While many seniors with early stage dementia can live independently or with the help of family caregivers, those with greater cognitive decline may need help from specially trained dementia care professionals in memory care communities. But because dementia symptoms can vary day to day or moment to moment, it’s not easy to pinpoint when it’s time for memory care.
“When talking about memory care, or some form of a different living arrangement, I’ll center the talk around ability to perform activities of daily living and safety,” says Dr. Philip Branshaw, an internal medicine specialist in Batavia, Illinois.
Read on to learn what doctors look for when evaluating signs of Alzheimer’s or another type of dementia, along with some simple tools they use to measure cognitive decline. Then, answer 13 questions about your loved one and their caregiving situation to see if it’s time for a memory care facility.
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“Often, seniors come in for regularly scheduled physical appointments and are hesitant to bring up memory problems,” Branshaw says. “It’s almost always the kids who bring up memory, or it’s an uncovering process to find dementia signs.”
During patient visits, Branshaw looks for red flags signaling Alzheimer’s disease or another form of dementia. Certain telltale characteristics can suggest that it’s time for memory care.
“Looking at someone, you can sometimes see they’re not as tidily dressed, their hair’s disheveled, or they’ve lost significant weight because they forgot to eat,” he says.
If a senior seems lost or agitated, or if they can’t carry on a conversation, those are concerning signs. From there, doctors may ask questions about a senior’s day-to-day life or perform a brief mental status exam.
The ability to perform activities of daily living (ADLS) — such as dressing, bathing, and using the restroom — is a common benchmark to judge whether a senior needs extra help.
To gauge a senior’s abilities and safety, a doctor may ask if they:
If any of these red flags are present, your loved one’s doctor may suggest a mental status exam.
Bringing up safety concerns is an important way to make family members aware of dementia behaviors, Branshaw says. He may ask relatives or caregivers if:
Ask yourself if your senior family member’s safety needs are being met, or if they could use extra help to avoid dangerous situations.
“In the office, we can perform a very easy, reproducible test that only takes a couple of minutes,” Branshaw says. If the patient can read, the mental status exam may give a reliable baseline for tracking dementia symptoms and memory loss. This exercise measures short-term recall, concentration, and spatial awareness, and it may test a senior’s ability to:
Another common test is to ask someone to draw a clock, Branshaw says. “Many people with dementia will draw all of the numbers up in one corner, rather than around the circle.”
Most of the time, aging adults will visit their primary care doctor or geriatrician, who will perform these baseline tests if they suspect memory problems. After that, they may refer the patient to a neurologist or other specialist for further analysis and a specific diagnosis of Alzheimer’s or another type of dementia.
“Family caregivers should reach out to a doctor right away when they start to notice signs of dementia,” Branshaw says. “That way, we can get a baseline exam done, and we can track test results over time to see if memory loss is getting worse.”
At first, a senior may score well on memory tests and only have minor impairment, like forgetting difficult words or where they left their glasses. But it’s never too early to bring up these concerns: By discussing dementia early, you give your elderly parent or relative the opportunity to be a part of senior living conversations.
“It’s better to have the conversation with the patient now, when they can feel some autonomy and take part in the decision of what happens next,” Branshaw says. “It’s helpful, physically and medically, for the senior to be a part of the decision and the transition.”
Talking with a doctor during early stage dementia can also help with tough conversations. Professionals may be better-equipped to broach topics like driving safety, home modifications, or the transition to senior living.
Worrying behavior changes, safety concerns, and caregiver burnout are top signs it’s time for a memory care facility. Ask yourself these questions to help assess your family’s situation.
“Adult kids or family caregivers often don’t notice something and think their parent is OK,” Branshaw says. This is because when you’re caring for someone with dementia full time, it can be hard to notice progressive changes, like steady weight loss over several months. This change could be shocking and obvious to a family member or friend who only see the person a few times a year.
Seniors with dementia may experience confusion and tension leading to violence or aggression. They may kick, hit, or bite caregivers. Verbal abuse and manipulation are also common: Aging relatives may insult family members and friends or accuse them of theft.
“Often, patients will get agitated or defensive in the office when we start to have the conversation about dementia — that’s a sign in itself,” Branshaw says.
Aggression can be particularly dangerous when a senior with dementia is cared for by an elderly spouse, which can lead to elder abuse. Agitation and violence are most common later in the day, due to sundown syndrome.
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Someone struggling with dementia may begin to decline social invitations and withdraw. Lower energy levels are a normal part of aging, but avoiding favorite activities is a red flag. Similarly, someone who was once confident could become nervous to drive, opting to go on walks alone.
A senior who took pride in their appearance may forget daily hygiene practices, like bathing or changing clothes. They may also struggle to style their hair or apply makeup and become too embarrassed to ask for help. In severe cases, people with dementia may develop elderly incontinence or neglect to clean themselves after using the bathroom.
Wandering is a common sign it’s time for a memory care facility. Seniors could become confused or disoriented and wander far from home without realizing where they are or how to get back. This can lead to dangerous situations like approaching busy roads or being caught in severe weather. At home, well-placed locks and alarms may be necessary to prevent wandering. Memory care communities often have unique layouts and outdoor spaces to permit safe, secure wandering.
Someone aging in place with dementia may begin to hoard household items or neglect laundry and cleaning. They could eat spoiled food or forget to clean up pet waste.
Alzheimer’s safety risks at home may include trip hazards, fall risks, kitchen appliances, guns, or household chemicals. Dementia care at home often requires significant safety modifications.
Forgetting to take prescription medication — or taking too much of it — can lead to serious side effects. Reminders, alerts, and pill separators may be effective for seniors with early-stage dementia, but people with significant cognitive decline need more intervention. Medication management is an important feature of memory care.
Seniors with dementia may require special diet plans to combat existing health conditions. Adults aging in place may forget to eat, or they may overeat after forgetting they’ve recently had a meal, leading to significant weight changes.
Balancing your loved one’s needs with your own is vital. It’s normal for dementia caregivers to feel frustrated or overwhelmed sometimes. But if left untreated, those feelings can lead to caregiver burnout and negative consequences for the caregiver and their loved one.
If your immediate answer is that nothing is going well, or you have to really think about it, it’s time to seek help when caring for someone with dementia.
If you can’t think of anything positive about your loved one, you may be burned out. Too much time together can lead caregivers to focus on the negatives. Take the space and time to consider your relationship with your loved one and recharge.
Caregiver burnout can have serious consequences, physically and emotionally. If your own mental or physical health is declining, consider the effect caregiving has taken on your life: Are you feeling depressed or anxious? Are the physical elements of caring for a loved one becoming painful? Declining health can put both you and your loved one at risk.
Signs of dementia anger may lead to physical, sexual, or emotional aggression. It can be hard to accept that your loved one would threaten your safety, but these severe behavioral changes are common. Monitor violent behaviors, especially if you’re a sandwich generation caregiver with children in the home.
You’ve answered 13 questions and determined that your loved one may need additional care. Ask your aging relative’s doctor about next steps and a dementia diagnosis, and talk about signs that it’s time for memory care. Memory care communities can provide the support needed for your loved one to age in a safe, stimulating environment where their medical and emotional needs are met.
Talk with a local Senior Living Advisor about your answers to these 13 questions, and learn more about memory care communities near you.
The information contained in this article is for informational purposes only and is not intended to constitute medical advice or diagnosis. Always seek the advice of your physician or other qualified health care provider regarding any medical condition or treatment, and never disregard professional medical advice or delay treatment based on anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.