Caring for cognitively declining elders

I'm 53 years old and I did not really think that I would be at the point where I would need to help take care of my 89 year old father; he always seemed so sharp and vigorous. I've had so many patients who have come to me telling me about how challenging it is physically, emotionally, and often financially to take care of their elderly parents. Now, I understand.

Increasingly, we are seeing more and more elderly afflicted by dementia. 20 or 10 years ago I was less familiar with the frequency of the diagnosis of this terrible disorder. I vaguely recall euphemisms about decreased cognitive capacity in older adults as "just part of getting old," or "dad doesn't have all his marbles now."

A recent study by Columbia University researchers published in October, 2022, found that over 10% of people 65 and older have dementia, and 22% have mild cognitive impairment (more common - age related senility). When I studied at Columbia about 25 years ago, I don't remember hearing about or being taught about these disorders. Now it is the focus of myriad medical and scientific researchers. Part of this discrepancy seems to be the fact that in the modern era people are living longer and that comes with pros and cons. Also, there seem to be correlations between external factors and the development of dementia, such as poverty and race. Interestingly, they did not find that biological gender was associated with different rates of dementia. If you want to read more about the findings of the study you can find it here: https://www.cuimc.columbia.edu/news/one-10-older-americans-has-dementia

Caring for an elder with dementia is very trying and emotionally upsetting. The individual who has Alzheimers, as an example, may first recognize on their own that they are forgetting more and more, but they are in denial and become defensive if family members point this out to them. As time and the disease progresses, however, the person with Alzheimers changes and becomes unable to remember their children's or grandchildren's faces and names. This is when the caregivers seem to be hit especially hard emotionally.

I knew a black teenager who was raised only by his grandfather. They both came from an impoverished background. The teen's life fell apart when his grandfather became demented. He lost contact with his friends. He dropped out of high school to help take care of him. He developed depression and feelings of helplessness because he did not know how to help. He took his grandpa to doctor's appointments and fed him, bathed him. Can you imagine doing this as a teenager? Well, at the end of his course of treatment his grandfather no longer recognized him and died soon thereafter. It seemed like such an unfair situation. But as we know, life is often unfair, inequitable, and unjust (sorry, a touch of cynicism here).

I'm sure there are elders who do not have family members or friends who can help them or choose not to do so. It is a great deal of work, time, and worry. Hiring a caregiver or placing the elder in a "memory assisted living" is very expensive and usually insurers won't cover it.

The elders who do have family members and/or friends who step up to the plate to be there and to help are to be credited and to be acknowledged for their self-sacrifice. They tell me, however, that they do not want thanks, they see it as their duty.

As time marches on and our elderly parents become more of a shell of their former selves, we face the harsh realization that we have fewer turns around the sun with them and without them. To continue the analogy, as we face the precious moments of our warmth in the sun, we must also realize that the moon is also turning and casts its dark shadows on our precious Earth. Shadows and light -- both part of life. Near the end, for most of us, it feels like there are more of the former and less of the latter.

In my next entry, I will talk more about coping with the great equalizer.