“I have been forgetting things for years, but now I forget in a new way. I used to believe I could eventually retrieve whatever was lost and then commit it to memory. Now I know I can’t possibly. Whatever’s gone is hopelessly gone. And what’s new doesn’t stick.”
This passage is just one of many favorites from Nora Ephron’s final book, I Remember Nothing -- a 161-page testament to the fact that as we age, our memories get worse and forgetting things becomes part of the daily routine. As I was rereading it this past weekend, the sentiment hit close to home, as I’m sure it does for millions of us:
“Where did I leave my keys?”
“Whose birthday was I supposed to remember?”
“Did I really just call the dog my husband’s name?”
These moments pop up for all of us from time to time, and for the most part they are normal signs that we’re getting older: forgetfulness comes with the territory.
But what if forgetting things happens far more often than it used to, or far more frequently to you than others your age? It could be a sign of mild cognitive impairment (MCI), which for many people is a precursor to Alzheimer’s disease.
According to the National Institutes of Health, people with MCI should still be able to carry out their normal daily routines but may experience some level of depression, irritability, aggression, anxiety, or apathy.
Making Cognitive Health a Priority
The good thing is you don’t have to manage these symptoms alone. Whether forgetfulness is simply a sign of normal aging or a symptom of MCI or dementia, you should raise any concerns you have with your doctor. Your health care team is there to help you maintain your cognitive health, or mentation, which is a top priority for most people.
In recent years, more and more hospitals and health systems across the country are making their older patients’ mentation a priority, too.
In the past, doctors in these health systems may have prescribed a medication to treat one condition at the expense of their patient’s memory or cognitive function. Now, if medication is necessary, more doctors prescribe drugs that do not interfere with mentation. Doctors are also increasingly on the lookout to prevent, identify, treat, and manage dementia, depression, and other mentation-associated conditions.
In 2015, The John A. Hartford Foundation launched a partnership with the Institute for Healthcare Improvement (IHI), the American Hospital Association, and the Catholic Health Association of the United States known as the Age-Friendly Health Systems initiative, which works to promote the 4Ms framework in health care settings. As of March 2022, more than 2,500 hospitals, medical practices, and long-term care organizations have been recognized by the IHI for their commitment to age-friendly care.
Age-Friendly Health Systems focus on four aspects of care: promoting older patients’ mobility, ensuring their medications don’t interfere with quality of life, and prioritizing what matters to patients themselves. Together with mentation, these 4Ms of age-friendly care represent a major shift in the way health care providers serve older patients at all levels of cognitive and physical health.
Aging happens to all of us. My own memory lapses drive my kids crazy, and my husband and I have agreed to omit the phrase, “Don’t you remember I told you ...?”
That’s why we at The John A. Hartford Foundation believe that caring for memory and cognition should be a normal part of our health care as aging is part of our lives. By asking “What matters to you?” instead of “What’s the matter with you?,” our health care providers can address our worst fears about aging and empower us to live our lives the way we choose.
For more resources on age-friendly care, visit johnahartford.org/agefriendly.
(A version of this article, by Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation, originally appeared on Next Avenue.)
Institute for Healthcare Improvement: "Health Systems Recognized by IHI."
The John A. Hartford Foundation: "Age-Friendly Health Systems initiative."
Frameworks Institute: “Aging.”