Cognitive decline is an empathic challenge.  Relatives can be challenging when healthy but much more so when age and disease affect mental processes.  The need for people maintaining dignity and independence must be balanced with the need for physical safety and financial security.  Understanding what is happening can be difficult.  Understanding the often gradual process of loss and letting the elderly transition gracefully is even tougher when they are far away.  Few people will admit disability even assuming that they know that they have disability.  They fear that self respect and dignity will be ripped away when they prove they can no longer competently complete tasks such as balancing the check book, managing financial affairs, or finding their way to the local grocery store.  Short term memory is usually the first cognitive skill affected followed by longer term memory and other mental abilities.  The loss of memory is corrosive to relationships because they don't know and have no way to know that it has happened.  Emotions and personality can remain intact for a long time, however.  Therefore, empathy of others becomes essential to
being treated with respect and feeling respected.  My mother-in-law is a good example.  The medication pathway she had traveled had rendered her sleepy, mostly passive, and often staring out the window.  She regularly lamented “this is no way to live”.  My wife, believing that this could not be right, asked me to investigate what her drugs could be doing to her.  There seemed to be a pattern, since the statin drug therapy starting 5 years ago could have caused confusion, memory, and behavior issues that caused the need of the next two drugs and she was the description of a person likely to suffer from these side effects. After consulting the family, all the drugs were stopped.  Her cognition has quickly returned but her memory has not.  That has led to an empathic challenge.  How would a person behave if they could think but not remember?  What happens if they need to check if the lights are turned off at night?  A seemingly crazy behavior of checking the lights over and over makes perfect sense if you simply can’t remember.  It isn’t her fault, she isn’t crazy, nor is it obsessive/compulsive.  It is my deficit if I become impatient and short.  I have to imagine myself in that situation.  Then it makes sense.  I lose my irritation and impatience.  She is just my mother-in-law doing what she always has done, frugally making sure that the lights are off.

--Dave
 


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