You can hear a lot on the phone, but you can hear less than you think about whether she is hearing you. Hearing and eyesight usually change slowly, and the first signs appear in the house, in the things she does without thinking about them. Your job on a visit is to look at those things and write them down.

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What to look at when you walk in

Look at the television. Note where the volume sits and whether it is higher than it was on your last visit. Ask her to show you the remote, and see whether she has moved closer to the set or leaned toward it. Turn it down a notch while you are there and see whether she notices right away.

Check the glasses. Are they the pair she wore last time, or has she switched to an old pair, one from a drawer, or a reading pair she uses for everything? Look at the lenses for smudges, and at whether the frame sits crooked on her face. Look for a magnifier by the chair or a lamp pulled close to the table where she reads.

Look at the phone. Many people turn the ringer up or hold the handset tight against one ear. Notice whether she holds it away from her face, or whether she has started using speaker for every call.

What the conversation shows

Pay attention to the questions she asks back. Repeated questions, a plain 'what did you say?' after a sentence she should have caught, or answers that fit a slightly different question can mean she is missing parts of speech, especially in a noisy room. Test it on purpose. Sit at the far end of the room, speak at a normal level, and see whether she answers your actual words.

Watch what she avoids. People who are losing hearing often skip group conversations, stop going to dinners with neighbors, or stop answering the door when they cannot tell who is outside. People losing sight often stop opening mail, give up a show they used to follow, or let the newspaper sit folded and unread.

Keep a short list on your phone. For each visit, write three lines: what the TV volume was, which glasses she used, and what she missed in conversation. Compare the list each time you call. One bad afternoon means little. Three visits in a row pointing the same way is worth a call to her doctor.

Before the next appointment

Ask her doctor when her hearing and vision were last checked, and whether a referral makes sense. Ask whether her glasses prescription is still current. Share the list you have been keeping, and ask whether the doctor has noticed any of the same things. If you cannot be there for the appointment, ask whether you can send a short written note beforehand.

Ask her what she has noticed herself. Some people know their hearing has slipped and hide it from family. Make it about your own difficulty rather than her failing. Try something like: 'I keep missing what you say on the phone, is it just me?' Her answer will tell you a lot.

What to do tonight

Call her and ask her to tell you about one thing she watched or heard this week. Listen to how she describes it, and whether she gets the details right. Then set your own check for the next visit. Sit where you can see the television remote and the glasses case, and write down what you see before you leave. If you find a pattern, send the list to her doctor's office and ask whether hearing or vision should be on the next appointment.

What to leave with the doctor

Bring the written list covering TV volume, glasses, phone habits, and missed conversation. Ask whether a hearing check or vision check is due, what the next step would be, and which of the signs you noticed should wait for the next visit and which should be looked at sooner. Ask which changes mean she should call the office between appointments.

If you need help arranging someone to look in on her in St. Louis between your trips, see Local Help for a St. Louis Parent. For how this desk checks its claims, see How We Write.