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Dealing With A Loved One’s Cognitive Decline

When a loved one begins to experience memory loss and other cognitive issues, it is only natural to wonder whether he or she is exhibiting signs of dementia.

Warning signs that one’s mental capacity may be diminishing can include:

  • Forgetting significant dates or previous life events
  • Asking for the same information repeatedly
  • Difficulty concentrating or keeping track of recurring bills
  • Taking much longer to complete certain tasks than before, or the inability to complete daily tasks in general
  • Getting lost when driving to a familiar location
  • Losing track of time
  • Inability to recognize one’s own reflection
  • Problems following a conversation or finding the right words to express one’s thoughts
  • Frequently misplacing possessions and sometimes accusing others of stealing them
  • Mishandling money
  • Paying less attention to grooming and hygiene
  • Losing interest in favorite hobbies or social activities
  • Changes in behavior or personality, such as becoming anxious, confused, depressed or easily irritated when deviating from routine.

 

If your loved one is exhibiting these signs, you should encourage him or her to see a physician for testing, diagnosis and treatment.

Dementia is a term used to describe a decline in memory and other thinking skills resulting from damage to nerve cells, or neurons, in the brain. Such cognitive impairment can be brought on by a number of medical conditions, including Alzheimer’s disease, which is estimated to account for 60 to 80 percent of dementia cases, according to the Alzheimer’s Association’s “2014 Alzheimer’s Disease Facts and Figures” report. Other conditions that can cause loss of capacity include vascular dementia, a reduction in blood flow to the brain because of narrowing arteries or blood clots; dementia with Lewy bodies, which are protein deposits in deteriorating nerve cells; Parkinson’s disease; frontotemporal dementia, in which sufferers experience a shrinkage of the frontal and side lobes of the brain; or a combination of conditions known as mixed dementia.

Regrettably, there is no cure for dementia: Current treatment can only slow the condition’s progress. (To be clear, certain causes of cognitive dysfunction, such as depression and chronic substance abuse, may be reversible with treatment; not all cognitive dysfunction is dementia.) Dementia typically progresses in five stages: mild cognitive impairment, mild dementia, moderate dementia, severe dementia and profound dementia.

Technically, doctors do not consider mild cognitive impairment to be a stage of dementia, because the impairment may never reach the later stages. With mild cognitive impairment, a person may experience a small but noticeable decline in memory and other thinking skills. However, the person can continue to live independently.

A person suffering from mild dementia may need assistance with some of the activities of daily living (which medical professionals often term “ADLs”). These basic activities required to live autonomously include eating, bathing, grooming, dressing and undressing, toileting, maintaining continence and transferring from bed to chair or wheelchair and back without assistance or supervision. Someone who lives alone and struggles with ADLs may need a home aide or need to move to an assisted living facility. Someone with mild dementia may also become confused in public and may require help handling finances.

With moderate dementia, a person may experience severe memory issues and have problems communicating. At this stage, he or she cannot live alone and needs assistance with most or all ADLs. A person with moderate dementia may forget the names of relatives and friends, and mistake one family member for another. He or she may also forget short-term information, such as something cooking on the stove or leaving the gas pilot on but unlit, which can pose a threat to the person’s safety and that of others. He or she may also be more prone to wander outside and become lost if unattended.

When a person suffers from severe dementia, he or she requires constant, hands-on care. At this stage, he or she may be unable to recognize family or friends. The person may also have difficulty walking and may eventually need to use a wheelchair. He or she may also experience uncontrolled movements and behave aggressively, especially when feeling threatened. Those with profound dementia often become bedridden.

Interacting With Those Suffering From Dementia

It is never easy to see the bright light of a loved one’s personality dim as dementia worsens. However, it is important to not treat your loved one any differently, even if he or she no longer recognizes you.

The January 2013 issue of the Arizona Center on Aging’s “Elder Care” contained a short article titled, “Communicating With Patients Who Have Dementia.” Written by Jake Harwood, Ph.D., a member of the University of Arizona’s Department of Communication, the article provides tips on the most effective ways to interact with people suffering from dementia. Harwood recommends speaking in simple sentences so as not to confuse the person. He warns against using “baby talk,” however, as it might seem disrespectful or patronizing and make the person less cooperative.

Repetition helps when trying to convey information that your loved one finds difficult to understand, though it is better to rephrase the message, Harwood says, rather than to repeat it. Elaboration can also improve comprehension, and pausing during conversation allows your loved one time to gather his or her thoughts before responding. When asking questions, Harwood suggests giving your loved one simple choices if possible to provide a sense of control. Harwood also suggests using objects such as photos or songs to encourage communication with a person suffering from dementia. Nonverbal cues can also be very effective at stimulating communication. Maintain eye contact with your loved one and face him or her at the same level; if he is sitting down, sit down across from him. Use appropriate physical contact and facial expressions to convey your point, smiling and staying calm when speaking.

Making Decisions For Yourself And Your Loved One

Accounting for the possibility of your own eventual mental incapacity is an important consideration for any estate plan. In 2014, it was estimated that more than 5 million Americans age 65 and older suffer from Alzheimer’s disease. This statistic is projected to more than triple by 2050 because of an aging baby boomer population and longer life expectancies, assuming that no medical advancements arrive to cure, prevent or stop the progression of the disease. If you also consider other forms of dementia, the number of those who will suffer significant memory loss and cognitive issues in the coming decades likely will be even higher.

A health care proxy and a durable power of attorney are two legal documents that allow you to appoint another person to make medical and financial decisions on your behalf once you are no longer able to do so. Of course, the agent you choose should be someone you trust to respect your wishes and to make decisions in your best interest. Often this person will be a relative, such as a spouse or adult child, or it may be a friend or trusted adviser.

The health care proxy and durable power of attorney can take effect immediately or upon the occurrence of a particular event, such as when your physician determines that you lack capacity to make medical and financial decisions. The latter option is called a “springing” power of attorney, and it is especially appropriate for individuals who may be concerned with giving decision-making authority to someone else while they are still able to make decisions for themselves. Note, however, that a springing power may not work in all states. Florida, for example, deems a power of attorney ineffective if the power becomes active at a future date or is contingent on the occurrence of a future event.

In conjunction with the health care power of attorney, you will want to create a living will or advance directive. This legal document will give your agent and your physician instructions as to whether to administer life-sustaining medical treatment if you are in the late stages of dementia, are terminally ill or are otherwise near death. The living will relieves loved ones of the burden of difficult medical decisions such as whether to keep you on life support if you have no possibility of regaining consciousness.

Once you create such documents, be sure to make their existence known to your loved ones. Also, provide copies of the executed documents to your appointed agents to present to medical and financial institutions when acting on your behalf. It is likewise a good idea to give copies of your health care proxy and living will documents to your health care providers. If your doctors know your wishes ahead of time, it will be easier for them to help ensure that those wishes are respected.

If you find yourself on the other side of the issue and your loved one appears to be showing signs of diminishing mental acuity, ask if he or she has medical and financial durable powers of attorney in place. If so, ask your loved one who he has appointed as his agent or agents, so that you can alert them of problems.

If no such documents are in place, encourage your loved one to meet with an estate-planning attorney to have these and any other documents such as wills or trusts drafted and signed as soon as possible. Diminishing capacity does not necessarily mean that your loved one already is unable to execute estate-planning documents. For example, someone with mild cognitive impairment, or even mild dementia, can be deemed to have the acuity necessary to execute these documents as long as he or she is lucid and understands his or her actions at the time the documents are signed.

It is always difficult to watch a loved one’s mental capacity decline, or to consider the possibility of one’s own future incapacity. However, it is important to be certain that you and your loved ones have appointed the appropriate agents to make health and financial decisions once that capacity is limited or gone. And it is crucial that you continue to interact with your loved one, treating him or her with dignity and respect no matter how the decline progresses.

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