Eldercare at Home: Memory Problems
Caregiving How Tos
Understanding the Problem
In our busy lives, all of us forget things at one time or another. As we age, this can happen more frequently and can be a natural part of the aging process. Some older people have little or no change in their memory, but, in others, forgetfulness can begin to interfere with their lives in a noticeable way. This might involve leaving bills unpaid, stoves on, or doors open-all of which can create serious safety concerns.
Short-term memory (remembering recent events) is what becomes impaired most often with aging. This might include planning, organizing, and following through with current events and activities. Often long-term memories of childhood or young adulthood remain vivid, even in the case of Alzheimer's disease, so it is short-term memory that is important to assess when there are concerns about a possible decline.
Often memory changes develop gradually over time. In the case of Alzheimer's disease there might be many years of gradual change such that spouses and family members slowly take over responsibilities or daily duties (for example, paying bills, administering medications, or making meals) that the individual had previously managed. When it becomes evident that the person needs help with tasks due to memory problems, an evaluation for possible Alzheimer's disease or other memory disorder is needed.
On the other hand, many people notice memory loss but are able to continue to manage their household and monetary affairs without difficulty. While it is always good to seek an evaluation for someone if there are worries, in this group it is likely that the person simply has mild memory loss that is normal with age. Many robust older people do not have any significant changes in their memory as they age. While slower retrieval of information is the constant feature in these people (such as the "her name is on the tip of my tongue" phenomenon), they otherwise keep good memory function.
Memory problems can be due to many conditions besides Alzheimer's disease. These conditions include Parkinson's disease, large and small strokes, depression, and medical problems such as thyroid disease. A detailed review of medicines is essential, since prescription, over-the counter, or herbal remedies can contribute to memory problems.
Some of these conditions can be treated or managed so that symptoms improve or stabilize. This is why it is important to schedule a medical check-up for the older person if you notice memory problems, particularly if they go along with other problems such as a change in weight, loss of appetite, gait instability, loss of urine control, or other new physical symptoms.
A dramatic change in daily functioning, such as a new episode of confusion, is important to recognize, as it could signify a new medical problem. An abrupt change in mental status is called "delirium" which is different from dementia. Delirium is a state of confusion that can happen over just a few days. Causes of delirium might be a urinary tract infection, pneumonia, dehydration, heart attack, or a response to medicine. Persons with delirium have trouble paying attention. They might not be oriented to the place and time, and they can have trouble carrying on a logical conversation. Older people with delirium might appear agitated or they may appear excessively sleepy and confused.
It is important to recognize delirium since people with memory problems are especially prone to having episodes of delirium if they become ill. The doctor or nurse should be notified immediately. Once the medical problem is treated, the delirium might improve and the person will be less confused, but his or her memory problems from the underlying dementia will still be there.
Your goals are to:
- Be alert for signs of short-term memory loss
- Be aware that memory changes often turn up as changes in daily functioning such as planning, organizing, and making decisions
- Make sure that memory changes are thoroughly evaluated by a doctor or nurse and that all appropriate treatments have been considered
- Keep a detailed record of all medicines the older person is taking, including prescription, over-the-counter, and any herbal remedies. This will help the doctor or nurse to decide whether these could be contributing to the problem
- Understand that delirium might occur in persons with dementia
- Learn techniques for helping reduce the emotional stress and burden of memory loss
Call the doctor or nurse immediately or go to the emergency room if any of the following symptoms occur:
- Sudden memory loss or confusion.
Sometimes a sudden memory loss is the result of a stroke, which might be accompanied by other stroke symptoms such as paralysis or confusion or slurred speech. It is important to get medical help immediately if a stroke has happened. Any other new episode of confusion that changes quickly over a day or a few days must be evaluated as soon as possible.
Call the doctor or nurse during office hours to discuss the following problems
- Significant memory loss following a change in medications.
Often older individuals take several different medicines, sometimes prescribed by several doctors. It is important to always review the list of medicines with the doctor or nurse at each clinic visit and to check with the pharmacist to be sure that the combination is safe. If there is a change in memory, sleepiness, gait unsteadiness, or any other change after starting a new medicine or a new dose of medicine, notify the doctor or nurse as soon as possible.
- Memory loss combined with other symptoms of decreased functioning
Most often memory loss progresses over time. Thus, the ability to manage daily affairs gradually becomes more impaired. When this occurs along with difficulty in planning, decision-making, word-finding, and other brain functions, there is a good chance that a dementia such Alzheimer's disease is present. It is important to have an evaluation by a medical doctor or psychologist to establish the diagnosis and make recommendations about continuing care.
- Memory loss combined with depression.
Persons with dementia often experience sadness, anxiousness, tearfulness, or a condition called apathy where they have very little interest or emotion. Sometimes it is helpful to have an evaluation for depression, as treatment with antidepressant medicine can help a person function better and avoid other symptoms such as irritability, sleeplessness, or anger.
Symptoms that should be reported at the older person's next regular appointment with the doctor.
- The older person can remember events that took place in the past better than recent ones.
Short-term memory loss does not allow the brain to make new memories. The older person may talk often about the old memories which were well stored before the memory problem began.
With greater memory loss, people are unable to remember what they just said. As a result, they may ask the same question or make the same statement over and over within a short period of time.
- Frequent reminding doesn't seem to help
With more serious memory loss, frequent reminding does not help very much. You may find yourself making the same request or remark several times within a short period of time without much success of the person's remembering what you have said.
- The older person does not think he or she has a memory problem
Sometimes people with serious memory loss have trouble realizing the extent of their loss. They seem to forget that they forget. They may deny the memory loss or play down the number of times that it has been happening.
Know the answers to the following questions before calling the doctor.
- Is there any new loss in mental function such as difficulty in paying attention, finding words, making decisions, telling time, remembering people, or remembering one's own name?
- Are there any new emotional symptoms such as a change in emotional state or personality, such as irritability or suspiciousness, that are unlike the person's usual self? Is there sadness or loss of interest in usual activities?
- Are there changes in the ability to function physically such as trouble sleeping, eating less, having urinary control, or walking with a steady gait?
- How often do the memory problems show up? Daily? Several times a week?
- Is there trouble recalling recent events?
- Have grooming or other daily habits changed for the worse?
- Are simple tasks hard for the older person to organize and perform?
- Does the older person get lost in familiar places?
- Are words forgotten, misused, or mispronounced?
- Does the older person become easily angered or agitated?
- Does the older person have difficulty in counting and managing money? Does he or she make unsafe decisions?
- Does he or she have difficulties remembering to take medications or miss doses of medicines?
- Are there other symptoms the person is having, such as changes in mood, changes in sleep-wake routines, and loss of interest in things he or she used to enjoy?
Here is an example of what you might say when calling for help:
"Hello, this is Linda Xavier. I am worried about my mother Antonia Xavier. She seems to be having memory loss that I have noticed for about a month. I also see that she is not able to take care of herself the way she used to. I have noticed that she's not been buying groceries or paying her bills, and last week she left her stove on."
- Be supportive.
Help the older person see the humor in situations but don’t make fun or demean the person for forgetting. Assure him or her that being forgetful is normal and that your love and support have not changed. In the case of Alzheimer's disease or other forms of dementia, it can be difficult to work with the older person, so discussing coping strategies with your doctor can be helpful.
- Be helpful and non-judgmental.
Do not quiz the person. Often it is natural to want to "test" to see how the older person's memory is functioning. Being questioned, "Do you remember this or that," can be very anxiety-provoking. It does not help improve memory in a person with memory loss, and can upset the person. Instead, be unconditionally supportive.
- Be patient.
Memory loss is frustrating for everyone. If the older person is trying to explain something to you and forgets a word, help him or her if you know the word. If the person loses something, look for it rather than asking him or her to remember. If there is a little memory slip-up, show the humor in it. Keep in mind that the problem isn't that older people won't remember to do things; they can't remember.
- Avoid arguments.
When people with memory loss make mistakes such as calling someone the wrong name, or confusing places and dates, unless it is absolutely necessary, do not argue or repeatedly correct them. They are not able to learn to get it right, and arguing or correcting them only creates more anxiety and distress.
- Avoid long activities, too much commotion, and unfamiliar settings
Be sensitive that changes in surroundings are confusing to the person with memory loss, and they can tire easily. This can lead to irritability and behavior problems when they are over-stressed. Short outings to familiar settings are best; avoid long trips, large groups, or loud chaotic settings, such as parties.
- Use reminding strategies. When memory loss is obvious, try these reminding techniques:
- Encourage carrying a memo book in the shirt pocket to write down significant events or people's names. Use neck chains for glasses or keys.
- Keep the person active with "over-learned" tasks. There are many activities that an individual might have over-learned through repetition during his or her lifetime. These might include playing an instrument, doing puzzles, crocheting, or other handicrafts that their hands can almost "do by themselves." These activities, especially those involving music, can be especially therapeutic.
- Encourage regular routines. Important activities, such as eating, exercising, or washing, should be tied to a particular time of day and place to be remembered more easily.
- Make your instructions simple and break tasks down into simple steps.
- Visit the Dementia section for more information and resources.
Problems You Might Have Carrying Out Your Plan
Lack of insight - often people do not recognize that they have memory loss.
It is frustrating when the person with memory problems does not recognize the problem or does not seem interested in doing anything to improve it. Be gentle and constructive in your approach. Try to work with the older person. Make your reminding strategies simple and clear. In cases where there has been major memory loss, such as with Alzheimer's disease, other behavioral problems may develop which can make the older person uncooperative and even aggressive. In such cases, you will need professional assistance. Most importantly, do not argue or confront the person, since people who do not have insight into their problem will not gain insight no matter how much evidence is presented to them.
Be sure that memory problems aren't interfering with taking medicines as prescribed. You might want to consider weekly pillboxes and a system of daily reminders. Typically it is best to have someone other than the person with memory problems responsible for dispensing the medicines to be sure they are taken properly.
Think of Other Problems You Might Have Carrying Out Your Plan
What other problems could get in the way of doing the things suggested in this section? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?
Keep notes of what you have tried and what the results were. This will give you a written record of what works and what doesn't and also is something to show the doctor and nurse so that they understand what you have done and can make recommendations.
Also, be sure that the memory problems are not caused by a medicine or a physical illness. Changing medicine might significantly improve memory. If the memory problem was due to a physical illness or depression, treatment is likely to improve memory.
There are also prescription medicines available that can help to stabilize memory somewhat for persons who are diagnosed with Alzheimer's disease. These medicines are not able to change the loss of brain cells that occurs with Alzheimer's disease but it is thought that they might be able to slightly reduce the rate at which a person loses memory. Your doctor can describe the risks and possible benefits of the various medicines with you if a diagnosis of Alzheimer's disease is made.
No herbal remedies or supplements have been shown to positively affect Alzheimer’s disease.
What to Do If Your Plan Isn't Working
Unfortunately, in many cases even with medicines, little can be done to improve memory. Memory loss from Alzheimer's disease can continue to worsen steadily no matter what you do. In this situation, your task is to help the older person live the fullest possible life even with memory problems and to manage problems that result from memory loss. This will take creativity, patience, time, and constant support from family and caregivers.
Ask for help. Your local hospital or medical center may have professionals who specialize in memory problems. The Alzheimer's Association also has much useful information and may be able to help you find help.