"Over the river and through the woods, to Grandmother's house we go."

We may not be going by horse and sleigh, but many of us will soon be visiting our aging parents for the Holidays. Whether you're visiting from out of town and haven't seen them in several weeks or months, or whether you'll just be spending more focused time with your in-town parents, you may be faced with some drastic changes.

There is a commercial out now -- I think it's for a Christmas music CD -- that shows home movie clips that could be from my own family. Remember when Mom and Dad took movies, and they had to have a strong helper in the background holding those gosh-awful 8 bizillion-watt lights? The kids in the movies are always squinting and putting their hands up in front of their faces as they stumble down the stairs in their pajamas, holding the hand of their baby sister, to find what Santa had brought them. The tree was real and was trimmed with family heirloom pieces -- those bubbling lights, those giant easily-breakable baubles, and those strangely-shaped delicate things that seemed like some type of alien life form. And tinsle! You had to be really good at hanging tinsel in my house -- none of this "throw-it-up-in-the-air" stuff. Each strand had to be delicately laid across the branches evenly and neatly.

The Holiday table was set with the largest turkey that the A&P sold, and there were enough side dishes to fill all the space on the table. Grandma made stuffing that the kids didn't' like, and the kids had a separate card table or two in the other room so the grownups wouldn't have to put up with us.

Now, as we make that journey home to visit, what will we find? Will Mom still be able to cook that turkey? Is Dad a little too frail for the kids to jump onto his lap? Did something get burned while cooking? Is there more anxiety, and less Holiday Cheer?

As our parents age, and become more ill, they are able to cope in many ways. Some of that coping takes the form of denial and covering up things that may be wrong. They do not want you to know that their memory is slipping. They do not want to face the possibly inevitable fact that aging is taking it stoll and independence is at risk. Will you play along with them and keep things status quo for fear of angering them? Will you take the chance that, by playing into their denial, you may be wasting perhaps the only opportunity you have to intervene? Will the next visit to your parents be to the emergency room because Dad drove into a bridge or a school bus, or Mom had a stroke that might have been prevented with better medical management?

We are so afraid of angering our parents that sometimes we do err on the side of risk-taking. I did. My weak suggestions that my mother may need to be seen for what I took as depression were answered with anger at my interference, so I kept quiet. Had I been more lovingly forceful, we may have discovered the extent of her vascular problems and had them treated more effectively. My mother was not depressed, I realized when she died, but was suffering from vascular dementia -- "Vascular dementia usually results from damage to brain function from multiple strokes (also known as multi-infarct dementia)," Sol Stern, M.D., Chief Medical Advisor, drkoop.com.

So, how do we tackle this dilemma?

First, trust your instincts. If you feel, in your heart, that something is amiss, do not ignore it. Explore how things are with your parents first through conversation. They might be relieved to open up in some cases, especially if the Holidays are causing them undue anxiety. If Mom is obsessing about whether she'll be able to feed 20 people in her home, offer to have celebrations elsewhere. Contact your siblings and other participating family members and work out a potluck arrangement. Let Mom still be the center of the kitchen by helping a little more. My parents actually began to want to go out for Holiday dinners to the local buffet. This certainly changed the ambiance, but we were able to adapt and continue the celebration at their home after dinner, with the added benefit of not having to clean up.

While you're in your parents' kitchen, take the opportunity to explore. Check the refrigerator for outdated or spoiled food; also for adequate nutritious foods. Look at the stove and the stored pots and pans for signs of burnt food. There may even be signs of controlled fire.

Do a safety check for them while you're home. Are the smoke detectors working? Do they own and know how to properly use a fire extinguisher, and is it handy to the kitchen area? Is it time to introduce the idea of an emergency response system? They are relatively inexpensive and easily installed.

Visit Dad in the workshop/garage and check out his car. Are there some dings and scrapes, possibly indicating unreported fender-benders? Ask him to take you for a drive to his favorite coffee shop and check out his driving. I'm extremely fortunate in that, whenever I visit my dad in Kansas, he takes me out in his new Blazer, and asks me, "How's my driving?" So far, luckily, I'm able to say, "Fine, Dad, and thanks for asking." It's not going to be easy to say, "Well, Dad, I think it might be time to turn in your car keys. Your independence. Your freedom."

That happened to my grandfather. I was an irresponsible teenager driving around with my friends one day when I saw my grandfather pulled over by the cops. Instead of stopping to see if I could help, I hunkered down and had my friends drive on by. Grandpa was resilient, though. When they said he couldn't drive any more, he purchased a three-wheeled bicycle with a giant basket on the front and an orange flag sticking up from the seat, and for the next several years I would see him all over town. Luckily, we lived in a small town with not much traffic and every kind of store you'd need within bicycling distance.

Check out your parents' medicine cabinets. Ask them about the prescriptions they take. See if they even know and understand whey they take them. Check the labels for the date they were dispensed. If the pharmacy sold them 30 pills in October with a dosage of one per day, why are there still 18 left in the bottle in late November?

The hardest thing you do in your life may be to confront your parents with your concerns about their well-being and safety. If need be, and if possible, bring in a professional. Explore your community's senior services. The Area Offices on Aging are a wealth of information and resource. If you can get a social worker or nurse to visit them from a home health agency, to do an assessment, or just to talk about your concerns, you will benefit greatly from the objectivity and professional nature of the information. Private care managers are available in many parts of the country as well. They can go a little farther than the social service providers because they are paid for privately and have no restrictions on the number of visits they can make. They can help come up with a realistic Plan of Action for you and your parents to take to ensure their continued independence and freedom of choice.

The worst thing you can do is nothing. Not making a decision is making a decision to "let the chips fall where they may." The crisis will come sooner or later. Planning equals options. Go visit your parents and do for them what you would want your kids to do for you.

Debra Sorensen, MSW, LISW, CMC, is a professional care manager and owner of Debra J. Sorensen & Associates Inc., a private geriatric care management company serving Northwest Ohio and Southeast Michigan. She can be reached at 419-367-8835 or e-mail Debra@professionalcareforyou.com.