Ways to manage cognitive decline

Learn how to cope emotionally and financially when dealing with Alzheimer's.

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Key takeaways

  • Stay in touch with your loved ones and keep the lines of communication open.
  • Watch for changes in mood or behavior.
  • Stay connected with their doctor and team of advisors.
  • Your loved one can't be admitted into a skilled nursing facility just because they have been diagnosed with Alzheimer's.

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 Fidelity Center for Family Engagement. "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).

Signs of Alzheimer's/dementia Typical age-related changes
Poor judgment and decision making Making a bad decision once in a while
Inability to manage a budget Missing a monthly payment
Losing track of the date or the season Forgetting which day it is and remembering it later
Difficulty having a conversation Sometimes forgetting which word to use
Misplacing things often and being unable to retrace steps to find them Losing things from time to time
Source: Alzheimer's Association.

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:

  • Keep it low key. Talk with your aging parents or spouse in a quiet atmosphere without a lot of visual stimulation. Avoid talking about these issues over dinner at a noisy restaurant or at the airport. Instead, find a quiet time at home to start the discussion.
  • Choose your words carefully. The language you use makes a difference. Convey your concern for the individual. Don't make the person feel overwhelmed or browbeaten. Offer to help by partnering with him or her.
  • Be specific. If you're concerned about a loved one's cognitive decline, try to cite specific examples of times you noticed it. Perhaps your parent or spouse forgot their brother's name, or couldn't remember the name of the bank they use.
  • Keep the discussion focused. Go into the conversation with a solid agenda and, if possible, agreement among other family members about how to handle the situation. Meet with your siblings and other family members in advance to discuss long-term care options and other strategies to make sure you are all on the same page.

Tip: Remember this is not just one discussion. It is a series of conversations in which the content 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:

  1. When a parent or loved one makes a direct request for help managing their finances or expresses that they are feeling overwhelmed by the task.
  2. When age starts to become a significant factor (on average when parents are in their 70s) and you are not engaged in their daily lives or aware of their financial realities.
  3. When there are hints or awareness of a change in circumstances and family members are not sure how to evaluate them. The fear of moving from independence to dependence can create defensive, secretive, and even combative behaviors, according to Habbershon. When life-stage fears are combined with the onset of dementia these behaviors can intensify. Families who can proactively create interdependent relationships can avoid many late-in-life aging struggles.

    Habbershon describes the mindset of interdependence as one of "dependent humility." Ironically, when we humbly acknowledge that it is OK to be dependent on one another in our relationships, we can learn to live more interdependently. Interdependence means understanding diminished capacity as the normal state of aging adults, and recognizing many people need help in this stage of life. Recognizing this allows defenses to drop and sharing of fear-based emotions with family and professional caregivers who can provide support for diminished capacity issues as minor as arthritis or as daunting as dementia.

Here are 5 practical expressions of interdependent families:

  1. Clarify and discuss beneficiaries on bank accounts, investments, insurance policies, etc.
  2. Ensure that your will is current and complete and share it with impacted people.
  3. Discuss health care wishes as a family and decide who the health care proxy will be. This is the person who will make decisions for you if you can't and should be separate from the person who serves as your patient or health care advocate.
  4. Create a living will as part of a larger "wish" discussion. This aligns family or caregivers around instructions on the kinds of care you want to receive.
  5. Scan and store your legal documents, including passwords and a list of trusted advisors (e.g., financial advisor, attorney, CPA) and share with your loved ones.

Read Viewpoints on Fidelity.com: How long-term care planning can help your loved ones

Next steps to consider

Use our planning, conversation, and resource guide.

Get help with caregiving, aging in place, family talks, and more.

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