Phil Burns*, a prominent Oakland, California, business owner with a philanthropic legacy, was in his 70s when it became apparent that his knowledge had begun to decline. His daughter Caroline*, now 62, and her siblings realized that their family had no language to talk about what was happening. Their father had been the patriarch and their mother, his staunch supporter and confidante, also had cognitive problems.

“It was impossible to admit what was happening to my father, and he wouldn’t go near the doctor, so we couldn’t do anything,” Caroline explains. “Both my parents were unaware of their deficits.” During this time, one of his father’s trusted assistants began covering for him, making decisions, signing papers and ultimately stealing from the company, claiming he had offered him money.

“When my mother had a big fall, everything collapsed and we were able to call the doctors and put guardrails in place,” explains Caroline. “But there was a lot of anger from (my father).”

The conversation about age and executive office came to the forefront this election year when President Biden withdrew his candidacy. The nation has debated the question of when it is time to step aside, step aside, recognize the end of a chapter, or simply admit that our capabilities are different. How do caregivers and family members contribute to this process long before mistakes are made, dignity is harmed, or worse, someone is harmed?

“So many caregivers face this challenge,” says Brent P. Forester MD, 58, the Dr. Frances S. Arkin Professor of Psychiatry at Tufts University School of Medicine and chairman of the center’s Department of Psychiatry. Tufts Medical. Working with dementia patients, Forester thinks a lot about what happens to older, productive members of society who want to figure out what’s next. “At some point, the people closest to you may need to step in and guide, advise, or give the person a little nudge,” says Forester. “Society must consider a holistic, multi-faceted approach to decisions made at this stage of life, including coaching and peer support. »

Recognizing normal aging and dementia

But what is “old age” and when exactly? “Because aging depends on many different factors, for many the idea of ​​giving up work can be overwhelming,” says Forester. “People can be at the top of their game in a certain way at 80, and when people love what they do, it ties into their professional and personal identity. Airline pilots have a mandatory retirement age, but there is no set end date for a neurosurgeon.

Cognitive changes don’t always affect everyday life, says Forester. “A small loss of memory does not necessarily raise a red flag. Half of Americans are only diagnosed with dementia when they can no longer drive or pay their bills. We need to provide more support to families and encourage people to pay more attention to what “normal aging” is and what dementia is. »