By JUDD MATSUNAGA, Esq.
As we grow older, it’s natural to feel concern about changes in our mental abilities. According to the Alzheimer’s Society of Canada, most of us will continue to have strong memories as we age. However, almost 40% of us will experience some form of memory loss after we turn 65 years old.
Here’s the problem. It is extremely common for people with memory loss to be reluctant to see a doctor for this type of problem. If you have an aging parent who’s experiencing memory loss, you want them to see a doctor to make sure they are safe. But they get upset when you bring it up or they think it is not necessary. Or perhaps they tell you that this is none of your business.
And so this becomes a cause of reoccurring arguments with an aging parent. You may find yourself at this impasse. You’re concerned, you feel like this is not normal aging and could be signs of brain malfunction. You want to make sure that everything is being done to help your parent, and seeing a doctor is part of that. And most geriatricians will agree with you on that.
Here’s some advice: “First, if your parent is refusing to get evaluated, I would recommend you back off a bit,” says geriatrician Dr. Leslie Kernisan, MD MPH in her blog, “Geriatrics for Caregivers.” She says, “Back off, take a deep breath, and then try to understand them better, and try to connect with them.”
She continues, “And then have a gentle conversation to make sure you understand how THEY see their memory loss situation. Once you’ve done that and reflected on what you’ve learned from those conversations, you can try again to step in and have a talk in which you’ll be encouraging them to do something, or maybe to agree to something.”
So in this Rafu Shimpo article, we’re going to review Dr. Kernisan’s six benefits for getting your parent to get evaluated for memory loss. But first I want to briefly mention the most common reasons that older adults often do not want to get evaluated for memory loss or late-life thinking problems. They are:
• Feeling embarrassed by the problems they are experiencing;
• Thinking its normal to get memory loss with getting older;
• Thinking there is nothing that can be done for memory problems in aging;
• Being afraid it could be Alzheimer’s or another type of dementia;
• Feeling afraid that they might lose their independence, or being told things like they can’t drive, they have to move out of their home, or they’ll have to start accepting help.
Given that there are so many reasons that an older person might resist seeing a doctor about their memory symptoms, and given that it is so common for this to become a point of contention between older adults and families, it’s understandable if you’re wondering if it’s really worth trying to make this happen. So, let’s cover Dr. Kernisan’s six benefits for getting a memory loss evaluation for the elderly:
• To objectively confirm the presence (or absence) of significant cognitive impairment.
In short, the cognitive assessment part of the medical evaluation should provide a snapshot of how well the brain is working now. This is important for confirming an older person’s concerns or perhaps their family’s concerns about memory and thinking. And if indeed the brain seems to be not working well, that is important information for all the stakeholders to know, the older person, their family, and their doctors.
• To identify and treat potential causes and help the person have the best thinking possible.
An evaluation can help identify and treat health problems that might be affecting brain function. Once we’ve confirmed by evaluation that there does seem to be some type of cognitive impairment going on, we can focus on what might be causing it, and what can we treat and improve.
This is really a critical step in doing what we can to help an older person’s thinking be the best it can be. It is also important to try to treat or reverse conditions that affect memory when possible. In some older adults their symptoms can significantly improve or occasionally even resolve once the underlying causes of cognitive impairment are identified and treated.
• To make sure the doctors are aware of the cognitive issues and modify health care accordingly.
If your parent is experiencing memory loss, it’s vital for their doctors to become aware of any cognitive issues so that they can consider modifying medical care. 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.
Now, you might think that doctors are likely to notice memory loss in their aging patients and take action on their own. This does happen sometimes, 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.
• To start the diagnostic process, if it might be Alzheimer’s or another form of dementia.
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 can make 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 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’s essential to start the process of evaluation and diagnosis so that you can eventually get some answers.
• If your parent’s memory and thinking problems are affecting their ADLs, IADLs or safety, a diagnosis can help you step in.
Now some people with memory or thinking problems willingly accept help, but many don’t. So often families and even doctors will find themselves debating whether to keep insisting on something that seems needed for health or safety reasons, but that the older person doesn’t want.
At times like these, it is really helpful to have a diagnosis, or at least a likely cause for why the older person is impaired. And if your parent does get diagnosed with Alzheimer’s or another form of dementia, this will generally make it easier to step in and insist on certain changes if and when the time comes to do this.
• To give families objective information that can help resolve family disagreements.
To be honest, a medical evaluation that confirms significant cognitive difficulties is not going to magically resolve all the family disagreements. In particular, the older person will often have difficulty understanding or accepting the findings. In fact, it’s not uncommon for them to get upset with the doctor who does the evaluation.
And so evaluation usually doesn’t get us the one thing we often desperately want, which is for the older person to understand the problem, accept it, and cooperate with assistance.
That said, an evaluation should be able to help a family gain a shared understanding of what is happening to mom or dad, and what to expect for the future. And then families can use that information to negotiate next steps together.
So in conclusion, now that we have covered the six benefits for getting a memory loss evaluation, here are Dr. Kernisan’s top five ways to encourage your parent to get a memory evaluation. These suggestions can work magic, especially if you’re getting nowhere with your reasons and explanations:
• Frame the evaluation as a way for your parent to achieve THEIR goals.
Example #1: If it turns out that your parent is afraid that the doctor’s visit might result in them losing independence, you might want to frame seeing the doctor as something that’s likely to help them maintain their independence.
Example #2: If your parent wants to remain at home for as long as possible, as many people do, you can say something like “I know it’s important to you to stay in good shape so you can keep living here for as long as possible, so let’s check with the doctor to make sure we’re doing everything we can to keep your mind and body working well.”
• Avoid framing it as a dementia or Alzheimer’s evaluation.
These terms are often intensely alarming to people. Instead, consider framing things more reassuringly. For instance, you could say that it’s pretty common for people to struggle a little more with their memory and other things as they age. But you’ve learned it’s often related to medications or certain treatable medical conditions.
Remind your parent that getting this addressed early will help them be able to continue to live at home or will enable them to continue doing something that is important to them.
• See if they’ll do it as a favor to you.
Most people don’t like being the person who needs help. But older adults are often willing to do something to help others. So sometimes it works to ask them to do it for you. Be sure to shower them with appreciation and gratitude.
• Enlist your parent’s doctor as your ally.
This can be a good option if your parent has a well-established relationship with a doctor they respect. If the doctor is willing to recommend that your parent come in, that can carry a lot of weight with some older adults.
• Enlist another trusted person of authority figure to be an ally.
Aging adults are often more willing to consider recommendations from someone other than their adult children. So, this could be another family member, a trusted friend, a religious leader, such as a pastor, minister, priest or rabbi, or it could perhaps be a professional such as an attorney or financial advisor. Just ask yourself: Whose opinion does my parent particularly trust or value? And see if that person would be willing to gently encourage the medical evaluation.
So, those are five tactics that you can consider.
Finally, bear in mind that if your aging parent has memory loss and has been reluctant to see a doctor, it’s probably going to take several conversations and efforts at encouragement before you see progress. So, if you don’t succeed at first, don’t give up. Give it a little time and then try again, perhaps using a different tactic. And remember, always avoid arguing and giving too many explanations.
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Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.