Having a conversation about changes a person sees in a loved one as they age can be difficult. Especially when the changes affect daily living. If you notice signs of cognitive decline in a family member, exercise your curiosity to look a little deeper. Some changes are normal as we get older but others indicate something which could be more serious.
Because of the stigma which continues to linger around Alzheimer’s and other dementia, it can be tricky to bring up your observations. Even dancing around the words “mild cognitive impairment” or “dementia” can change the dynamic of the relationship. How should someone approach this subject in a way that doesn’t upset a family member and trigger denial?
There is the conversation itself, and there is the mental preparation. I’m not talking about the scripting and rehearsing (which I do recommend). I’m talking about framing the situation and gaining the perspective needed before proceeding down this path. I talk about this in The Dementia Field Guide in greater detail, but when the topic is raised a line is drawn between the past and the future. You may be able to continue, but there won’t be any “going back” to before.
To continue along with the trust you’ve earned over decades, be very intentional in your approach. I encourage my clients to remember these five things before talking with a loved one about cognitive changes they may have noticed.
- At all costs, preserve DIGNITY. One of the reasons Alzheimer’s and dementia carry such a stigma is because we focus on the loss of independence, control, and power associated with a diagnosis. While such loss is inevitable, these constructs usually fade gradually over the course of years or even decades and there are many enjoyable “seasons” ahead. All the while, your family member remains a sentient being with the same human needs we all have in order to survive and thrive.
- Prepare to have the conversation more than once; DENIAL takes time to overcome – each at their own pace. Set yourself up for success each time: consider the environment, time of day, and disposition of your family member as well as yourself before you raise the topic.
- The dictionary definition of dementia, paraphrased, is that two or more key cognitive functions – memory and one other – have been changed enough to affect daily life. Do your observations fit that DEFINITION? (You can take a free, anonymous assessment to help you sort through your observations.)
- Several medical conditions mimic symptoms of dementia. Remain open to medical opinion; don’t draw a foregone conclusion. Only a doctor is medically qualified to identify cause(s) of change to make a conclusive DETERMINATION. I advise my clients to avoid using the words “Alzheimer’s” or “dementia” when they have the conversation. Until you know otherwise, assume the changes you’ve noticed are the result of a treatable condition. Blame the changes that concern you on some other potential medical problem. Perhaps hearing loss, vision loss, depression, stress, isolation, hypothyroidism, vitamin deficiency, or something else is the root cause.
- If you become a dementia caregiver for a spouse or close family member, your relationship will rely on a different kind of trust from your loved one going forward. Avoid any situation which could damage that trust. If there is bad news, DEFLECT the blame to another source besides you. Therefore, let the doctor deliver the diagnosis so you are your loved one can “be in this together”.
If the diagnostic path reveals a treatable condition, seek medical intervention to restore wellness and quality of life. If the diagnostic path reveals cognitive changes that point to dementia, the family has some planning and preparation ahead. Develop a family plan as soon as possible so your loved one’s voice will be heard and honored. This is one of several reasons why proactivity, on taking a DIAGNOSTIC path, is an advantage.