Over the years I have often been asked by the elderly if they should be concerned about their memory loss and if they had dementia, because they could not remember everything they had to buy at the shops. Interestingly, the question often came from individuals who did not have dementia. These people lived independently and were fearful that their health would suddenly decline and that they would face moving into a nursing home. Many older adults are fearful of developing dementia. Individuals with dementia, on the other hand, rarely reported concerns with memory loss when asked as part of the psychological assessment “my memory is great, it has never been better!” is the response I often get. However, there was evidence of memory loss as those individuals had great difficulty describing the events that led them to moving into the facility.
Briefly, let’s review dementia, as often people have difficulty differentiating dementia and Alzheimer’s disease. Dementia is a broad term used to describe many different diseases including: Alzheimer’s disease, vascular dementia, fronto-temporal dementia, dementia due to Parkinson’s disease, alcohol abuse and so on. Currently, there is no cure for dementia. However, the progression of the disease can be reduced by limiting alcohol intake, staying in a good routine, keeping physically active, trying new activities and having a well-balanced diet. Dementia is often not detected in its early stages, as the individual may not discuss any changes that they have with their family or the symptoms can be subtle that they can be attributed to stress. This potentially explains why many older adults are diagnosed with dementia once the disease has advanced and why moving into supported accommodation can be difficult. Individual with dementia may have reduced insight into their level of support needs.
Dementia does not account for all the memory loss in late life. There are a number of other conditions as well as lifestyle factors which can influence cognitive changes. For example, changes could be due to new environment, poor sleep, worry, the effects of medication, depression, anxiety and adjustment. When an older person is removed from their community due to declining physical health they can become more isolated. Isolation can affect emotional wellbeing and memory. If we do not interact with others and all days blend into one, we cannot quite remember what day it is or what we need to do tomorrow. It is well established that loneliness and isolation can be detrimental to our physical and emotional health. The effects of loneliness on memory is less evident.
There are two distinct two types of memory that we have and they are called declarative and procedural memory.
Not remembering how to complete tasks affects an individual and their wellbeing. Not engaging in meaningful activities which activate procedural memory can particularly affect an individual and their sense of belonging and purpose in life. This is an area where the delivery of emotional care and engagement can see drastic improvements in an older person and their functioning. For example through targeted and supported activities such as craft, gardening, cooking, walking and social outings as well as strategies to address negative self-talk, low self-esteem and feelings of hopelessness.
Supporting older people to improve their engagement and participation in their community can improve their wellbeing. Mental health conditions, such as depression and anxiety, are the same conditions throughout the lifespan. Treating a mental health condition can improve how the older person feels and their activity levels. Once the individual becomes more engaged in their environment, take part in meaningful activities, practice good sleep hygiene and improve their dietary intake they can experience improvement in their memory.
It is normal not to remember everything that happens every day in one’s life. For example, I am not sure if the last time I purchased milk was on Sunday or Monday. It does not really matter. Sometimes we can become so fixated on the fear of memory loss that it can cause us unnecessary stress and worry. Instead of focusing on memory loss we should put more effort on focusing on our engagement and activity levels. Being engaged in activities and interacting with others can improve our wellbeing, physical and emotional health.
PS. I just remembered, the last bottle of milk was in fact purchased by my husband on Saturday ;)