The sooner we know what’s going on, the sooner we can help that person. – Melissa Batchelor, PhD, RN, FNP, FAAN
It may be challenging to communicate with an older adult who has memory loss associated with aging, dementia, and Alzheimer’s. There are a lot of reasons that these discussions can be hard for families to have, but knowing a few strategies can help. In this week’s episode, you’ll learn about the six tips for talking to someone you think may have a memory problem.
Part One of ‘Six Tips for Talking to Someone You Think Has A Memory Problem’
Previously, we talked about the ten warning signs of Alzheimer’s Disease:
- Memory loss that disrupts daily life.
- Challenges in planning or solving problems.
- Difficulty completing familiar tasks at home, work or play.
- Confusion with time or place.
- Trouble understanding visual images and spatial relationships.
- New problems with words in speaking or writing.
- Misplacing things and losing the ability to retrace steps.
- Decreased or poor judgment.
- Withdrawal from work or social activities.
- Changes in mood or personality.
All of those ten warning signs are things you need to pay attention to over time, and to look for patterns. Do you see something that concerns you every afternoon at a certain period of time? Do you only see it in the morning? Paying attention and documenting these types of details will help your healthcare providers figure out what’s going on.
Keeping a journal to write down when and where you have seen any of the warning signs is a helpful strategy and helps to keep things objective. Write down the changes that you see in somebody’s memory, their thinking, or their behavior. What are they doing or what are they not doing that’s worrying you? What specific day do they usually happen? How long have you been seeing that particular behavior, or when’s the last time they did something that they used to do all the time?
Another consideration are major life changes – such as the recent loss of a spouse. Is their behavior changing because they have been trapped in their house for three months because of COVID-19? Depression and anxiety can look like a memory problem. Or is there some type of family stress that is happening? Has anyone else seen the changes that you are seeing?
Help them maintain their independence for as long as possible. – Melissa Batchelor, PhD, RN, FNP, FAAN
Here are the six tips for how you’re going to have this conversation …
(1) First of all, you need to think about who needs to have the conversation and when they need to have that conversation.
You may need to work with that family caregiver or an adult child to have that conversation. Or maybe you have a close enough relationship where you can at least have the conversation, but think through what’s going to be the best time of day to approach this person, whereas what’s going to be the best location? And typically, being in a quiet and familiar place is going to be very helpful. But knowing who should have the conversation and when you should have it are both critical. And you also need to prepare and be prepared for some pushback. A lot of times, we start off having these social conversations, but when we start asking very direct questions, people can get mad at you. Don’t take this personally; you may just need to revisit the conversation later but add it to your journal.
(2) Know that this conversation may not go as planned.
You also may need to have this conversation more than once. You may need to have part of the conversation you want to have and then stop through part of it if you’re upsetting the other person. If you’re getting push back, you’re better off just to let it go and come back and talk about it again another day. But don’t forget to keep notes about that. Where did the conversation take place? What time of day was it? What went well and what didn’t go well? And what do you think you should do the next time you try to have this conversation? You do need to try to have the conversation earlier rather than later.
Part Two of ‘Six Tips for Talking to Someone You Think Has A Memory Problem’
(3) Have the conversation early and do not ignore the warning signs.
You don’t need to jump right to the conclusion that this memory change is definitely Alzheimer’s and they’re demented because there could be another reason. It could be the beginning of delirium, which is an acute change in someone’s ability to think. They may have something wrong with their thyroid or have a bladder infection or some other underlying infection. They could be getting dehydrated. They could be constipated. It’s incredible how much your bowels can impact your brain as you get older. So, please don’t ignore the warning signs because they need to be evaluated in case there’s a reversible cause.
(4) Have a very specific plan on how you’re going to start the conversation.
You need to be very non-confrontational. Pay attention to your non-verbal body language; instead of sitting directly across from the person, maybe sit down beside them to somehow make them feel that you’re on the same team and have the same concerns. Be willing to help them. You can say something like, “I’ve noticed that you’re not going out and seeing people as much as you used to. And I’m concerned.” They may have a very different reason for why they’re doing something that’s not related to a memory issue. Having urinary incontinence will keep someone at home and could be due to an infection or constipation (yes, constipation can make someone incontinent) that both of these things can be treated and get the older adult out and about again. Try to find out why they aren’t going out and engaging socially if that’s the symptom you’re seeing.
Another way you can start the conversation would be to check on them and ask open-ended questions that let them decide which way the conversation should go. And then, the third way would be to notice whatever symptoms that you saw and ask, “Has this ever happened to you before?” and ask them things like, “I heard you got lost the other day at the mall. Has that ever happened to you before?” This is why keeping up with a journal is essential because you have most symptoms of Alzheimer’s disease appearing like twenty years before we ever get to a diagnosis. It has to be more moderate before it’s bad enough that they can’t take care of themselves, and people will intervene.
Sometimes, just knowing that somebody is on your side can help you take the next step to actually going and talking to a doctor about it. -Melissa Batchelor, PhD, RN, FNP, FAAN (10:10-10:17)
(5) You need to understand that the person you’re talking to is probably going to tell you that they are fine.
It could be that they know now that you think they have a problem and want to avoid the conversation or may not believe they have a problem. If that’s the case, there’s no need to fight that. You just need to point out the things that you’re concerned about and be prepared to have the conversation at different points over time. Preserve your relationship with them rather than force the issue.
(6) Offer your support
It goes back to sitting down beside them, being on the same team with them, and letting them know that you want to help them maintain their independence for as long as possible. You want them to be able to live in their home for as long as possible. And you also need to tell them that many other things could be causing their memory problem. And that’s the part where you can suggest for them to talk to a doctor about it. And then, let them know that the sooner we address this, the sooner we know what we’re dealing with because there are some things that you’re going to need to get in place.
If it truly is a memory problem, in the next episode, we’re going to talk about what it takes to get to a diagnosis. And if that happens to you, you may need to find a different provider and get a different opinion, because that’s not how this disease is diagnosed. It’s a diagnosis of exclusion, which means we rule everything else out first.
I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults.
I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor.
My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities.
Find out more about her work at HERE.