arm, Medicare would not pay for her rehabilitation in a nursing home unless she first stayed in the hospital for three days. (Tom Gralish/Philadelphia Inquirer/MCT)

It can be difficult to determine if an adult who prizes his or her independence is still capable of living alone. Here are 10 tell-tale signs offered by aging and elder care expert Carolyn A. Brent, author of "Why Wait? The Baby Boomers' Guide to Preparing Emotionally, Financially & Legally for a Parents' Death" to consider:  

1. The house is messier than you recall. You may remember a parent who enjoyed a house that was spotless and things were organized, clean and in the right place. However, upon visiting with Mom or Dad now, the home is cluttered and not nearly as clean as normal. This could be a sign that your parent is having a difficult time keeping up with all the chores. She may feel overwhelmed or his physical health may be slowing him down. Ask your parent if help is needed with the clutter, but do it in a way prompts a conversation indicating an offer to help. Keep an eye to discern if the clutter and filth are getting worse with each visit. 

2. The bills and other mail are piling up.  We all get busy, but basic tasks that were often dealt with quickly and easily may now be falling by the wayside. This may be a sign that your older parent could be getting overwhelmed and not able to manage their daily affairs. It may also indicate forgetfulness and memory issues. 

3. The checking account balance is wrong and bills are going unpaid. This may be another sign of memory issues or difficulty with simple math cognition. It can also indicate a general apathy, a mindset that can be equally problematic for someone with the glut of responsibility required to effectively live alone.

4. Your parent is losing a lot of weight.  A parent who may have lost their partner or who is generally depressed often loses interest in eating. Check their refrigerator and pantry to see if there is enough fresh and edible food. At the very least, you may want to think about bringing groceries by or looking into a service that offers prepared meal delivery. 

5. They have forgotten the basics of hygiene.  If you notice that your parent is wearing the same clothing day in and day out or that their hair or skin appears dirty on a fairly regular basis, they may have lost the motivation, ability or forethought to look after themselves. They may have forgotten  or simply no longer care that such personal hygiene and cleanliness is an important part of daily living and maintaining one’s good health.

6. They appear in inappropriate clothing. There is cause for concern if your parent dons summer clothing in the dead of winter or leaves the house in a nightgown and slippers for a trip to the store. This often happens when the elderly are suffering from confusion and lose the ability to have discretion in social situations. 

7. There are signs of forgetfulness in the home. Confusion can also show up in the kitchen and can prove to be deadly if not dealt with quickly. There are stories of older people who accidentally burned their houses down because they left a pot on the stove for hours and fell asleep or have flooded the home when they forgot to turn off the tap. Or, perhaps more subtly, the milk is in the pantry and the bread is in the refrigerator. 

8. Your parent regularly misses appointments and other events. Forgetfulness, absentmindedness and memory issues may also show up when it comes to keeping certain appointments, recognizing key dates, or, even more importantly, maintaining medication dosages on schedule.

9. They are just acting plain weird. This is always the sign that families dread the most. No one wants to turn into the “crazy cat lady” or the “man who mutters to himself.” But, unfortunately, between aging, mental degradation and the side effects from medication, you may note that your parent has lost their personalities and behavior has taken an odd turn. If you see signs of paranoia, fear, strange phone calls and conversations and nervousness, this should not be overlooked.

10. They exhibit signs of depression. There are a number of classic signs that can be connected with someone suffering depression. A loss of interest in caring for one’s self as well as a lack of participation in socialization and in once-loved hobbies can mean that your parent needs treatment or should reside in an environment where they can be around other people. Sometimes depression comes from a sense of loneliness or the realization that they can no longer do things for themselves. Putting them somewhere that offers assistance, socialization and activities can help cure the loneliness and put them back on track to a more fulfilling, active and engaged life.

Aisha Sultan is home and family editor for the St. Louis Post-Dispatch.