Dec. 12, 2022 – Betsy E., a 58-year-old editor in Delaware, was looking forward to seeing her 79-year-old aunt for Thanksgiving. It had been almost 3 years since they last saw each other, because holiday plans had been canceled due to the COVID-19 pandemic.
“I had kept in touch with Aunt Vera by phone, and she was conversational,” says Betsy, who asked that her real name not be used for this article. “She always had a tendency to repeat herself, so I didn’t think much of it when she repeated the same stories as if I had 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 stood 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, the senior director of care and support at the Alzheimer’s Association, says the holiday season “is often a time when families come together. It may also be a time when extended family members notice cognitive changes in a loved one they don’t see regularly.”
Even if you often talk by phone, “it’s not the same as seeing firsthand how the person is navigating daily life,” Moreno notes.
Two officials from Brightview Senior Living – an organization of 45 senior communities across the United States– echo Moreno.
Patrick Doyle, PhD, vice president of hospitality services for Brightview and principal faculty at the Johns Hopkins Center for Innovative Care in Aging, and Cole Smith, corporate director of dementia care at Brightview, say it’s important “to acknowledge that each person has a different baseline for cognitive health” and to “use your knowledge of your relative to understand when their behavior is out of the norm for them.”
For example, some people seem to recall every name, date, and number they’ve ever learned. For them, not remembering their grandchild’s birthday would be “exceptionally unusual.”
Short-term memory declines with aging, but people in the early stages of Alzheimer's disease “often experience memory loss to an extent that it begins to disrupt their daily life,” say Doyle and Smith. “The individual may be missing important events, forgetting to take medications they have taken for many years, or they may even be starting to mix up names and details about their friends and family.”
Another common warning sign is that the person may have a hard time doing familiar tasks.
“Often, people with early stages of [Alzheimer's] may get lost driving or walking to routine places," they say.
Other warning signs include:
- Recent traffic violations, accidents, or dents and damage to the car
- Reluctance to walk usual distances
- Changes in personal hygiene
- Missed medical appointments
- Changes in financial habits (for example, missing bills)
- Changes in sleep habits
- Decrease in usual standard of housekeeping
- Scorched pots or pans
- Confusion with time or place
- New problems with spoken or written words
- Misplacing objects
- Changes in mood or personality
- Social withdrawal
- A hard time following recipes or doing other complex tasks
- Forgetting names of friends or family
- Trouble understanding visual images
- A hard time retracing steps
- Diminished or poor judgment
Starting a Conversation
Don’t dismiss your relative’s symptoms, Doyle and Smith urge. “There is a lot of fear associated with [Alzheimer's], and this can cause people to try to rationalize the observed behavior as normal, when it is a clear deviation from the person’s norm.”
Instead, “jump into action” if you’re concerned – although it can be a “delicate subject, so proceed with caution.”
Use your knowledge of your relative to determine how they will likely respond when you broach the subject.
“Some people experiencing cognitive decline are aware, and will make statements about their own observations and concerns; in that case, offer your support and get a thorough clinical assessment," they say.
Moreno also recommends talking to other family members before sharing concerns.
“Ask if others are noticing the same signs you see.” Some family members may dismiss the changes, saying they're a part of normal aging; and spouses may “cover for one another,” she warns.
'Be Honest and Compassionate
“When it comes to what to say, be honest and compassionate,” Moreno advises. “Start by sharing some of the things you’re seeing and asking if your loved one is also concerned. ‘Mom, I noticed you were having a hard time making holiday cookies and I’d like to talk to you about why that happened. You’ve been making them for years and it’s not like you.'"
Moreno recommends focusing on specifics and sharing them in a way you think the family member will be able to hear. “Let them know you’ve got their back.” And if your first attempt doesn’t go as well as you would have liked, “take time to regroup. You might try a different time of day or recruit someone else to talk to your loved one” like another family member, friend, or trusted person from their faith community. You can also share your concerns with the person’s doctor.
Doyle and Smith note that some people living with dementia “do not have an awareness of their deficits and may even be offended by the suggestion that something is wrong, making a conversation about your concerns more challenging and delicate.”
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’ – share that you are concerned about their health and say it would make you feel more comfortable if they went with you to see a doctor.”
And avoid “coming across as accusatory or demanding.” People “respond better to compassion, care, and support,” Doyle and Smith observe, stressing that there is “no one approach that works for everyone,” since “every person is unique, and family dynamics vary dramatically.”
The Alzheimer’s Association’s 24/7 hotline provides advice and guidance (800-272-3900) and its website offers conversation tips to help families navigate this delicate process.
As for Betsy, after noticing her aunt was not herself, she decided to contact her aunt’s son.
“There had been some estrangement, and my cousin hadn’t seen my aunt for a long time. But once he heard what was going on, it motivated him to want to heal things with her, go to the doctor with her, and make a plan with her for her future, so he’s coming for Christmas.”