Many of us have experienced the heartbreak of watching a loved one's memory and connection with family and friends slip away. Today, an estimated 5.7 million Americans suﬀer from Alzheimer's disease, and experts expect that number to increase rapidly as the baby boomer generation ages.*
"Alzheimer's disease is the sixth leading cause of death in the US and is estimated to aﬀect 16 million people by 2050," says Ruth Drew, director of family and information services at the Chicago-based Alzheimer's Association. "One in 9 individuals over the age of 65 and one-third of people over age 85 are likely to be touched by this disease."
Alzheimer's is one of the main forms of dementia, which involves impaired brain function, the loss of short-term memory, and trouble completing even basic, familiar daily tasks. Caring for family members with this disease can take an emotional as well as ﬁnancial toll on families. Arranging for the care of a person suﬀering from dementia can be complex and expensive. Adding to that complexity, patients are often unable to manage or understand their ﬁnances.
What can families do? Although there is no cure for these types of illnesses, there are steps you can take now to reduce the impact of dementia on those aﬀected. To the degree families are able to acknowledge the signs of a progressive disease early, they can begin to align around the emotional realities and impact on the family. "Be empathetic to the fears of those most directly affected, and, be caringly bold by establishing an open family dialogue about all aspects of the disease process," says Dr. Tim Habbershon, Managing Director of Family Engagement at Fidelity. "Clarify family member roles and seek outside partnerships as first steps in your preparations."
When is a change a sign of dementia?
When a loved one shows signs of a change in judgment or memory, the ﬁrst step is to determine whether it's a normal sign of aging or something else. Many of us will experience some type of cognitive impairment as we age. Indeed, many older people ﬁnd their short-term memory is less sharp, and it's more diﬃcult to multitask (see table below).
Losses in memory, attention, or problem-solving ability aren't necessarily signs of dementia. So how can you tell whether these cognitive changes are more serious? The Alzheimer's Association, a national support and research organization, oﬀers 10 tips for identifying Alzheimer's disease. They include looking for personality and mood changes, decreased or poor judgment, and confusion with time or place.
Regular check-ins and conversations with your loved one also can help identify problems early. Look for changes in their normal routine. Piles of unopened mail and unpaid bills may be a sign that something's wrong. You can also encourage your loved one to take you to an appointment with their primary care doctor so you can better determine whether there's been any change in their health or adjustments to prescriptions.
Trusted professionals such as ﬁnancial advisors or accountants may be in a position to notice changes in long-time clients. For example, reviewing assets and investments may be diﬃcult to do for someone with a cognitive impairment.
Medical professionals play an important role in determining whether cognitive issues are early signs of dementia or are simply normal signs of aging. Specialists such as geriatricians and neurologists have expertise in identifying dementia, including Alzheimer's.
The impact on a family caring for a loved one with Alzheimer's can be dramatic, according to Drew. "On average, people live 4 to 8 years after a diagnosis. But some people can live up to 20 years more, depending on the kind of medical care they receive, the quality of their treatment facility, and how fast the disease progresses in the brain."
Habbershon suggests relationship health in the family is key to coping with care requirements. It is critical that your family agrees on expectations around the circumstances and emotional realities. Use the skill of processing out loud, which is saying what you are thinking and feeling in a way that creates congruence: "We are entering a new season as a family that is filled with uncertainty, that will challenge us emotionally, and may strain our relationships. Let's stay open and connected to each other." Equally important is individuals and families showing compassion toward themselves. Emotions can run the gamut from sad and crushed, to fear and anger. Sometimes family members may be at a loss, stressed, overwhelmed, and want to escape, and need other people to manage the moment. All of those realities are normal, and the family actually needs to embrace them.
When it comes to planning for health care expenses, Drew recommends that people work with their ﬁnancial advisor to determine Long-Term Care insurance coverage options. "Remember, Medicare does not pay for long-term care. You can't be admitted into a skilled nursing facility just because you've been diagnosed with Alzheimer's. If you have a family history of this brain disease, additional coverage may provide access to a better facility or more comprehensive treatment options. Some policies may cover home health care, but many do not, so do your homework," adds Drew.
Drew concluded, "As the largest nonproﬁt funder of Alzheimer's research, our hope is that innovative drugs and treatment options can be developed to slow progression of Alzheimer's and one day cure it. For now, there are steps people can take to enhance brain health. A nutritious diet, physical activity, social engagement, and mentally stimulating pursuits have all been associated with helping people stay healthy as they age. These factors might also help reduce the risk of cognitive decline and Alzheimer's disease."
Tip: Call the Alzheimer's Association 24-hour help line at 800-272-3900 or visit www.ALZ.org to tap into a variety of caregiver and family resources.
Start talking early
Conversations about aging can be diﬃcult, but they're also critically important—particularly from a ﬁnancial perspective. For instance, if a loved one is suﬀering from some sort of cognitive impairment, it may be very diﬃcult to protect their ﬁnances if estate planning tools such as powers of attorney aren't already in place. If you do not have your family estate plans in place, Habbershon suggests you seek a financial planner who knows how to help you talk about your wishes and fears, and has the skills to draw your family into the planning process. This step can give you a foundation for your larger care planning.
Unfortunately, if a loved one's disease progresses and their ability to think and share thoughts declines, it will become more diﬃcult for your loved one to express their wishes. And yet, knowing those wishes will be a critical guide to help you through the many decisions that you may have to make.
"Most people feel they have all the time in the world to have these conversations," says Harriet Warshaw, advisor to The Conversation Project, a Massachusetts-based nonproﬁt dedicated to helping people talk about their wishes for end-of-life care. "Yet we know that life is unpredictable; stuﬀ happens. So we recommend you have the discussion about end-of-life care early. Gather your family members together to hear what matters most to your loved ones—all at the same time."
Here are some tips for starting conversations related to aging and cognitive decline:
Tip: Remember this is not just one discussion. It is a series of conversations the content of which may change over time. For ways to begin the conversation with your loved ones, read Your Conversation Starter Kit (PDF).
Warning signs to watch for
Adult children's engagement in their parents' ﬁnancial aﬀairs typically ramps up in response to age and changes in health and mobility. Parents' ability to remain independent erodes in their 70s. There are 3 "tipping points" that adult children should be aware of that may signal the need to step in and get involved in a more direct fashion with the ﬁnances:
Here are 5 practical expressions of interdependent families:
Next steps to consider
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