Expert advice to help guide this tough but important conversation
It's natural to be concerned when a loved one seems more forgetful or confused than usual. It may be difficult to express your concern, however, because you're afraid of what memory loss can mean — and how the person may react if you broach the subject.
"It’s scary to think your loved one might have Alzheimer's disease or another type of dementia," says Magdalena Bednarczyk, MD, a geriatrician at Rush University Medical Center. "But it's important to have that conversation because people experiencing memory changes often don't realize it. Or they know something is wrong, but they're reluctant to tell anyone. Either way, the problem isn't addressed and gets worse."
If you notice a pattern of memory or behavioral issues that are affecting a loved one's ability to function, it's essential to talk about it so they can be evaluated. A geriatrician or primary care doctor can help determine whether those issues are related to dementia or something else, such as a medication, chronic health condition or depression.
To help initiate and guide what can be a difficult conversation, Bednarczyk offers these six tips.
1. Plan what you're going to say.
If you witness memory or behavior changes, don't speak up in the moment. However well-meaning, blurting out, "You've been really forgetful lately," or "You're not acting like yourself; what’s wrong?" may cause your loved one to get defensive, upset or withdrawn.
Take the time to come up with a plan for how to have a respectful, productive conversation. Start by considering these questions:
- Has your loved one noticed the symptoms?
- Do they think their memory/behavioral issues are just a natural part of aging?
- What could be stopping them from seeing a doctor? Fear? A logistical or financial issue? Do they think there won't be any point to seeking help?
- What approach has worked in the past to help persuade your loved one to do something they were unsure about doing?
- Who could be the best person — or people — to broach the subject? Is it better to have a one-on-one talk or involve others?
- Does your loved one prefer to have a lot of information to understand all possibilities, or take things one step at a time?
- Would they feel better if someone offered to go with the doctor with them? If so, who?
2. Set a soothing scene.
Once you are ready to approach your loved one, figure out the best place and time to talk.
"I don't recommend talking in a public space, like a restaurant," Bednarczyk says. "You want to be in a familiar but quiet surrounding where you won't be interrupted and your loved one will feel comfortable, not threatened or anxious."
Select a time when neither of you will be rushed so you have enough time to address concerns, answer questions and plan next steps. Don't try to squeeze the talk in before work or between activities; pick a day when you aren't working, or arrange to stop by and bring dinner after work.
"Also, it's a good idea to have the conversation shortly before a scheduled appointment with your loved one's primary care doctor or geriatrician. That way, they can see their doctor soon after your talk," Bednarczyk advises.
If there isn't an appointment already on the calendar, call the doctor's office and check availability so you can plan to have your talk close to when you'll be able to schedule the exam.
If your loved one doesn't have a primary care doctor or geriatrician, you may need to help find one. Ask relatives and friends who live in the area for recommendations of doctors they like and trust. Or look at the online physician listings for nearby hospitals: for example, Rush's Find-a-Doctor tool.
Make sure you aren't dictating — 'This is what we're going to do' — but convincing your loved one to help figure out a way to move forward. You want this to be a partnership.
3. Explain why you're concerned — without being judgmental.
You're sitting with your loved one, ready to have the conversation, but how do you begin? Begin by explaining why you wanted to talk: You care, and you're concerned.
To make it clear why you're worried, give specific examples of incidents or behaviors you've noticed. But make sure to use nonjudgmental language. "You don't want your loved one to feel it's their fault and you're blaming them," Bednarczyk says.
For example, instead of saying, "You haven't been paying your bills," which sounds accusatory, try a softer — but still specific — approach: "You seem to be finding it difficult to pay the bills."
4. Encourage a dialogue.
"Make sure you aren't dictating — 'This is what we're going to do' — but convincing your loved one to help figure out a way to move forward," Bednarczyk says. "You want this to be a partnership."
That means doing the following:
- Talk openly and honestly. Don't be afraid to let your loved one see that this is hard for you, too.
- Be a good listener. Let your loved one express their thoughts without interrupting, and don’t be dismissive even if you don’t agree.
- Ask your loved one for feedback. Did they notice something was off? What are they concerned about?
Remember: This conversation is a beginning, not the end. You don't have to resolve everything in one day. The goal for now is to establish good communication and trust.
5. Create a positive plan of action together.
End your talk on a positive note and, if possible, with agreed-upon next steps — starting with scheduling a medical evaluation with a primary care doctor or geriatrician.
"If your loved one has anxiety or expresses doubts about seeing a doctor or any part of the plan, try to emphasize that this process will help them, not cause harm," Bednarczyk says.
In some instances, memory loss not related to dementia is reversible. For instance, doctors can change or adjust medications, or refer a person to a therapist to address depression. And if the diagnosis is dementia, knowing early will enable your loved one — and you — better prepare for the future.
6. Don't get discouraged if the process takes time.
Even if you make every effort to have a calm, respectful, caring conversation, it may not go as planned. Your loved one may insist nothing is wrong. They may get angry, upset or defensive, or simply refuse to talk about it. They may say they don't need to see a doctor, or give an excuse — "I'm too busy."
If that happens, and you find yourself getting frustrated or flustered, don't keep pushing in that moment. Step back, give both you and your loved one a chance to calm down, then try again after a week or two. If you think it will help, ask another family member or family friend to join the next conversation.
If you still can't convince your loved one to get help, don't hesitate to call their primary care doctor or geriatrician and ask the staff to recommend resources to help you. Many hospitals, including Rush, also have social workers and resource centers available to offer guidance.
"You may need help, and that's OK," Bednarczyk says. "That's what we're here for — to support you and your loved one every step of the way."
Reviewing how to talk to someone with memory loss
- Plan what you want to say.
- Choose a time when you won't be rushed, and a setting that is quiet and unthreatening.
- Be compassionate and helpful, not judgmental.
- Problem-solve together; don't dictate.
- Try to come up with tangible, agreed-upon next steps.
- Ask for help from a doctor, social worker or family member if necessary.
Dealing with memory loss can be extremely stressful for both the person experiencing it and the person caring for them. But it's important to keep your emotions from boiling over. If you find yourself getting angry or exasperated, step away and compose yourself before resuming the conversation. Anger can be especially distressing for someone with memory loss, and you don't want your loved one to think you blame or resent them.