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Aging in Place Accommodations for Limited or Failing Memory

By Robert F. Bornstein, PhD and Mary A. Languirand, PhD

Back in 2011 we discussed coping with dementia, and described some of the common early signs of memory loss. As you'd expect, most people experiencing these early signs of memory loss are aware that something is wrong, and frightened about it. They usually begin searching for information to figure out what's going on, and many people consult their physician, seeking tests and treatments. Tests can be helpful, but keep in mind that while some memory-impairing conditions have obvious physical substrates (like signs of stroke or brain atrophy), many do not. This is one area of medicine where structure does not always mirror function: Some people with extensive brain atrophy are virtually helpless while others with very similar patterns function pretty much normally. The most accurate information regarding functional capacity-the "bottom line" in any dementia-will come not from brain images, but from neuropsychological tests that assess a broad array of cognitive skills.

Ironically, these neuropsychological tests, while highly accurate, are of limited use at the earliest stages because the results tend to confirm what you already really know-you might have a problem which bears watching. The good news is, having now established your baseline level of cognitive functioning periodic re-testing can yield very useful data, helping identify areas of loss and allowing your physician to generate a reasonably accurate prediction of how (and how rapidly) things will progress.

Tests notwithstanding, once you've determined that additional support is needed to accommodate memory problems, there are a number of things you can do. Among the most important are:

  • Implementing orienting cues

    Orienting cues are sources of information that tell you where you are, and what you should be doing. A familiar environment, in and of itself, is an invaluable orienting cue, and a key resource for successful aging in place. Prompts and reminders help too: The same electronic or paper datebooks that kept you organized at work can keep you on schedule for appointments, meetings, and other events today. You can purchase pillboxes that sound an alert when it's time to take your medication. Every cable company offers at least one 24/7 news channel that provides frequent reminders of the date and time.
  • Maintaining the environment to reduce risk

    A well-maintained house is the best defense against many risks related to memory loss. In early dementia one's ability to respond rapidly to unexpected problems deteriorates (so panic at the sound of a smoke alarm may lead to a fall down the stairs rather than appropriate corrective action). Prevention is the strategy of choice here, so repair or replace those appliances and fixtures that you've meant to get around to fixing. Replace old fire extinguishers, and be sure you know how to use the new ones. Make sure fire and smoke alarms, carbon monoxide detectors, and burglar alarms are in good working order, and that you know how to activate and de-activate them reliably. Consider investing in a Personal Emergency Response System so you can summon help quickly.
  • Obtaining in-home care

    The ideal accommodation for diminished memory is having somebody there to help, and more often than not spouses or partners provide this sort of support early on in the process. Sometimes two members of a couple have different needs and each can assist the other, and studies show that those willing to take on new roles and responsibilities may be able to extend their joint independence significantly (for example, the healthier partner takes the wheel as the less healthy partner's driving abilities wane). When memory loss becomes too great for the healthier partner to handle, it's important to be realistic as well: In-home care can prolong aging in place, and improve your quality of life immeasurably. If you feel selfish spending money on in-home care because of failing memory, keep in mind that regardless of who is the "identified patient", both partners will benefit. In-home care provides the healthier person an opportunity to rest, recharge his or her batteries, run errands, and attend to various personal matters. In this respect in-home care not only helps keep the person with memory problems safe and comfortable, it represents an important source of support for the healthier partner as well.
 

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, which is available at amazon.com, or may be purchased directly from HarperCollins Publishers.

Our latest book is entitled How to Age in Place: Planning for a Happy, Independent, and Financially Secure Retirement, published by Ten Speed Press, a division of Random House.