When you suspect that a loved one may be displaying some early signs of a cognitive impairment, it can be difficult to confront that person with your concerns. Exactly how you broach that initial conversation can depend, in part, on your relationship to the person or your family dynamic.

However, Carolyn Lazaris, a community educator with the Alzheimer’s Association and co-facilitator of Coastline’s Savvy Caregiver Program, said the most important step you can take is finding the fortitude to actually have the conversation.

Generally, having a conversation early on – when you first notice the changes in your loved one – can help you avoid a crisis later.

“Oftentimes, what happens with a crisis is that it takes away some options we might have otherwise had,” said Lazaris. She said it’s also important to have the conversation sooner rather than later because it enables your loved one to become part of the decision-making process, to voice their wishes, and to talk about what matters to him or her.

Plan to talk:
There are plenty of reasons why you may hesitate to break the ice. You may try to rationalize or downplay some of your loved one’s cognitive changes. You may be concerned that broaching the subject at all will anger them. But once your loved one’s memory, language or judgment skills begin to interfere with daily life, it’s time to talk.

“We’re much more likely to have successful conversations when we strategize about ways to start that conversation,” Lazaris said.

Before sitting down to talk, you may want to write notes detailing instances when you’ve noticed changes in your loved one’s cognition. Think about how you’re going to start the conversation – and where you’re going to have it.

Consider how the other person might feel in that situation, and practice ahead of time. Lazaris also recommends having the conversation in the morning.

“For a person with a cognitive impairment, they’re working really hard all day long to stay focused and get things done and not let anyone know they’re having trouble,” she said. “By the end of the day, they’re exhausted. So that’s not the time to talk because they might shut you down.”

Encourage your loved one to seek professional help:
After talking to your loved one about the changes you’ve been noticing, there are some other topics to consider. Encouraging your loved one to have a medical evaluation should be a top priority. For starters, an evaluation could help determine if the cognitive issues are actually dementia or if they’re occurring due to another condition.

“It could be as simple as a vitamin deficiency, a [urinary tract infection] or the wrong kind of medication. You want to get an assessment because there may be something that could be corrected,” said Lazaris. “What happens, though, is that there is fear and stigma attached to going to the doctor to get assessed. But it’s important to have that diagnosis.”

If you’re worried that your loved one may downplay their cognitive changes with their health care provider during a routine exam, you may want to consider writing a note to the doctor.

You can talk to each health care provider about signing a HIPAA authorization form, which will enable them to discuss your loved one’s medical information with you. (The HIPAA form is different than a health care proxy, which is only activated when a patient can no longer make his or her own decisions.)

Reach out:
Lazaris said it can be challenging to know where to turn, which is why it’s important to connect with your local council on aging or Coastline to know what options are available. Even if you are the sole caregiver for your loved one, she said you are not the only person on your care team.


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