November is here, which means the holiday season is in full swing. To me, Halloween is like a warm-up for the “real” end-of-the-year holidays. Gorging myself on my kids’ Halloween candy is just a preview of the upcoming battle against the culinary temptations of Thanksgiving, Christmas, and countless holiday parties in between.
Of course, the holiday season is ultimately about spending time with the people you care about the most, and people go to great lengths to do so. Thousands of Americans will suffer through the monotony of a long drive, the mild humiliation of an airport TSA screening, or even the unique odor emanating from a seat partner on a long-distance bus trip, just to be home for the holidays.
In my line of work, the holiday season is a busy time. It’s the time of year when adult children take time off from the distractions of their everyday lives, and everyone is back in town to see Mom, Dad, or Grandma.
This is the time when many families begin to notice, to suspect, and even to discuss, the fact that a loved one may be showing signs of cognitive decline.
As a lawyer, I typically use the term “cognitive decline” rather than “dementia” or “Alzheimer’s.” These are closely related medical issues, of course, but I feel that cognitive decline more accurately addresses the legal consequences of these conditions.
It is rare for someone to suddenly become incompetent (to use the legal term) overnight. Instead, it is usually a gradual process in which a person’s cognitive function slowly declines. The difficulty is distinguishing between ordinary, old age forgetfulness, from something more serious.
The Alzheimer’s Association (www.alz.org) lists 10 Warning Signs of Alzheimer’s on their website. The complete list is worth reviewing if this is a topic that concerns you. The warning signs on their list include memory loss that disrupts daily life, or confusion with time or place.
It was the third warning sign on their list that caught my attention: “Difficulty with completing familiar tasks at home, at work or at leisure.” They provide examples as having trouble driving to a familiar location, managing a budget, or remembering the rules of a favorite game. It’s the last line that really spoke to me. It states: “What’s typical? Occasionally needing help to use the settings on a microwave or to record a television show.”
In the mid-1990’s, no one on earth could operate a VCR as well as my grandmother, who lived with my family during childhood. She had a true skill for deciphering VCR recording instructions clearly written by someone with only the faintest grasp of the English language. She always managed to record all of “her shows,” as she called them, and has a vast library of reruns to choose from.
We didn’t know it then, but looking back now it’s obvious. Gradually, she began to struggle to operate the VCR the television. In hindsight, this was a sign of things to come.
A few years later, on Christmas morning, we finally learned that her cognitive decline was neither minor nor attributable to old age forgetfulness. I recall my mother calling for my father, Steve, to get something from the kitchen. My grandmother looked at us, with a puzzled look on her face, and said, “Steve? His name’s not Steve.”
We quickly figured out she wasn’t joking. In fact, she couldn’t name a single person in the room. What was particularly strange is that she knew who we were – her daughter, her son-in-law, and her grandchildren – just not what our names were.
A trip to the hospital ultimately provided a diagnosis – vascular dementia, a condition with Alzheimer’s-like symptoms cause by a series of small strokes. In the short-term she did improve and remembered all of our names. However, over the course of the next ten years, her memory slowly slipped away.
This year, pay attention while you’re home for the holidays. Ask questions and talk with your family if you think a loved one may be experiencing diminishing capacity. If they are, the time to plan for their future is now. Talk about who they would want to care for them or manage their affairs if they are no longer able to do those things for themselves. Encourage them to have a good power of attorney, advance directive, living will, and last will and testament in place.
This can be a tough conversation for children to have with their parents. Just remember that you’ll be the one picking up the pieces, whether your parents do any planning or not. The best time to get their affairs in order is now, while they are still in relatively good health and spirits.