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December 12, 2022 — Betsy E., a 58-year-old editor in Delaware, was excited to see her 79-year-old aunt for Thanksgiving. It had been almost 3 years since they last saw each other due to holiday plans being canceled due to the COVID-19 pandemic.
“I kept in touch with Aunt Vera on the phone and she was chatty,” says Betsy, who requested that her real name not be used in this article. “She was always prone to repeating herself, so I didn’t think much about it when she kept repeating the same stories like I’d never heard them.”
But when Betsy arrived at her aunt’s, she was “shocked”. There was moldy food in the fridge. A stack of dust-covered library books sat in the hallway, some due over 6 months ago. Usually, Aunt Vera cooked a lavish Thanksgiving dinner, but this year she said she didn’t know what to cook and suggested going to a restaurant.
Monica Moreno, senior director of care and support at the Alzheimer’s Association, says the holiday season is “often a time when families get together. It can also be a time when extended family members notice cognitive changes in a loved one they don’t see regularly.”
Even if you’re on the phone a lot, “it’s not the same as seeing first-hand how the person is doing in everyday life,” Moreno notes.
Red flags
Two officials from Brightview Senior Living — an organization of 45 senior living communities across the United States — agree with Moreno.
Patrick Doyle, PhD, the company director of dementia care for Brightview and major faculty at the Johns Hopkins Center for Innovative Care for the Elderlyand Cole Smith, Brightview’s director of dementia care, say it’s important to “recognize that each person has different core cognitive health values” and “use what you know about your loved one to understand when their behavior is outside of the Normal lies you.”
For example, some people seem to remember every name, date, and number they’ve ever learned. It would be “extraordinarily unusual” for her not to remember her grandchild’s birthday.
Short-term memory declines with age, but people in the early stages of Alzheimer’s disease “often experience memory loss to a degree that begins to interfere with their daily lives,” say Doyle and Smith. “The person may miss important events, forget to take medications they have been taking for many years, or even begin to mix up names and details about their friends and family.”
Another common warning sign is that the person may have a hard time completing familiar tasks.
“Often people with early stages of [Alzheimer’s] can get lost driving or walking to routine places,” they say.
Other warning signs are:
- Recent traffic violations, accidents or dents and damage to the car
- Aversion to walking usual distances
- Changes in personal hygiene
- Missed doctor appointments
- Changes in financial habits (e.g. missing bills)
- changes in sleeping habits
- Decrease in the usual household standard
- Burnt pots or pans
- Confusion with time or place
- New problems with spoken or written words
- moving objects
- Mood or personality changes
- social retreat
- Having a hard time following recipes or completing other complex tasks
- Forgot names of friends or family
- Problems understanding visual images
- Having a hard time retracing steps
- Decreased or poor judgment
Start a conversation
Don’t dismiss your relative’s symptoms, Doyle and Smith urge. “There’s a lot of fear associated with that [Alzheimer’s]and this can result in people attempting to rationalize observed behavior as normal when it is a clear departure from the person’s norm.”
If you’re concerned, you should “take action” instead – although it can be a “sensitive issue” so proceed with caution.
Use what you know about your relative to determine how they are likely to react when you bring up the topic.
“Some people experiencing cognitive decline are aware of it and will make statements about their own observations and concerns; In that case, offer your support and get a thorough clinical evaluation,” they say.
Moreno also recommends speaking to other family members before raising concerns.
“Ask if others are noticing the same signs you are seeing.” Some family members may dismiss the changes, saying they are part of normal aging; and spouses may “stand up for each other,” she warns.
“Be honest and compassionate
“When it comes to what to say, be honest and compassionate,” advises Moreno. “Start by sharing some of the things you see and ask if your loved one is concerned too. “Mom, I’ve noticed you’re having a hard time making Christmas cookies and I’d like to talk to you about why that happened. You’ve been doing them for years and it’s just not like you.'”
Moreno recommends focusing on details and sharing them in a way that the family member can hear. “Let them know you have their back.” And if your first try doesn’t go as well as you would like, “take the time to regroup. You can try a different time of the day or hire someone to talk to your loved one,” such as another family member, friend, or trusted person in your faith community. You can also share your concerns with the person’s doctor.
Doyle and Smith note that some people with dementia “are unaware of their deficiencies and even take offense when they suspect something is wrong, which makes talking about your concerns more difficult and sensitive.”
If you have a strong relationship with your relative, “you can leverage that connection by asking the person if they can do you a favor — let them know you’re concerned about their health and say you are.” would feel more comfortable if they went to the doctor with you.”
And avoid “appearing reproachful or demanding.” People “respond better to compassion, caring, and support,” observe Doyle and Smith, emphasizing that there “is no one approach that works for everyone” because “every person is unique and family dynamics vary dramatically.”
The Alzheimer’s Association’s 24/7 hotline offers advice and guidance (800-272-3900) and its website offers talking tips to help families navigate this delicate process.
Betsy, after realizing that her aunt was not herself, decided to contact her aunt’s son.
“There had been a certain estrangement and my cousin hadn’t seen my aunt for a long time. But when he heard what was going on, it motivated him to want to heal things with her, take her to the doctor and make a plan with her for her future, so he’s coming for Christmas.”
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