For more information about the author, click to view their website: Dementia360 - A Presbyterian SeniorCare Network Program
Dementia and
Decision Making: What Family Caregivers Need to Understand
Making
decisions is something most of us do automatically. From the time we wake up,
we choose what to wear, what to eat, how to spend our time, and who we want to
be with. We decide how to spend our money, when to run errands, whether to
attend an event, and how to respond to everyday situations. Even when decisions
are small, they give us something important: a sense of control over our lives.
For many
couples and families, decision-making is shared. Spouses talk through finances,
medical concerns, and family plans. Adult children may consult parents for
advice. Some decisions are made independently, while bigger ones are discussed
together.
When dementia
enters the picture, that rhythm begins to change.
One of the most
difficult transitions for family caregivers is realizing that the person who
once helped make thoughtful, responsible decisions may no longer be able to do
so safely. Dementia affects areas of the brain responsible for reasoning,
judgment, planning, insight, and understanding consequences. As the disease
progresses, decision-making becomes harder and less reliable.
At first, the
changes may be subtle. Your loved one may make small financial mistakes, forget
appointments, or show poor judgment in situations that once felt routine. Over
time, the difficulties often become more noticeable and more serious. There may
come a point when you recognize that stepping in is no longer optional — it is
necessary.
This shift can
feel overwhelming.
Many caregivers
describe a deep sense of loss during this stage. It is not just the loss of
memory. It is the loss of partnership. The loss of shared problem-solving. The
loss of being able to lean on someone who once leaned on you.
Even more
challenging is the fact that people living with dementia often do not recognize
their own impaired judgment. The part of the brain responsible for insight is
frequently affected. That means your loved one may truly believe they are
making sound decisions. They may not understand why you are concerned or why
you are trying to help.
This can lead
to tension, frustration, and conflict.
Some of the
most pressing decisions relate directly to safety.
Driving is one
of the most common and emotionally charged examples. For many adults, driving
represents independence. Giving up the keys can feel like losing freedom. Yet
dementia can affect reaction time, spatial awareness, and decision-making
behind the wheel. Without intervention, the risk of an accident increases —
potentially putting your loved one and others in danger.
Another major
concern is whether someone is safe at home alone. Dementia can increase the
risk of wandering, leaving appliances on, forgetting to lock doors, or
misjudging potentially hazardous situations. What once felt like a safe,
familiar environment may gradually become unsafe without supervision.
Medication
management is another critical area. Taking too much medication, skipping
doses, or mixing up prescriptions can lead to serious health consequences. A
person may insist they can handle their pills independently, even when evidence
suggests otherwise.
Medical
decision-making becomes more complicated as well. In hospital or clinical
settings, understanding treatment options requires memory, reasoning, and the
ability to weigh risks and benefits. Without support, a person with dementia
may agree to treatments they do not fully understand — or decline care that
could improve comfort and quality of life.
While safety
concerns are often urgent and obvious, other decisions may seem smaller but are
equally important.
Quality of life
decisions shape how a person experiences each day.
For example,
declining opportunities for social interaction can gradually lead to isolation.
A person may say no to attending religious services, visiting friends, or
participating in family gatherings. They may prefer sitting quietly at home,
even if they once enjoyed being active and engaged.
Over time,
reduced social interaction can affect mood, cognition, and overall well-being.
Similarly,
choosing not to participate in activities can limit mental stimulation. A
person may lose interest in hobbies, games, music, or conversation. What
appears to be a simple preference, “I don’t feel like it,” can slowly narrow
their world.
Eating is
another area where decision-making matters. A person with dementia may forget
to eat, insist they are not hungry, or lose track of mealtimes. Inadequate
nutrition can lead to weight loss, weakness, low energy, and increased health
risks.
Personal
hygiene decisions also carry consequences. Avoiding bathing or changing clothes
may increase the risk of infections and discomfort. Yet the person may not
recognize the need or may resist assistance.
For caregivers,
these daily decisions create a steady emotional strain. Each choice feels
layered. If you step in, you may feel guilty for overriding their independence.
If you do not step in, you may worry about safety, health, or long-term
consequences.
There is also
the emotional weight of role reversal. An adult child may now be guiding a
parent. A spouse may feel more like a protector than a partner. The balance of
power in the relationship shifts in ways that can feel unfamiliar and
uncomfortable.
Frustration is
common. You may find yourself thinking, “You used to be so careful,” or “You
would never have done this before.” It is important to remember that these
changes are caused by damage to the brain. They are symptoms of the disease,
not stubbornness, laziness, or intentional defiance.
Grief often
accompanies this stage. Caregivers grieve not only who their loved one used to
be, but also the shared decision-making that once defined their relationship.
Even when your loved one is physically present, the dynamic you relied on may
feel altered.
At the same
time, there is often an increased sense of responsibility. You may feel that
every decision now rests on your shoulders. Financial planning, medical care,
daily routines, and long-term arrangements may all require your oversight. The
mental load can be exhausting.
Understanding
how dementia affects judgment can help reframe some of these challenges. The
brain changes associated with dementia interfere with abstract thinking, risk
assessment, and insight. This means a person may genuinely believe they are
capable of managing tasks that have become unsafe. They are not choosing poor
judgment; their brain is no longer processing information the way it once did.
For family
caregivers, recognizing this can soften some of the anger and confusion. It
does not make the decisions easier. It does not remove the stress. But it can
clarify that the conflict you feel is rooted in the disease itself.
Decision-making
in dementia is rarely black and white. It is a gradual shift, with
responsibilities increasing over time. It involves balancing independence with
safety, dignity with protection, and autonomy with well-being.
Above all, it
is a deeply human experience that carries complexity, emotion, and love.
If you are
navigating this transition, know that the weight you feel is real. The
responsibility is significant. And the mix of grief, frustration, and
protectiveness you carry is a natural response to a difficult journey.
This article was written by Amy Kowinsky, RDN, CDP, Executive Director of Dementia360, a program that provides guidance and support to families on the dementia journey. If you are feeling unprepared, alone, stressed or scared, Dementia360 can help. For more information, go to www.srcare.org/dementia360 , email [email protected] or call 412-435-8950.
Hearing loss is common as we get older, but that doesn't mean it should be ignored. For many older adults, hearing changes happen gradually. They may not realize how much their hearing has changed, or they may become accustomed to asking people to repeat themselves, turning up the television, or avoiding conversations in noisy environments.Family members are often among the first people to notice that an older loved one may be having difficulty hearing. Recognizing the signs and approaching the subject with patience and understanding can make it easier for a senior to receive the hearing care they need.Understanding Hearing Loss in Older AdultsAge-related hearing loss can develop slowly over time. Rather than suddenly losing the ability to hear, an older adult may gradually have more difficulty understanding certain voices, following conversations, or hearing higher-pitched sounds.Hearing loss can affect more than the ability to hear words. It can make communication more challenging and may cause an older adult to miss important information or feel frustrated during conversations.Because hearing loss often develops gradually, a person may not realize that others are speaking normally while their ability to hear and understand has changed.Signs Your Loved One May Have Hearing LossFamily members may notice signs of hearing loss before an older adult recognizes them.Some common signs include: Frequently asking others to repeat themselves Turning the television or radio volume up very high Having difficulty following conversations Struggling to hear in restaurants or other noisy environments Frequently misunderstanding what people say Having difficulty hearing on the telephone Watching people's faces closely while they speak Complaining that everyone seems to mumble Avoiding social gatherings or group conversations Responding inappropriately because they misunderstood a question If several of these behaviors sound familiar, it may be worthwhile to encourage your loved one to have their hearing evaluated.Hearing Loss Can Affect More Than CommunicationIt can be easy to think of hearing loss as simply a problem with hearing conversations. However, communication difficulties can affect many areas of an older adult's daily life.Someone who struggles to hear may become frustrated when talking with family and friends. They may stop participating in group conversations because they cannot follow what is being said.Over time, an older adult may begin avoiding restaurants, community activities, family gatherings, or other social situations where hearing is difficult.Helping a loved one address hearing difficulties can make it easier for them to remain engaged with the people and activities they enjoy.Why Some Seniors Resist Hearing CareIt isn't unusual for an older adult to be reluctant to acknowledge hearing loss.They may believe that their hearing is "good enough," feel embarrassed about needing hearing aids, or worry that others will view them differently. Some people may also assume that hearing loss is simply an unavoidable part of aging.Family members should approach the conversation with compassion rather than criticism.Instead of saying, "You can't hear anything anymore," try explaining how better hearing could make everyday conversations easier and help your loved one stay connected with family and friends.Start the Conversation With UnderstandingTalking about hearing loss can be sensitive. Choose a quiet, comfortable time to discuss your concerns rather than bringing up the subject during a frustrating conversation.You might explain that you've noticed they are having difficulty hearing and that you would like to help them find out why.It can also help to make the conversation about their quality of life rather than focusing on what they are doing wrong.For example, you can point out that a hearing evaluation could help them hear conversations more comfortably at family gatherings, restaurants, or other activities they enjoy.Encourage a Hearing EvaluationIf you or your loved one notices signs of hearing difficulty, the next step is a professional hearing evaluation.A hearing evaluation can help determine whether hearing loss is present and provide information about the type and degree of hearing difficulty.Depending on the results, a hearing professional can discuss available options and help determine what may be appropriate for the individual's hearing needs and lifestyle.It's important not to purchase hearing aids simply because someone else has had success with a particular model. Hearing needs vary from person to person, so professional guidance is valuable.Hearing Aids May HelpFor some people with hearing loss, hearing aids can make communication easier.Modern hearing aids come in a variety of styles and features. A hearing professional can help determine which options may be appropriate based on an individual's hearing loss, lifestyle, comfort, and personal preferences.It can take some time for a person to adjust to wearing hearing aids. Family members can support the process by being patient and encouraging their loved one as they become comfortable with their devices.How Family Members Can Improve CommunicationEven when an older adult is receiving treatment for hearing loss, family members can make conversations easier.Try these simple communication strategies:Get Their Attention FirstMake sure your loved one knows you are speaking to them before beginning a conversation.Face Them When You SpeakFacing the person can make communication easier and allows them to see your facial expressions and other visual cues.Reduce Background NoiseTurn off the television or move to a quieter area when having an important conversation.Speak ClearlySpeak at a natural pace and avoid shouting. Speaking louder does not always make speech easier to understand.Be PatientGive your loved one time to process what you've said and respond. If they don't understand, try rephrasing the statement rather than simply repeating the same words louder.Don't Ignore Sudden Hearing ChangesWhile gradual hearing loss is common, sudden changes in hearing should not be ignored.If an older adult experiences sudden hearing loss, particularly in one ear, they should seek prompt medical attention. Sudden hearing changes can have different causes and may require urgent evaluation.Other symptoms such as dizziness, severe ear pain, drainage, or sudden neurological symptoms should also be evaluated by a healthcare professional.Hearing Care Can Help Older Adults Stay ConnectedHearing is an important part of maintaining relationships and participating in everyday life. When an older adult has difficulty hearing, the effects can extend beyond conversations.Families can play an important role by recognizing potential signs of hearing loss, approaching the subject with compassion, and encouraging professional hearing care.If you suspect that a parent, grandparent, spouse, or another loved one is experiencing hearing loss, don't wait until communication becomes extremely difficult. A professional hearing evaluation can provide valuable information and help your loved one understand their options.Darrell M. Sipe Opticians & Hearing Aids provides hearing care services designed to help individuals better understand their hearing needs and explore appropriate solutions.Better hearing can mean more meaningful conversations, greater participation, and more opportunities to stay connected with the people who matter most.If you're concerned about a loved one's hearing, start the conversation today. A hearing evaluation can be an important first step toward better communication and a better quality of life.
Our eyes allow us to enjoy many of life's most important momentsfrom seeing the faces of family and friends to reading a favorite book, driving, working, and enjoying the outdoors. As we age, however, changes in our vision become more common.Some changes are a natural part of getting older, while others may be related to eye diseases or other health conditions. The good news is that there are steps you can take to help protect your vision and support healthy eyes throughout your life.Here are some important ways to care for your eyes as you age.Schedule Regular Eye ExaminationsOne of the best things you can do for your vision is to have regular comprehensive eye examinations.An eye exam isn't only about determining whether you need a stronger prescription for your glasses. Your eye care professional can also evaluate the health of your eyes and look for signs of potential problems.Some eye conditions can develop without obvious symptoms in their early stages. Regular examinations can help identify changes early, when they may be easier to manage.Your recommended examination schedule may depend on your age, health, family history, medications, and individual eye-care needs.Don't Ignore Changes in Your VisionAs you get older, you may notice changes such as needing more light to read, having difficulty seeing at night, or experiencing increased sensitivity to glare.While some vision changes can be associated with normal aging, you should not ignore significant or unexpected changes.Contact an eye care professional if you experience: Persistent blurry vision Difficulty seeing at night New or increasing floaters Flashes of light Distorted vision Double vision Loss of peripheral vision A sudden change in your eyesight A sudden change in vision can require prompt medical attention, so don't wait to have it evaluated.Protect Your Eyes From the SunYour eyes are exposed to ultraviolet (UV) radiation throughout your lifetime. Protecting them from excessive sunlight is an important part of maintaining healthy eyes.When outdoors, wear sunglasses that provide 100% UVA and UVB protection. A wide-brimmed hat can provide an additional layer of protection.If you wear prescription glasses, prescription sunglasses can provide both vision correction and protection from bright sunlight. Polarized lenses may also help reduce glare from surfaces such as roads, water, and snow.Eat for Your Eye HealthA healthy, balanced diet supports your overall health and can contribute to healthy eyes.Include a variety of fruits and vegetables in your diet, particularly colorful produce and leafy green vegetables. Fish, nuts, and other nutrient-rich foods can also be part of a balanced eating pattern.If you are considering vitamins or supplements specifically for eye health, talk with your healthcare provider or eye care professional before taking them.Manage Your Overall HealthYour overall health and your eye health are closely connected.Certain conditions, including diabetes and high blood pressure, can affect the eyes. Following your healthcare provider's recommendations for managing these conditions is an important part of protecting your vision.Take prescribed medications as directed, attend recommended medical appointments, and discuss any new vision symptoms with your healthcare providers.Protect Your Eyes From InjuryEye injuries can happen at any age. Wearing appropriate protective eyewear can help reduce the risk of injury when working with tools, chemicals, machinery, or other materials that could potentially harm your eyes.Protective eyewear may also be appropriate for certain sports and hobbies.Don't assume that an activity is safe simply because you have done it many times before. A moment of protection can help prevent a serious eye injury.Take Breaks From Digital ScreensComputers, smartphones, tablets, and other digital devices are part of everyday life for many older adults.Spending extended periods looking at screens can contribute to digital eye strain. Symptoms may include tired eyes, dryness, headaches, and temporary blurry vision.Try following the 20-20-20 rule: every 20 minutes, look at something approximately 20 feet away for at least 20 seconds.Adjusting your screen position, brightness, and lighting can also make digital devices more comfortable to use.Avoid SmokingSmoking can negatively affect your overall health and is also associated with an increased risk of several eye-related problems.If you smoke, quitting can be an important step toward improving your overall health and supporting your long-term eye health.If you are interested in quitting, speak with your healthcare provider about resources that can help.Get Enough SleepYour eyes need rest, just like the rest of your body.Not getting enough sleep may contribute to tired, dry, or irritated eyes. Establishing a consistent sleep routine and giving your eyes a break throughout the day can help promote greater comfort.If you regularly experience significant eye discomfort or dryness, talk with an eye care professional.Review Your Medications With Your Healthcare ProviderAs we age, many people take medications for a variety of health conditions. Some medications can affect the eyes or cause changes such as dryness or blurred vision.Don't stop taking a prescribed medication on your own. Instead, talk with your healthcare provider if you notice new vision-related symptoms or have concerns about your medications.Keep Your Prescription Up to DateYour vision prescription can change as you age. Even if your glasses are still in good physical condition, the prescription may no longer provide the clearest vision possible.Signs that your prescription may need to be updated can include: Squinting to see clearly Frequent headaches Blurry vision Eye strain Difficulty reading Trouble seeing at night Difficulty seeing clearly at a computer An eye examination can determine whether your prescription needs to be changed.Be Aware of Age-Related Eye ConditionsAs we get older, the risk of developing certain eye conditions increases. These may include cataracts, glaucoma, age-related macular degeneration, and other conditions that can affect vision.Some of these conditions may not cause noticeable symptoms during their early stages. That's another reason regular eye examinations are so important.Your eye care professional can help you understand your individual risk factors and recommend appropriate care.Protecting Your Vision Is a Lifelong CommitmentYou can't prevent every change that may occur in your vision as you age, but you can take steps to support your eye health and identify potential problems early.Regular eye examinations, healthy lifestyle choices, UV protection, appropriate protective eyewear, and paying attention to changes in your vision are all important pieces of a long-term eye health plan.Don't wait until a vision problem begins interfering with your daily life before seeking help. If you've noticed changes in your eyesight or it's been a while since your last eye examination, consider making an appointment with your eye care professional.Darrell M. Sipe Opticians & Hearing Aids is committed to helping patients maintain clear, comfortable vision with professional eye care and quality optical services.Your eyes have been with you for a lifetime. Taking care of them today can help you continue to see the people, places, and experiences that matter most for years to come.
Hearing plays an important role in how we communicate, connect with others, and experience the world around us. Because hearing loss often develops gradually, many people do not realize their hearing has changed until it begins affecting their daily lives.You may find yourself asking people to repeat themselves, turning up the television, or having difficulty following conversations in busy restaurants. These may seem like minor inconveniences, but they can be signs of hearing loss.Recognizing the early signs of hearing loss is an important first step toward getting the help you need. Here are 10 common signs that it may be time to have your hearing checked.1. You Frequently Ask People to Repeat ThemselvesOne of the most common signs of hearing loss is frequently asking others to repeat what they have said. You may hear that someone is speaking but have difficulty understanding the words clearly.If this happens regularly, especially during conversations with family members, friends, or coworkers, it may be worth scheduling a hearing evaluation.2. You Turn Up the Television or RadioDo family members or friends tell you that the television or radio is too loud? You may not notice that the volume has gradually increased because it seems comfortable to you.Needing higher volume to hear your favorite programs can be a sign that your hearing has changed.3. Conversations Are Difficult in Noisy PlacesRestaurants, family gatherings, sporting events, and other busy environments can be challenging for people with hearing loss.You may be able to hear someone when you are in a quiet room but struggle to understand them when there is background noise. This happens because hearing loss can make it more difficult to separate speech from competing sounds.4. You Have Trouble Hearing on the PhoneIf you find yourself struggling to understand conversations over the telephone, hearing loss could be a contributing factor.You may notice that you need to turn up the phone volume, switch the phone from one ear to the other, or ask the person on the other end to repeat themselves.5. You Feel Like People Are MumblingPeople may seem to be speaking clearly to everyone else, yet their words sound muffled or unclear to you.You might hear the sounds of speech but have trouble distinguishing individual words. This can be especially frustrating when talking with children or people who have softer voices.6. You Avoid Social Situations Because Hearing Is DifficultHearing loss can make social activities more challenging. If you have difficulty following conversations at restaurants, parties, family gatherings, or community events, you may begin avoiding those situations altogether.Unfortunately, withdrawing from social activities can lead to feelings of loneliness or isolation. Addressing hearing difficulties can make it easier to remain engaged with the people and activities you enjoy.7. You Have Difficulty Following Group ConversationsFollowing a conversation with several people can be difficult when you have hearing loss.You may lose track of who is speaking, miss parts of the conversation, or find yourself watching people's faces closely to understand what they are saying.If you frequently feel lost during group conversations, a hearing evaluation may help determine whether hearing loss is contributing to the problem.8. You Rely More on Watching People's Faces or Reading LipsPaying attention to facial expressions and lip movements is a natural way to supplement what you hear. However, if you find yourself relying heavily on watching someone's face to understand a conversation, your hearing may not be providing enough information on its own.You may notice that communication becomes particularly difficult when someone turns away from you or when you cannot see their face.9. You Have Difficulty Hearing Certain SoundsHearing loss does not always mean that every sound becomes quieter. Some people have difficulty hearing particular frequencies or speech sounds.For example, high-pitched sounds may become harder to hear. You may have trouble understanding children's or women's voices or distinguishing certain consonants when people speak.These changes can make conversations difficult even when you feel like you can still hear most sounds.10. Friends or Family Members Notice Your Hearing DifficultySometimes the people around you recognize a hearing problem before you do.A spouse, adult child, friend, or coworker may point out that you frequently misunderstand conversations, ask for repetitions, or keep the television volume higher than usual.If someone you trust has expressed concerns about your hearing, it is worth taking those concerns seriously.Why Early Hearing Care MattersHearing loss can affect more than your ability to hear sounds. It can influence communication, relationships, confidence, and participation in everyday activities.The good news is that hearing difficulties do not have to prevent you from enjoying conversations and staying connected with the people around you. A professional hearing evaluation can help determine whether hearing loss is present and provide information about options that may help.It is also important to remember that hearing loss is not necessarily just a normal part of getting older. While age-related hearing changes are common, hearing difficulties can have many causes and can affect adults at different stages of life.When Should You Have Your Hearing Checked?If you recognize several of these signs yourself, or if friends and family have expressed concerns about your hearing, consider scheduling a hearing evaluation.A hearing professional can evaluate your hearing and help you better understand what you are experiencing. Depending on the results, they can discuss appropriate options for improving communication and hearing.You don't have to wait until hearing loss significantly interferes with your life before seeking help. Identifying hearing changes early can help you take steps toward staying connected, communicating more comfortably, and continuing to enjoy the sounds that matter most.If you or someone you love is experiencing signs of hearing loss, contact Darrell M. Sipe Opticians & Hearing Aids to learn more about hearing testing and hearing care services.
Dementia360 is a support program for families caring for someone living with dementia at home, to help them keep their loved one at home, living comfortably and safely for as long as that is their goal. Dementia360 provides guidance, teaching, problem solving, connections to community resources, and ongoing support to help families experience better days because they have the knowledge, skills, and support to be successful. Life doesn't prepare anyone to be a dementia family caregiver. This leaves many families feeling unprepared, alone, stressed, and scared. And everyone is so different in how they are impacted by the disease; this includes the person with the disease but also their family and friends. Getting answers and solutions to what is most important in your situation is a very personal journey, a journey no one should have to go on alone. When you enroll in Dementia360, you are paired with a care coordinator who is a dementia expert. The role of the care coordinator is to get to know you, your loved one, and your situation, understand what is working well, what is not going well, and what are your worries for the future, and then support you, over time, to put plans, interventions, strategies, and resources in place to stabilize the present, and help you think through the future, so you can sleep better at night. Discover Peace of Mind: Compassionate Help for Family CaregiversCaring for a loved one with Alzheimers disease or another form of dementia can be one of the most profound and challenging roles a family member can undertake. The emotional, physical, and mental toll of dementia caregiving can be overwhelming, leaving many family caregivers feeling isolated, exhausted, and unsure of where to turn. Thats where Dementia360 steps in, offering family caregivers a knowledgeable expert and a compassionate partner and guide in the dementia journey. Who Should EnrollNo matter where you are on the journey of caring for a family member with dementia, it's never too early or late to ask for help. Whether you are just beginning to notice changes or you are navigating more advanced stages, we're here to help you every step of the way. What Sets Us Apart: Tailored Dementia Support for Your Unique Situation At Dementia360, we understand that caring for someone with dementia goes beyond providing meals and managing medications; it is about learning how to better manage the day to day of living with dementia and continue to do the things that make life worth living. With Dementia360, you get deep dementia expertise, but equally as important, you have a partner who understands your unique situation, priorities, and challenges, and can help tailor solutions to what will work best for you. Your Loved One Deserves the Best and So Do YouAt Dementia360, we believe that supporting family caregivers is one of the most powerful ways to improve the lives of people living with dementia. You give so much of yourself to your loved one let us give you the resources, community, and support you need to thrive.Dont wait until burnout strikes. Start building your support system today by reaching out to the compassionate team at Dementia360 to learn more about how our program can help your family.