Last Updated July 2015
Understanding the Problem
In our busy lives, all of us forget things at one time or another.
As we age, this can happen more frequently and can be a natural part of the aging process. Some older people have little or no change in their memory, but, in others, forgetfulness can begin to interfere with their lives in a noticeable way. This might involve leaving bills unpaid, stoves on, or doors open—all of which can create serious safety concerns.
Short-term memory (remembering recent events) is the type of memory that becomes impaired most often with aging. This might include planning, organizing, and following through with current events and activities. Often long-term memories of childhood or young adulthood remain vivid, even in the case of Alzheimer’s disease. So it is short-term memory that is important to assess when there are concerns about a possible decline.
In the case of Alzheimer’s disease there might be many years of gradual change such that spouses and family members slowly take over responsibilities or daily duties that the individual had previously managed (for example, paying bills or making meals). When it becomes evident that the person is no longer able to do these tasks, an evaluation for possible Alzheimer’s disease or other memory disorder is needed.
On the other hand, many people notice memory loss but are able to continue to manage their household and monetary affairs without difficulty. While it is always good to seek an evaluation for someone if there are worries, in this group it is likely that the person simply has mild memory loss that is normal with age. Many healthy older people do not have any significant changes in their memory as they age. While slower retrieval of information is a frequent feature in these people (such as the “her name is on the tip of my tongue” phenomenon), they otherwise keep good memory function.
An abrupt change in mental status is called “delirium” which is different from dementia. Delirium is a state of confusion that can happen over just a few days. Causes of delirium might be a urinary infection, pneumonia, dehydration, heart attack, or a response to medicine. Persons with delirium have trouble paying attention. They might not be oriented to the place and time, and they can have trouble carrying on a logical conversation. Older persons with delirium might appear excessively sleepy and confused.
It is important to recognize delirium since people with memory problems are especially prone to having episodes of delirium if they become ill. The healthcare provider should be notified immediately.
Once the medical problem is treated, the delirium might improve and the person will be less confused, but the memory problems from the underlying dementia will still be there.
Memory problems can be due to many other conditions besides Alzheimer’s disease.
These conditions include Parkinson’s disease, large and small strokes, depression, and thyroid disease, for example. A detailed review of medicines is essential, since prescription, over-the counter, or herbal remedies can contribute to memory problems.
Some of these conditions can be treated or managed so that symptoms improve or stabilize. This is why it is important to schedule a medical check-up for the older person if you notice memory problems, particularly if they go along with other problems such as a change in weight, loss of appetite, gait instability, loss of urine control, or other new physical symptoms.
What are typical age-related memory changes?
Some changes in memory are related to aging, but do not indicate serious memory problems. Here are some examples:
- Sometimes forgetting names or appointments, but remembering them later.
- Making occasional errors when balancing a checkbook.
- Occasionally needing help to use the settings on a microwave or to record a television show.
- Getting confused about the day of the week but figuring it out later
- Sometimes having trouble finding the right word.
- Making a bad decision once in a while.
- Sometimes feeling weary of work, family and social obligations
- Developing very specific ways of doing things and becoming irritable when a routine is disrupted
Your goals are to:
- Be alert for signs of short-term memory loss
- Be aware that memory changes often turn up as changes in daily functioning such as planning, organizing, and making decisions
- Make sure that memory changes are thoroughly evaluated by a doctor or nurse and that all appropriate treatments have been considered
- Keep a detailed record of all medicines the older person is taking, including prescription, over-the-counter, and any herbal remedies. This will help the doctor or nurse to decide whether these could be contributing to the problem
- Understand that delirium might occur in persons with dementia
- Learn techniques for helping reduce the emotional stress and burden of memory loss
Click on each of the topics below to read more.
Call the healthcare provider immediately or go to the emergency room if any of the following symptoms occur
Sudden memory loss or confusion
Sometimes a sudden memory loss is the result of a stroke, which might be accompanied by other stroke symptoms such as paralysis or confused or slurred speech. It is important to get medical help immediately if a stroke has happened. Any other new episode of confusion that changes quickly over a day or a few days must be evaluated as soon as possible.
Call the healthcare provider during office hours to discuss the following problems
Significant memory loss following a change in medicines (including use of natural supplements, or over the counter medications for sleep, pain, and energy)
Often older individuals take several different medicines, sometimes prescribed by several healthcare providers. Sometimes they take over the counter medicines or natural supplements. It is important to always review the list of medicines with the healthcare provider at each visit and to check with the pharmacist to be sure that the combination is safe. If there is a change in memory, sleepiness, gait unsteadiness, or any other change after starting a new medicine or a new dose of medicine, notify the healthcare provider as soon as possible.
Memory loss combined with other symptoms of decreased functioning
As discussed above, most often memory loss progresses over time such that the ability to manage daily affairs, self-care such as grooming, and other daily activities becomes more impaired over time. When these things have occurred, and the older person has persistent difficulties with memory loss as well as trouble with planning, decision-making, word-finding, and other brain functions, there is a good chance that a dementia such as Alzheimer’s disease is present. It is important to have an evaluation by a healthcare provider to establish the diagnosis and make recommendations about continuing care.
Memory loss combined with depression
People with dementia often experience sadness, anxiety, tearfulness, or a condition called apathy where they have very little interest or emotion. Sometimes it is helpful to have an evaluation for depression, as treatment with antidepressant medicine can help a person function better and avoid other symptoms such as irritability, sleeplessness, or anger.
There are also symptoms that can wait to be reported until the next regular appointment with the healthcare provider
The older person can remember events that took place in the past better than recent ones
Short-term memory loss does not allow the brain to make new memories. The older person may talk often about the old memories which were well stored before the memory problem began.
Repetition
With greater memory loss, people are unable to remember what they just said. As a result, they may ask the same question or make the same statement over and over within a short period of time.
Frequent reminding doesn't seem to help
With more serious memory loss, frequent reminding does not help very much. You may find yourself making the same request or remark several times within a short period of time, without the older person remembering what you have said.
The older person does not think they have a memory problem
Sometimes people with serious memory loss have trouble realizing the extent of their loss. They seem to forget that they forget. They may deny the memory loss or play down the number of times that it has been happening.
Know the answers to the following questions before calling the healthcare provider
- Is there any new loss in mental function such as difficulty in paying attention, finding words, making decisions, telling time, remembering people, or remembering one's own name?
- Are there any new emotional symptoms such as a change in emotional state or personality, such as irritability or suspiciousness, that are unlike the person's usual self? Is there sadness or loss of interest in usual activities?
- Are there changes in the ability to function physically such as trouble sleeping, eating less, having urinary control, or walking with a steady gait?
- How often do the memory problems show up? Daily? Several times a week?
- Is there trouble recalling recent events?
- Have grooming or other daily habits changed for the worse?
- Are simple tasks hard for the older person to organize and perform?
- Does the older person get lost in familiar places?
- Are words forgotten, misused, or mispronounced?
- Does the older person become easily angered or agitated?
- Does the older person have difficulty in counting and managing money? Do they make unsafe decisions?
- Does he or she have difficulties remembering to take medications or miss doses of medicines?
- Are there other symptoms the person is having, such as changes in mood, changes in sleep-wake routines, and loss of interest in things he or she used to enjoy?
There are many things that you can do on your own to help an older person with memory problems
Be supportive
Help the older person see the humor in situations and give reassurance that being forgetful is normal and that your love and support has not changed. In the case of Alzheimer's disease or other forms of dementia, it can be difficult to work with the older person, so discussing coping strategies with the healthcare provider can be helpful.
Be helpful and non-judgmental
Do not quiz the person. Often it is natural to want to "test" to see how the older person's memory is functioning. Being questioned, "Do you remember this or that," can be very anxiety-provoking. It does not help improve memory in a person with memory loss, and can upset the person. Instead, be unconditionally supportive.
Be patient
Memory loss is frustrating for everyone. If the older person is trying to explain something to you and forgets a word, help them if you know the word. If the person loses something, look for it rather than asking them to remember. If there is a little memory slip-up, show the humor in it. Keep in mind that the problem isn’t that older people won’t remember to do things - they can’t remember.
Avoid arguments
When people with memory loss make mistakes such as calling someone the wrong name, or confusing places and dates, unless it is absolutely necessary, do not argue or repeatedly correct them. They are not able to learn to get it right, and arguing or correcting them only creates more anxiety and distress.
Encourage doing familiar things that are pleasant
Avoid long activities, too much commotion, and unfamiliar settings. Be aware that changes in surroundings are confusing to the person with memory loss, and they can get tired easily. This can lead to irritability and behavior problems when they are over-stressed. Short outings to familiar settings are best; avoid long trips, large groups, and loud chaotic settings.
Encourage regular routines
Important activities, such as eating, exercising, or washing, should be tied to a particular time of day and place, so they can be remembered more easily.
Use reminding strategies. When memory loss is obvious, try these reminding techniques:
- Encourage carrying a memo book to write down significant events or people's names. Use neck chains for glasses or keys.
- Keep the person active with "over-learned" tasks. There are many activities that older people might have over-learned through repetition during their lifetimes. These might include playing an instrument, doing puzzles, crocheting, or other handicrafts that their hands can almost “do by themselves.” These activities, especially those involving music, can be especially therapeutic.
- Encourage regular routines. Important activities, such as eating, exercising, or washing, should be tied to a particular time of day and place to be remembered more easily.
- Make your instructions simple and break tasks down into simple steps.
- Visit the Dementia section for more information and resources.
Problems you might have carrying out your plan
“My mother doesn’t realize—or doesn’t care—that she is very forgetful.”
It is frustrating when the person with memory problems does not recognize the problem or does not seem interested in doing anything to improve it. Be gentle and constructive in your approach. Try to work with the older person. Make your reminding strategies simple and clear. In cases where there has been major memory loss, such as with Alzheimer’s disease, other behavioral problems may develop which can make the older person uncooperative and even aggressive. In such cases, you will need professional assistance. Most importantly, do not argue or confront the person, since people who do not have this insight into their problem will not gain insight no matter how much evidence is presented to them.
Be sure that memory problems aren’t interfering with taking medicines as prescribed. You might want to consider weekly pillboxes and a system of daily reminders. Typically it is best to have someone other than the person with memory problems responsible for dispensing the medicines to be sure they are taken properly.
Think of other problems you might have carrying out your plan
What additional problems could get in the way of doing the things suggested in this section? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?