Judd Matsunaga
People call cancer the “Big C” to avoid saying the actual word. Historically, people feared the diagnosis so much that they treated it as a taboo or a bad omen. Using a nickname helped soften the blow of a scary disease. Cancer and Heart Disease are still the two leading causes of death in the U.S. (source: Centers for Disease Control). Currently, Alzheimer’s Disease, No. 6 on the list, is making noise, especially since the oldest of the baby boomers hit 80 this year.
Perhaps we’re going to start hearing people say “the Big A” to avoid saying the actual word “Alzheimer’s.” While normal aging brings mild cognitive changes — like slower processing speed or occasionally misplacing items — it does not interfere with your ability to live independently. Dementia, which is not a normal part of aging, causes severe cognitive and behavioral decline that disrupts daily life.
With normal aging, you are fully capable of managing personal finances, doing household chores, driving and operating daily appliances. You may just take a little longer to learn new technology or multitask. You might forget the name of an acquaintance but remember it later or occasionally miss an appointment. Long-term memory and general knowledge remain intact. If you have memory loss or other worrisome changes in your loved one, it might be time to see the doctor.
The problem is that the older person might refuse to see a doctor about memory loss. Quite possibly, they are afraid that it might be Alzheimer’s or another type of dementia. That could mean that they might lose their independence or be told things like they can’t drive, they’ll need to move out of their home or they’ll have to start accepting help. They might worry that they won’t be able to remain themselves and they might lose control of their lives.
So, given there are so many reasons that an older person might resist seeing a doctor about their memory symptoms, this Pacific Citizen article offers six reasons why your aging parent should get their memory loss problems evaluated (source: betterhealthwhileaging.net):
Benefit No. 1: Objectively Document Memory Loss & Cognitive Symptoms
An evaluation can independently document the presence or absence of significant problems with memory or other aspects of thinking. This is usually done through a combination of the health providers interviewing the patient and also doing some type of office-based cognitive test, e.g., the Mini Mental Status Exam. In short, a cognitive assessment provides a snapshot of how well the brain is working now. This is important for confirming an older person’s concerns, or their family’s concerns, about memory and thinking. If indeed the brain seems to not be working well, that is important information for all stakeholders to know.
Benefit No. 2: Identify & Treat Causes of Memory Loss
This is really a critical step in trying to treat or reverse conditions that affect memory. It’s doing everything we can to help an older person’s thinking be the best it can be. In some older adults, their symptoms can significantly improve or even resolve once the underlying causes of cognitive impairment have been identified and treated. An evaluation can help identify and treat health problems that might be affecting brain function. Once we’ve confirmed through evaluation that there does seem to be some cognitive impairment going on, we can focus on figuring out what might be causing it, what can we treat or improve.
Benefit No. 3: Make Doctors Aware So They Can Make a Medical Care Plan
Now, you might think that doctors are likely to notice memory loss in their aging parents and take action on their own. Sometimes this does happen, but unfortunately, a lot of research shows that busy doctors often don’t notice an older person’s cognitive impairment unless it is specifically brought to their attention. When a doctor realizes that their patient is having memory loss, this can be an opportunity for them to encourage their patient to start involving family in their care.
Benefit No. 4: To Start the 6-12 Month Alzheimer’s Monitoring Plan
If your parent might be developing Alzheimer’s or another form of dementia, doctors will often need to monitor them over 6-12 months before they feel confident making a diagnosis. That’s because to diagnose dementia, it’s usually necessary to rule out other causes of treatable cognitive impairment, such as delirium, other medical problems and maybe even certain psychiatric conditions. This process almost always takes time and might require trying to treat problems such as depression to see if cognitive symptoms improve with treatment. You probably won’t get a definitive answer at the first medical visit. But it is essential to start the process of evaluation and diagnosis so that you can eventually get some answers.
Benefit No. 5: To Help With Activities of Daily Living (ADLs) & Safety Problems
If your parent’s memory and thinking problems are affecting their ADLs or safety, a diagnosis will help you step in. If your parent is struggling with IADL’s (Instrumental Activities of Daily Living), which are more cognitively demanding tasks such as managing finances, cooking and medication management, they will eventually need more help or support. Now, some people with memory or thinking problems willingly accept help, but many don’t. If your parent does get diagnosed with Alzheimer’s or another form of dementia, this generally will make it easier to step in and insist on certain changes.
Benefit No. 6: Objective Information Helps Resolve Family Disagreements
When an aging parent starts experiencing memory loss or thinking problems, it’s really common for family members to disagree about the situation. For instance, family members might disagree about whether the problems are there or how significant they are. Families will definitely often disagree about what to do, especially if it seems like the parent needs more help but is refusing it. If an evaluation confirms significant cognitive impairment, this can help resolve family disagreements and mobilize a family to step in more. Families can then use that information to negotiate next steps together.
In conclusion, just because it’s worthwhile to get an evaluation does not mean it will be easy. As dementia progresses, you have to learn a different form of communication. The dementia brain is struggling with working memory, e.g., logic and step-by-step directives. As the left hemisphere of the brain gets weaker, the right hemisphere of the brain starts to become more dominant. That’s the side of the brain that interprets emotion, e.g., the tone of voice, the rhythm of voice, the emotionality that you’re bringing to the conversation. So, as dementia progresses, it becomes less important what you’re saying and more important how you’re saying it. Good luck!
Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or. The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or constitute legal or tax advice and should not be treated as such.
Past “Legal-Ease” columns may be viewed here.