Difficult Discussion Strategies–Memory Loss (with 1/2/15 update)*

“Don’t dramatize small failures,” cautions 92-year old Woman’s Club member Edie. She elaborates: “People have weaknesses, but they also have strengths so don’t zero in on the weakness—like forgetfulness—it’s only one piece.  When it happens in younger people, they say they’re only ‘senior moments.’  They don’t make a big deal about it.”

A senior moment?  A potential time bomb?  Initially we may wonder how to distinguish between the two? Then we wonder how to bring up the subject.

First, a highly regarded professional, Dr. Pasquale Fonzetti, MD,PhD, Chairman of the Institutional Review Board, Associate Director of the Memory Evaluation and Treatment Service (METS) and Staff Neurologist, The Burke Rehabilitation Hospital in NY, explains “There’s benign forgetfulness.  We all forget but we keep our checkbook, we go to work, we do our daily activities.”

Then, he says, there’s forgetfulness that can be a sign of dementia and should be a concern “if it’s interfering with everyday activities—if it’s interfering with social or occupational functions or activities of daily living.”  Dr. Fonzetti gives this example: “When older parents start forgetting appointments, forgetting things they have done before like how to balance their checkbook or how to follow a recipe that they’ve prepared many times, an evaluation is called for.” He further tells us, dementia is a slow process.

*Since December 2014 a TV ad has been running, sponsored by the Alzherimer’s Association. It features a wife who has lost her keys….again. The husband finds them in the refrigerator. I’m reminded of another of Dr. Fonzetti’s many examples, when I spoke with him– of a person’s leaving the checkbook in the freezer. At the time I thought it an exaggeration and omitted it from his last quote in the preceding paragraph. Obviously I shouldn’t have.

Dr. Fonzetti stresses that “ify”–my word–memory is a delicate subject. He elaborates, saying that adult children come in with their parents and even well-meaning children don’t always handle it well. “It’s important—very important—to talk very diplomatically and with respect to a parent… Proud parents would hate to lose independence, especially if it’s related to a cognitive misfunction.”

We obviously don’t want to make parents feel unhappy, defensive, or outright angry or scared.  Referring to the discussion strategies in Saturday’s post, we could say something like:

“You know, Mom/Dad, lately I’ve noticed—and maybe you have too—“(this pulls them in as an equal participant) “that you’ve been asking the same questions over and overYou know it could be your medication

(Here you’re  inserting a benign, but legitimate possibility, not worst-case scenario, thus lessening the emotional part of the discussion).

Parental response: “I don’t know what you’re talking about.”

“You don’t know what I’m talking about.”

(We repeat back and we confirm respect with an accurate account)

“Well, yesterday you asked if I was going to cousin Joe’s party and I answered you—several times. And you just asked me again today twice, if I was going to cousin Joe’s.”

Response:  “Of course, I didn’t hear you.” (Possibly true, possibly pride.)

(Now we reflect back, confirming what was said, and reiterating caring.) 

“Yes, you may not have heard me the three times yesterday and now again today.  You know it could be a hearing problem.”

(We offer another reasonable possibility since there is one; otherwise, we reiterate “medication.”)            

Do you think it makes sense to check it out with Dr. Smith?”

 (Respectful, validates parent participation.)

In some instances, using the 2014 Alzheimer’s Assn. TV ad mentioned earlier as a conversation starter, could help begin a difficult conversation.

If safety is not an issue (there’s no threat to life and limb), seeking a doctor’s help in a timely manner, ideally initiated by (otherwise in cooperation with) parents, is best. If safety is an issue, it’s obviously necessary to act immediately. In both instances jumping to conclusions can be problematical. (An old post “A Sad Story,”  is a true story about jumping to conclusions and how easily one can fall into the trap.)

In addition to the discussion strategies, it’s helpful if we can:
  • Gain information (reading, internet, friends) and check out concerns with our parents’ doctor, before taking actions that could change a life or damage a relationship.
  • Be supportive.  Look for creative or alternative solutions.  If we aren’t creative, it may be helpful to seek out a friend (with an older parent) who is.
  • Beware of role-reversal.
  • Recognize that proving we’re right may be less important than reaching our goal.  (Do we want to be right or do we want our parents to “buy in”?)
  • Say as little as possible–the less said, the better–when having an uncomfortable or difficult conversation.  And stick to the subject. It’s easy to get side-tracked or add a well-intended tid-bit or thoughtless word that makes us vulnerable to an argument.
  • Keep “What’s the Goal” first and foremost in mind. The doctor will ultimately be called in any event (immediately if safety is at stake). Otherwise there’s wiggle room.

isn’t having parent cooperation the best way to help them age well? Getting them to buy into–or at least accept–your suggestions, leads to the smoothest start….even if it takes a lot of patience and some additional time.

Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well.

Resources:
Alzheimer’s Association: www.alz.org
The American Academy of Family Physicians: www.familydoctor.org
The Mayo Clinic: www.MayoClinic.com
www.helpguide.org  describes itself as “a trusted, nonprofit resource” that offers support and information; “not a substitute for professional advice.”

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