Normal ageing or something more? The green, orange, red framework

Lin had noticed her father slowing down after her mother died two years ago. That made sense...grief, loneliness, adjusting to life alone. He was 82. Of course, he was slower than he'd been at 75.

But over the past six months, something had changed.

It wasn't just that he moved more carefully or forgot the occasional name. The house that had always been immaculate was cluttered. He'd lost weight. Not a little, but enough that his clothes hung loose. He'd forgotten two medical appointments. Bills were piling up unopened on the kitchen table.

Lin had tried helping. She'd organised a neighbour to check in twice a week. She'd set up automatic bill payments. She'd arranged Meals on Wheels.

But when she visited last month, she found him wearing the same shirt he'd had on three days earlier. He seemed confused about what day it was. And there were four uneaten meals in the fridge.

"I kept telling myself he was just adjusting, that he needed more time," Lin told us. "But deep down, I knew this wasn't normal ageing anymore. I just didn't want to admit it. Admitting it felt like admitting I couldn't keep him safe on my own."

Lin made an appointment with her father's GP the next day.

The GP visit revealed what Lin had been afraid to acknowledge: her father had moderate depression (treatable), early cognitive impairment, and significant nutritional deficiency. He needed more than neighbour check-ins and meal delivery. He needed daily oversight, medication management, and comprehensive support.

Six months later, her father is in residential aged care. It wasn't the outcome Lin had hoped for when she first started noticing changes. But it was the right decision at the right time.

"The hardest part was accepting that love and good intentions weren't enough," Lin said. "He needed professional care I couldn't provide. And once I stopped trying to manage everything myself, I could actually be his daughter again instead of his exhausted, failing caregiver."

🟢 GREEN: Normal ageing or temporary changes
→ Monitor, plan proactively, no urgent intervention

🟠 ORANGE: Concerning patterns of functional decline
→ GP visit within weeks or months, build support systems

🔴 RED: Urgent medical concerns or safety risks
→ GP within days, emergency services if needed, immediate safety plan

Key transitions:

• GREEN → ORANGE: When isolated incidents become patterns (once vs. repeatedly over months)

• ORANGE → RED: When patterns become unsafe or involve medical emergencies

What this looks like:

Physical:

• Slower movement, longer task completion

• Tiring more easily, needing rest

• Needing glasses or a higher TV volume

• Occasional stiffness

Cognitive:

• Occasionally forgetting names or locations of items

• Taking longer to recall information

• Needing to write things down more

• Missing an appointment once every few months

Social/Emotional:

• Preferring smaller gatherings

• Grieving after loss but still functioning

• Temporary mood changes after life events

Key characteristic: Mild, stable changes that don't significantly interfere with independence or daily function. Still managing home, finances, medications, and self-care.

What to do:

✅ Monitor regularly
Check in, notice if patterns change
✅ Have proactive conversations
This is the best time for kitchen table discussions
✅ Get important documents done
Power of Attorney, Enduring Guardianship, and Advance Care Plans while capacity is clear
✅ Create baseline
Know what "normal" looks like, so you'll notice changes
✅ Build your knowledge
Learn about the health care, home care and aged care systems before a crisis

What this looks like:

Orange = patterns, not isolated incidents. Key word: repeatedly over weeks or months.

Home management:

• House progressively messier (3-6 months)

• Cooking less, meals are very simple

• Laundry piling up, same clothes repeatedly

• Garden overgrown (when used to maintain)

Daily tasks:

• Bills are unpaid over multiple visits

• Mail is piling up, unopened

• Shopping less or not much at all

• The fridge is empty or has lots of expired food

• Medication confusion - wrong/missed doses

• Forgetting appointments multiple times

Mobility:

• Walking shorter distances, using furniture for balance

• Gait changing (shuffling, unsteady)

• Avoiding stairs

• Stopped/reduced driving

• One fall

Social:

• Stopped activities for months

• Seeing friends much less

• Declining invitations

• Less interested in hobbies

• Increasing isolation

Mood:

• Depressed, flat for weeks/months

• More irritable than usual

• More anxious

• Personality shifts

Cognitive:

• Forgetting conversations/appointments regularly

• Asking the same question multiple times daily

• Occasionally confused about dates

• Trouble following conversations/TV

• Repeating stories frequently

Key characteristic:
Multiple areas affected + patterns over months + functional impact
BUT basic self-care is mostly intact 
AND not immediately unsafe.

What to do:

🗓️ This week:

1. Document observations
   Write down specific examples with dates

2. Talk to locals
   What are neighbours/friends noticing?

3. Book GP appointment
   Within 1-2 weeks for a comprehensive assessment
   
   📅 This month: 

1.  Attend GP with documentation
2. GP assessment
   Treatable causes, cognitive screening, falls risk, medication review, functional assessment
   
   
3. Build support
   Informal village + My Aged Care (1800 200 422) for services
   
   📆 Next 3-6 months:
   
   
4. Monitor trajectory
   Stable, improving, or declining?
   
   
5. Re-assess regularly
   Every 3 months

What this looks like:

Red = immediate safety concerns or medical emergencies

Medical red flags (GP within days or emergency):

🚨 Sudden cognitive change

• Fine last week, confused this week

• Could indicate: stroke, UTI (common in the elderly), medication reaction

• Action: Emergency (000) or GP TODAY

🚨 Multiple falls or a serious fall

• 2+ falls in 3 months OR fall with head injury/loss of consciousness

• Progression: Falls → hospitalization → decline → loss of independence

🚨 Significant unexplained weight loss

• 5%+ body weight in one month OR 10%+ over 3-6 months

• Clothes hanging loose, gaunt appearance

🚨 Severe self-neglect

• Not bathing for days/weeks

• Same clothes worn continuously

• Unsafe/unsanitary living conditions

• Clear malnutrition/dehydration

🚨 Dangerous confusion

• Getting lost in familiar places

• Leaving the stove on repeatedly

• Can't find the way home

• Extremely poor financial decisions

• Forgetting critical medications

🚨 Severe behavioural changes

• Sudden aggression, paranoia, hallucinations

• Extreme personality changes

• Severe depression with suicidal ideation

🚨 Living alone + multiple orange flags

• Solo living + functional decline = high risk

Safety red flags:

• No food + unable to shop

• Utilities shut off because of  unpaid bills

• Medication errors are causing health consequences

• Unsafe driving with accidents

• Financial exploitation

What to do:

🚨 If sudden confusion, fall with injury, stroke symptoms: → Call 000 immediately

🚨 If urgent but not emergency:

TODAY:

• Call GP: "Multiple red flags, needs urgent assessment"

• If no same-day appointment: emergency or after-hours clinic

THIS WEEK:

1. Medical assessment
   Full exam, cognitive testing, medication review, blood work

2. Contact My Aged Care
   1800 200 422, request priority assessment

3. Immediate safety plan:

• Daily checks (who? how often?)

• Emergency key access

• Remove hazards

• Can they be alone? If not, who stays?

4. Family emergency meeting
   Coordinate in the next 72 hours

THIS MONTH:

5. Follow specialist referrals

6. Begin formal care (home or residential)

7. Legal documents if not done (POA, ACD)

8. Ongoing monitoring

 

Typical trajectory (if unaddressed):

GREEN (Normal ageing)
↓
ORANGE (Concerning patterns)
↓ (without intervention)

RED (Urgent safety concerns)

But not always linear:

Some skip orange:

• Sudden stroke → immediate red

• Acute illness → rapid decline

Some stay orange for years:

• Early intervention works

• Treatable causes addressed

• Appropriate services prevent decline

Some bounce between levels:

• Temporary decline from grief (green → orange → green)

• Progressive condition with plateaus

• Good/bad days

Temporary vs progressive decline

Temporary:

• Cause: Specific event (a loved one's death, hospitalisation, UTI, medication change)

• Pattern: Plateaus or improves over 2-3 months with treatment

• Example: After spouse dies, withdrawal for 3-4 months, then gradually re-engages. Function returns.

Progressive:

• Cause: Underlying condition (dementia, Parkinson's, heart failure)

• Pattern: Worsens over 6+ months despite interventions

• Example: After spouse dies, withdrawal + worsening memory. Antidepressants help mood slightly, but memory declines. House messier. Hygiene declining. Progressing despite treatment.

When unsure:

• Orange flags 3+ months → GP assessment

• Red flags → immediate assessment

• Don't wait for certainty. Let professionals assess

 

GREEN:

• Minimal support currently

• Proactive planning conversations

• Legal documents

• Regular family check-ins

ORANGE:

Informal: More frequent visits, neighbour check-ins, family helping with complex tasks

Formal (My Aged Care): Domestic help, Meals on Wheels, transport, social activities, allied health

Works when: Basic self-care intact, home safe with modifications

RED:

Maximum home care: Daily personal care, meals, 24/7 emergency response, nursing visits, intensive coordination

OR Residential care when:

• 24-hour oversight needed

• Registered nursing is required daily

• Behavioral symptoms unmanageable

• Falls risk extreme

• Family is completely burned out

 

If flags include significant memory/confusion/cognitive changes, a dementia-specific assessment is needed.

Why early diagnosis matters:

1. Rule out treatable causes (depression, B12 deficiency, thyroid, medications)

2. Access treatment (medications can slow progression)

3. Legal planning while capacity exists

4. Early support access (memory clinics, day programs, respite)

5. Family preparation

If dementia is suspected: 
GP assessment first → possible specialist referral

Contact:
Dementia Australia 1800 100 500

Document the specifics.

Don't say: "Mum's not doing well."

Say: "Mum has fallen twice in 3 months. Lost ~8kg in 4 months. $600 unpaid bills. Same clothes, 3 visits over 2 weeks. Asked the same question about my sister 5 times today."

Bring:

• Changes by category with dates

• Local observations (neighbours, friends)

• Current medications (full list)

• Falls/injuries/acute events

• Weight changes

At appointment:

Your role: Provide factual observations even if the parent says "I'm fine"

Why they'll minimise:

• Lack of insight (common with cognitive decline)

• Don't want to worry you

• Fear of losing independence

GP will assess:
Medical history, medication review, cognitive screening, functional assessment, mental health, falls risk, physical exam, and blood work.