Dec 19, 2014 — It’s never easy to bring up the declining health of parents and loved ones, especially at a time that’s meant to be happy and celebratory. But Dr. Norman Foster, Director of the Center for Alzheimer’s Care, says there are many benefits to discussing the matter with the whole family around. He provides pointers for bringing the topic up and how to move forward with everybody involved.

Interview

Interviewer: What should you do if you think an elderly family member shows signs of memory loss? We'll tell you, coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Norman Foster is the director for the Center of Alzheimer's Care, Imaging and Research at the University of Utah. If we notice as family member showing signs of memory loss, is that a concern?

Dr. Foster: It is a concern. And I wanted to talk a little bit about the holidays. We often find that the holidays bring out concerns because they're more recognizable. Either because now we're seeing the person and how they're functioning at home where maybe we don't get the chance to see them very often, or there are new challenges with the holidays. The Christmas cards didn't get sent out or they didn't get sent out right. Or maybe certain people in the family didn't get gifts as expected.

Interviewer: So, these are signs that if you notice these, these should be...

Dr. Foster: These are huge, huge issues that need to be addressed.

Interviewer: Some red flags.

Dr. Foster: And then, by having other family members there, it may be that other family members can compare notes. Have you noticed this? I was a little concerned because mom didn't seem to know that we had talked last week. Is that something you're experiencing too? You can compare notes and see whether your concerns really are validated or not.

On the other hand, this is also the time when family members getting together can begin to address these problems. So just observing that there's a problem is one thing, but getting all the family members together on the same plan and in agreement is another challenge.

Interviewer: So even around the holidays where that's the last thing you want to talk about, right?

Dr. Foster: Absolutely. So it's a good opportunity. How many other times do you get all the family members together to develop a unified plan and some general agreement about management? And yet, it's a very challenging time, too.

Interviewer: So you recognize it. You've talked to some of the other family members. You've confirmed it. At that point, what do you do? Because this is the important part, it sounds like, as far as you're concerned.

Dr. Foster: That's right.

Interviewer: Recognizing one thing and doing another.

Dr. Foster: That's right. And so what happens often and the first appropriate step is to voice that concern to the person. Now it may be to the person and their spouse, for example. And then expect or hope them, encourage them to get the evaluation to see if there's something medically important that is wrong or not.

Interviewer: So you recognize it. Would you recommend it during the holidays, when everybody's there, this conversation is had? And how does it even start?

Dr. Foster: We want to have knowledgeable, empowered, care partners. And that's what we're looking for. We're looking for a care team, a supportive team. And I think this is important that, "Mom, we're all concerned. We're here to help you. We're looking out for your best interests."

Interviewer: So come from a place of empathy and understanding.

Dr. Foster: Empathy and understanding. And you have your family here. I often end up saying to patients in clinic that you're very fortunate to have concerned family members. In fact, we know that not having concerned family members is probably the best predictor of early unnecessary institutional care.

Interviewer: Wow. So, Dr. Foster, you're right behind me here. You're whispering in my ear as I'm going through this process.

Dr. Foster: Right.

Interviewer: We've checked notes. Now we're talking to mom. We suspect that you might have some memory problems and we're concerned about you. What do I say now, Dr. Foster?

Dr. Foster: Well, one of the things is I can help. So, you could ask, "Who is your doctor?" "Can I help you by calling and making an appointment?" And then when I, as the son, am making the appointment for the mother, I can be sure that I'm going to be there. In other words, by you making that appointment, you're going to make it at a time, on a day that you can be there with her.

Interviewer: Yeah.

Dr. Foster: So that she doesn't have to go in to a sometimes fearful, daunting, situation alone.

Interviewer: What is the downside if I don't do this?

Dr. Foster: Think about the quality of life. Somebody who's depressed or has memory problems can withdraw from social activities. When the patient withdraws from social activities, other family members, often spouses, also withdraw from other social activities. And so you really need to be focused on quality of life. "Mother, I'm concerned about you. You don't seem to be going out and meeting with your friends anymore. You aren't getting out of the house."

I mean, there are practical consequences to memory problems which, if the memory problems are not addressed, don't go away by themselves. And understanding why mom isn't getting out. Is it depression? Is it Alzheimer's disease? Is it some other problem causing memory loss? Is it just anxiety? These things are all treated in different ways. And so there's unnecessary disability that comes along with not knowing what the problem is or having it evaluated.

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