It’s hard to see someone you care about in pain. We’ve all experienced pain in some capacity, so when we have a loved one having a hard time, it reminds us how unpleasant it was. But there are situations when someone close to you starts to suffer in a different way—and may not even fully realize what’s going on. Maybe they’re not losing their physical mobility, but memories or skills are slipping away from them instead.
This puts you in a difficult position. If your loved one, for example, fell and broke their leg, the process would be relatively straightforward: They’d seek medical attention, get an X-ray, and end up in some type of cast or supportive boot with instructions on how to get around with crutches, a walker, or a wheelchair. Sure, no one is thrilled with the injury taking several weeks (or months) to heal, but they’ve seen the X-ray and know their leg is broken.
Seeing someone you care about exhibiting signs of dementia is a different story—from recognizing the signs, to the steps leading up to a potential diagnosis, to knowing how to discuss it with the person and other important people in your life. Lifehacker spoke with several experts on dementia and memory care to get a better idea of how to handle these situations.
Dementia can look different for each person
Noticing that a loved one is becoming more forgetful or has gotten in the habit of repeating themselves can be alarming. Your mind might immediately jump to whether the person could be showing signs of dementia, or if it’s just run-of-the-mill aging. On the one hand, you don’t want the person you care about feeling patronized, or as though you’re trying to take away their autonomy; on the other hand, you’re concerned about their safety.
While the early indicators of dementia look different for each person, there are some common threads, Teepa Snow, a licensed registered occupational therapist and memory care expert for A Place for Mom, a senior living advisory service, explains. “For this person, it is not the same as before—something of importance is changing, including attention, flexibility, ability, interests, emotional stability or range, or awareness of self or others,” she tells Lifehacker.
The signs of dementia
For the most part, the signs of dementia fall into two categories (though there’s certainly overlap): cognitive changes (e.g. memory loss) and psychological changes (e.g. unusual aggression). According to Lisa M. Cini, author of Hive: The Simple Guide to Multigenerational Living, and expert in aging, Alzheimer’s, and long-term care design, these are some of the most common signs of dementia:
- Personality changes.
- Frustration with their lack of being able to find the right words.
- Repeating comments or stories over and over. (Though it’s not simply telling a story at breakfast and repeating it at dinner—it’s more consecutive.)
- Paranoia (thinking people are talking about them or trying to hurt them).
- Difficulty play games they could before.
- Driving and having difficulty remembering where they were going or how to get home.
At the same time, Cini says that we should also be aware that there are other conditions that can cause similar symptoms, like a urinary tract infection (which can cause serious confusion in older patients), a chemical imbalance in their brain, or their medications being off. If any of these are a concern, it’s time to take the person to the doctor for diagnostic testing in order to rule these causes out.
Meanwhile, the symptoms listed above can take many forms, so Snow—whose work focuses on dementia—spelled out a few specific situations that you may notice, or your loved one notices about themselves:
Changing patterns of episodic social interactions or activities
This isn’t when someone suddenly stops their daily or routine socializing, but rather something they did episodically. These might include holiday activities, volunteer or work-related tasks, or home maintenance tasks. In some cases, these activities might be skipped, mishandled, or cause emotional distress in ways they never did before.
Falling for scams or following suggestions from unreliable sources
This may also include situations where your loved one grants another person access to their valuable resources without concern, and, in doing so, may seem to ignore details or facts that previously would have caught their attention.
Difficulty getting places
This could include having more trouble getting to unfamiliar locations or returning from familiar ones—especially if a different route is needed.
Difficulty finding things located in familiar places or spaces
They may simply overlook them, or say that someone must have moved them or hidden them.
Odd or unusual thinking or statements
These can be about specific situations or events from a person’s history that are inaccurate or inconsistent with their previous awareness or knowledge. They can include thoughts or statements regarding relationships, finances, resources, or a sequence of events or outcomes.
Having new challenges with financial matters
This includes making mistakes, taking risks, or not doing routine tasks on time and possibly hiding the evidence.
These can include not recalling meetings, appointments, agreements, conversations, or decisions. Also, the person may have problems accepting that something is true, even after there is evidence that it did occur.
New issues in judging time and the passage of time
The person may think that something that occurred in the past just happened recently, or believing that something was done recently, when in fact it has not been done in an extended period of time. Examples include visits, calls, connections, and daily routines of care or responsibilities.
Changes in emotion
This can include shifts in emotional flexibility, emotional range, or emotional reactivity to both familiar and unfamiliar situations, interactions, or events—ranging from apathy to extreme fright, flight, or fight reactions.
How to talk about dementia with the person you’re concerned about
While these conversations are never easy, there are ways you can prepare for bringing up the topic of dementia with someone you care about. Here are some tips from experts that might help:
When it comes to bringing up the subject, Dr. Wilfred Van Gorp, a neuropsychologist and the director of the Cognitive Assessment Group, says being direct is the best approach. He suggests using something like “I’m concerned about your memory—I’d like to go with you to the doctor to have this looked at” as a way to start the conversation.
Don’t diagnose the person
Being direct about your concerns with a loved one’s memory is one thing, but jumping right in with your armchair diagnosis isn’t the way to do it. “Don’t be prescriptive and say you think they have dementia,” Caroline Tapp-McDougall, the author of The Complete Guide for Family Caregivers and publisher of Caregiver Solutions magazine tells Lifehacker. “Only a qualified healthcare provider, like your doctor or a specialist, can make an official diagnosis of dementia.”
Along the same lines, Tapp-McDougall stresses the importance of preparing yourself for the fact that the person might not have dementia. “Remember, not all memory loss is the same, and some memory loss can be considered to be a natural part of the aging process,” she says.
Make it a one-on-one conversation
Instead of ambushing the person you’re concerned about with a roundtable discussion about their memory challenges, both Cini and Tapp-McDougall recommend making this a one-on-one conversation. “Whatever you do, don’t gang up on them, respect them and focus on helping them instead of taking away their freedom,” Cini says.
Ask about their concerns
If you start by saying that you are worried about their memory, Tapp-McDougall suggests following up to see if they have the same concerns. “They may have noticed they aren’t able to read or write too well lately, or they may have found themselves feeling moody and agitated, or forgetting things more often,” she says.
But, they may also deny that anything is wrong. If this happens, Tapp-McDouglass says that it’s best not to argue with them. “Remember to meet them where they are, don’t argue and don’t make them feel bad,” Cini adds. “This is way harder on them than it is on you.”
Focus on safety and solutions
Instead of trying to address everything at once, Cini suggests keeping discussions only to areas that directly impact their safety, like driving or taking medications. If your loved one pushes back during the conversation, or objects to your views, Tapp-McDougall recommends—without directly disagreeing with them—providing a few examples of things that may put them at risk, including a few key incidents.
Along the same lines, Cini says that you should already have thought through potential solutions to a safety problem before bringing it up with the person. “If you don’t have a solution or way to help them, you really should not be discussing these issues with them,” she explains. “For example, if driving is now an issue, have a solution, such as driving them or setting up an Uber account so they can still go out and enjoy life.”
So much of what you say during this conversation will hinge on your tone and approach. This starts with sitting down in a quiet, private spot for a one-on-one discussion and using a gentle tone of voice, Tapp-McDougall says. “Express that you are concerned about them because they haven’t been themselves lately, [but] don’t say it in a critical or accusing way—otherwise they may become defensive,” she explains.
Denial is the most common reaction to these conversations, Tapp-McDougall notes, and it usually doesn’t help when you aggressively point out examples of forgetfulness or confusion that make them feel bad. “Reassurance that you’ll be there with them to help is key,” she says. “This is a frightening, depressing, and potentially embarrassing time.”
Before the conversation, seek out support if you need it
“Make sure you are in a good place: emotionally, physically, and cognitively,” Snow advises. “It may be that you want to connect with a professional who is familiar with brain changes that happen with increasing age or changing life circumstances, so that you get the support you need before you start an uncomfortable and unfamiliar conversation.”
If you’re not sure where to start, Snow says that there are agencies, organizations, and individuals who provide services like this, including geriatric care managers and your local Area Agencies on Aging.
How to discuss potential signs of dementia with other people your loved one depends on
In addition to your loved one with possible memory issues, it’s also important to bring up your concerns with the other people they depend on a daily basis—whether it’s a spouse, sibling, or neighbor. But that may also be easier said than done. Again, Van Gorp recommends bringing this up directly with family members (or others close to the person), saying something like “Have you noticed Dad is awfully forgetful lately? Maybe we should go to the doctor and have this looked at.” Here are some other strategies:
Get their perspective
The first step in having this type of conversation, Snow says, is to seek out the other person’s perspective and awareness of what you have noticed about the person you both care about. “Don’t try to convince the person that you are right, but rather figure out what they are picking up on, or how they are viewing the situation,” she explains. “Starting an argument about seeing things differently will definitely make future interactions and support more problematic.”
If the other person seems unaware of what you are noticing, Snow says that you might try something like the following: “So, I’m wondering if you are noticing any changes in how Mom is handling meals? I just noticed there were a lot of expired and moldy items in the fridge. That just doesn’t seem to be what I have seen her do in the past.” Then listen to what the other person offers back. “If you are not noticing any acceptance or agreement, you might want to pause and consider another resource for support,” Snow adds.
Start talking about a plan
Maybe you’re not to the point of having to put a plan into motion, but that doesn’t mean it’s too early to bring it up. According to Michael Bloch, CEO & Founder of Pillar Life—an app that helps families and communities organize caregiving efforts—a dementia care plan is a written document meant to help caregivers understand who the patient is and what they need, as a way of extending their quality of life. Here’s more information about what that could look like.
When it’s time to bring in experts
Sometimes, there’s an incident that makes it clear that it’s time to seek input from healthcare professionals for the person you care about. Other times, it can be hard to tell when to make that move. According to Van Gorp, this is a case of sooner being better.
“The best time [to bring in experts] is early after noticing. The medications and interventions are most effective early,” he tells Lifehacker. “Don’t wait. Once the damage is done it’s often too late.” He recommends contacting either a general practitioner or a neurologist.