Dealing with memory loss in older people

January 8, 2008 12:54 PM

How can I constructively discuss my grandmother's short-term memory loss with her?

I'm currently staying with my grandmother for a couple of weeks - she's in her early 80s. She had a second pulmonary embolism just before Christmas and is still recovering from that (breathlessness). I, and others in the family, are worried about her short-term memory loss. I have noticed this for about the last three years. Other family members have noticed it but thinks it comes and goes.

A trivial example is her confusion about what day it is - this morning she asked six times in twelve minutes what day it was. A more important example is that she is not able to remember to take her drugs (she has three lots to take at different times each day). The most important, warfarin, is supopsed to be taken at 6pm. We have put up reminders in places where she is likely to be. The last couple of days I've said "it's six o'clock" at 6, and she's asked what the significance of the time is. We have been through what she has to take when at least four times in the last three days, and I know my cousin did so before that, and she has made notes on it, but still can't remember it. My grandmother is a very bright woman (was an academic) and is still able to have challenging intellectual conversations, though next day she may have the same conversation again. It's not lack of capacity or inability to reason, it's memory loss. Left alone she spends a lot of time obsessively looking through her diary to find out what's happening that day. She also tells stories about past events (from her childhood to a few years ago) which I don't think are true (conflict with other people's stories, or I was there and know they are not true). I'm not too bothered about this - it's her past and if she wants to rewrite it that's fine - but we are worried in particular about how to get her to take the drugs when no-one's around.

We have talked with her about the fact that she forgets them and she has accepted that she has short-term memory loss, but an hour later she will have forgotten that conversation. We want her to talk to the GP about it but this is very difficult as she constantly says there is not a problem. We have also discussed strategies like someone telephoning her or calling in at six each day to remind her, but because most of the time she doesn't remember that she forgets them she is unhappy about this - she has lived alone for 40 years and been very independent.

Has anyone any experience of talking to people about short-term memory loss and have suggestions about how we can get her to accept that, certainly at the moment, this is a serious problem?

Additionally, should memory problems be something that should stop her driving? She's not driving at the moment but is very keen to start again.

We are in the UK, if that makes any difference, and the rest of the family lives 300-600 miles away from her. Thanks to all.

posted by anonymous to health & fitness (8 comments total)

Oh, I do feel for you. We went through something very similar with my GrandMom... First it was taking her meds, the memory lapses. Then it progressed into loss of schedule. We were taking turns staying with her. She'd be up nights and want to sleep during the day when we were at work... She would not eat enough, even when we made her favorite things. And, like yours, she didn't acknowledge that she had a problem. The docs weren't much help (in US) but it was either dementia or alzheimer’s.

The car is a big concern because she could forget how to get back home or get into an accident more easily... Taking meds on schedule is also difficult to arrange unless you can find a service that will come in "x" number of times a day to administer the meds.

From our (limited) experience - there's no way to explain the situation to them that we found. And, if she's independent like mine was, she will be resistant to any help. My other GrandMom was kept at home until she kept trying to walk down the street with a clothespin in one hand and a pinecone in the other, trying to "go back home to Papa." But, she was "docile" and ended up in assisted living with no fuss. The independent GrandMom fell and broke her hip and needed rehab. She never went home after that, but kept wanting to know when she was going to be able to go....

It's great that you're able to assess the situation and find some help, now, while she can be at home. Check into any type of elder care assistance available to you in the UK. I'm sorry to not have any concrete advice, other than to tell you that each person is unique and you'll have to tailor any assistance to her specific needs. It can be a downward slope, I'm afraid.
posted by mightshould at 1:56 PM on January 8, 2008

Holy moly possum, we just went through this at the beginning of the year.


You have to stop her driving, first and foremost.

She's a danger to herself if her memory is this bad. What if she leaves the oven/toaster on. Or the front door open or eats food that she forgot to refrigerate or forgets to eat?

All things that happened to my grandmother.

It's not really something you can ignore. First thing is either her g.p. or local aged care team.
Sounds like she's no longer able to make fully informed decisions as she's not capable of holding all relevant information in her head at any one time.

You can word it like..... "Grandma, I've noticed your memory is a little bit skew-wiff. Mine gets like that too sometimes. How about we make an appointment at the g.p. to make sure you're not anaemic or don't have a urinary tract infection. Both of these can make you feel under the weather or tired without any other symptoms. I'm sure I'm being a big fusspot, but I love you and when I have to leave, I won't feel comfortable unless this is sorted. Please just humour me, and see lovely Dr X. I'll come with you. We'll make a day of it and go for lunch and a film after. "

I don't think anaemia is likely to affect her memory, but grannies know all about it and understand it. Something she's likely to be happy to have treated. Urinary tract infections can make the sanest grannies seemingly demented. One course of antibiotics and they're back to their normal selves. But she may have vascular dementia or depression.

Please don't leave her living alone without this being seen to.

It's horrible. But we just got the doctor and our local aged care team involved. It progressed and she's now in an aged care facility. But her memory is now so bad, she doesn't remember many conversations till the next one.

Good luck possum. Please feel free to email me with any questions or suggestions if I haven't been specific enough.
posted by taff at 2:03 PM on January 8, 2008 [2 favorites has favorites]

Consider that the mixture of meds might be causing a problem. You could make a list of everything she is taking and research yourself for interactions and side effects or go to a good pharmacist for advice.
My grandmother developed what seemed like severe dementia at 84, mixing people up, thinking people long passed were still alive and so on. A very daring caretaker took her off all medication and it cleared up in a day (I am NOT recommending that method!).
posted by InkaLomax at 2:26 PM on January 8, 2008

This might be expensive, but here are my two suggestions:

Can you hire someone who checks on her once or twice a day? Signing up for the UK equivalent of "meals on wheels" might be the easiest answer. Said person can bring her food, and remind her, verbally, to take her meds. I have done Meals on Wheels here in the States and was made aware of special conditions, etc. for each person I visited. It was easy enough to make sure that X person answered the door, ate their food, whatever it was I was asked to do for about 15 minutes at a time.

Secondly, if that is not a good option and a nurse/medical provider is too expensive, can you get her a device of some kind with an alarm on it that goes off daily and tells her to take her medicine? It could be anything from a call service where she answers the phone to a Blackberry. If farmers can use it to train cows to come in at a certain time, there HAS to be a device with an alarm on it for grandma's medicine.

Not being in the UK, I'm not sure what options you have, but surely even a neighbor could pop in every day to ensure she's medicated, alive, and conscious.

My suggestion if she balks at these options, you might have her doctor explain what's going on to her and have someone come and videotape it. She can see evidence that she was told these things and agreed to them, hopefully.

Honestly, she needs managed care. Her pride and sensibilities may be resistant to it, but hopefully she will be lucid and aware at some point enough to understand what is happening if a doctor and a family member are both involved.

My grandmother (who is dead now) had dementia related to a series of strokes; the fire dept. called us numerous times after picking her up walking down the street screaming "my house is on fire" in her underwear. I understand completely your concern and hope that you can find a part-time care provider or neighbor willing to help.
posted by Unicorn on the cob at 2:56 PM on January 8, 2008

My first thought was that her meds urgently need to be evaluated (and is she taking/eating anything else that can interfere with proper effectiveness?)
posted by desuetude at 5:48 PM on January 8, 2008

The Alzheimer's Association website has a lot of good information about dealing with folks who have memory loss.

If your grandmother doesn't have a neurological diagnosis, she needs to see a neurologist pretty soon.
posted by ikkyu2 at 7:14 PM on January 8, 2008

Write to her GP about your concerns. In the UK, drivers over 70 only have to sign a form saying they are medically fit to drive to keep their license, without even so much as an eye test. I'm not sure, but I believe her GP is the only one who can recommend her license be revoked.

As for the pills, there are a lot of clever electronic devices to help people remember their pills. For extreme cases, there are even devices that dispense the pills at the correct time but do not allow access at any other time to prevent accidentally taking multiple doses because you forget if you took it or not.
posted by happyturtle at 11:44 AM on January 9, 2008

You seem to be getting all the right points. She can't remember your conversations about this so talking to her about it isn't much help. She can't be trusted to manage her medication. She can remember long-term memories with ease. She can reason well. She just can't remember yesterday or even a few minutes ago. Those are facts. Adjust your behavior around them. They are probably going to get worse, not better.

What I have found, via my elderly grandfather, is that while he can't remember specific facts, he can be conditioned. For example, a new medication would be news to him and have to be explained with every single dose for a while. But eventually he'd take it without any resistance. The habit would form. He'd still ask what it was, but he would go along with it quite easily.

I hope your grandma keeps her wits about her. Carrying on a fun and witty conversation is good for her, and even if she doesn't remember the specifics of it, she will carry forward some impression that you are interested in her and that she loves and likes you. Memory is a utilitarian function which you must expect to decline, but that doesn't mean you can't make an impression on your elders, or condition them to certain behaviors when needed.

Perhaps a better way to say it is that they can't remember but sometimes they can still learn.
posted by scarabic at 7:14 PM on January 11, 2008