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.
Learn signs of Alzheimer’s or another type of dementia doctors look for, and 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.
“Often, seniors come in for regularly scheduled physical appointments, and are hesitant to bring up memory problems,” says Branshaw. “It’s almost always the kids who bring up memory, or it’s an uncovering process to find dementia signs.”
There are several tell-tale warning signs it’s time for memory care Branshaw looks for during patient visits — red flags that Alzheimer’s disease or another form of dementia may be a concern. “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 agitated, lost, or 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) like dressing, bathing, and using the restroom, is a common benchmark to judge when a senior needs extra help.
It’s helpful, physically and medically, for the senior to be a part of the decision and the transition. Dr. Philip Branshaw, internal medicine specialist
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, says Branshaw. 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,” says Branshaw. 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 may test a senior’s ability to:
Another common test is to ask someone to draw a clock, says Branshaw. “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 be referred 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,” says Branshaw. “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 the time someone’s burned out, they’re depleted. They have nothing left to give. Teepa Snow, dementia care expert
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,” says Branshaw. “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 more well-equipped to broach topics like driving safety, making home modifications, or starting 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.
1. Have friends or family members commented on changes in behavior?
“Adult kids or family caregivers often don’t notice something and think their parent is OK,” says Branshaw. 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 sees them a few times a year.
2. Is your loved one agitated or aggressive?
Seniors with dementia may experience confusion and agitation that lead 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,” says Branshaw.
Aggression can be particularly dangerous when a senior with dementia is cared for by an elderly spouse, leading to elder abuse. Agitation and violence are most common later in the day, due to sundown syndrome.
3. Is your aging relative withdrawn or nervous?
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, go on walks alone, or even leave the house.
4. Are hygiene needs met?
A senior who took pride in their appearance may forget daily hygiene practices, like bathing or changing clothes. Similarly, someone may struggle to style their hair or apply makeup and be 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.
5. Does your loved one wander? 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.
Family caregivers should reach out to a doctor right away when they start to notice signs of dementia. 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. Dr. Philip Branshaw, internal medicine specialist
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.
6. Are living conditions safe?
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.
7. Are medications properly managed?
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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 those with significant cognitive decline need more intervention. Medication management is an important feature of memory care.
8. Is your loved one getting proper nutrition?
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.
9. Have you started to feel caregiver burnout?
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. Teepa Snow, a noted dementia care specialist, recommends asking yourself the next four questions to determine if burnout is a problem.
10. What are two things that are going OK, and one thing you wish were different?
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.
11. What are some things you still like about your loved one?
If a caregiver can’t think of anything, says Snow, “That person is burned out. They’re tired, they need space and time, and there needs to be an immediate response.”
12. Is caregiving affecting your health?
Caregiver burnout can have serious consequences, physically and emotionally.
“By the time someone’s burned out, they’re depleted. They have nothing left to give — they’re either depressed, anxious, or a combination,” says Snow. If nothing changes, the caregiver and their loved one are at risk, she notes.
13. Are you and your family safe?
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 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.