Yesterday completely got away from me between an unplanned meeting and then an appointment that took much longer than it should have. On the other hand, the result of the appointment was more good news than bad. For those who have never dealt with it, I have now entered the group of millions of people with tinnitus. The good news part is that the high frequency hearing loss that probably triggered it is not bad and my “ear health” is fine. The discussion with the ENT doctor was informative and since it took me nearly three months to get through the initial and follow-up visit with my primary care physician and then the appointment with the specialist, I have been adapting to this new condition. I can’t say that I’m happy about it, although since I am knocking on the door of my 61st birthday, there are certainly many worse chronic problems that I could have.

We discussed options that I could try that are successful with some people and I might check into those. We also discussed the reality that hearing does often diminish with age and the signs to be alert for. In fact, the doctor made an interesting observation about how people who have problems seeing don’t mind going to an optometrist, but they’re willing to accept some hearing loss without seeking help.

That brought to mind the elderly relative who had significant hearing loss, was well aware of it, absolutely refused to do anything about it, and yes, she had worn glasses all her life and was quite faithful about getting her eyes examined and increasing her prescription whenever that was required. It is a bit curious, isn’t it?

Okay, after this post I’ll go back to “fun” topics. Because of the well-deserved attention of Alzheimer’s, there is a tendency for we non-medical individuals to lump all dementia in older people into that category. That is not inherently a problem in the sense that other forms of dementia often have essentially the same impact on family and friends as Alzheimer’s. Treatment, however, can be different and in seeking the appropriate treatment, family and friends need to recognize that medical and non-medical treatments are extremely limited for many types of dementia. While there are standard treatments for Alzheimer’s, for those who have dealt with it, you are aware of the limitations, but they do have tests to be able to verify that the condition is Alzheimer’s. Sadly, once dementia in whatever form it takes or degree of it there is, in general grows progressively worse, sending the individual into a downward spiral.

That’s why I want to discuss “Partial Impairment” which is what many people experience and it is not necessarily a prelude to Alzheimer’s. Before I do, please be aware that I am not medically trained and you can seek information published through medical sources for more details. In a broad brush stroke, Partial Impairment is the situation where severe memory lapses interfere with day-to-day functioning and might cause a problem for an individual continuing to live independently. It can also result in increased “living in the past” where an individual only wants to talk about past experiences and people and is reluctant to deal with current day activities. This condition is intermittent and the individual can go for days or weeks with no problem, then have a day or series of days of “episodes”. The unpredictability can lead to the suspicion of “playing head-games”, and while that might be true, more often it is not. If you can emotionally do so, embrace the situation and allow it to co-exist within reality as much as possible. For example, if the individual persists in calling you by the name of a long-dead relative or friend, correct the person gently and don’t make an issue of it. If the individual wants to speak only of events that are long passed and of no interest to anyone else, try to patiently listen yet again.

Since partial impairment can interfere with health and safety functions, such as not remembering to take medications, not remembering to throw spoiled food away, maybe not remembering to take care of basic personal hygiene, assistance with living whether through at-home care or in a facility will probably be required. Again, this is a step beyond manageable memory lapses and you may need professional assistance in determining if the individual that you care about has taken that downward step. If so, it is usually not a physical danger and the individual can continue in this state for a  number of years. Finding a means to emotionally support yourself becomes just as important as arranging for care of the individual. There is nothing good about these situations and certainly nothing easy. It is, however, a reality of life that you may be faced with.

Disconcerting Content Alert! I don’t know many people who are not understandably worried about Alzheimer’s as it applies to a relative or friend. There are a lot of books, many more articles, and numerous foundations and groups to consult about specifics of this insidious disease. One of the sad realities that I learned while writing Your Room at the End: Thoughts About Aging We’d Rather Avoid is that while Alzheimer’s is the most recognized form of dementia, it is far from being the only one. There is, in fact, something referred to as Partial Dementia and this is what a lot of us encounter with older relatives and friends. Before getting to that though in Part II, I want to address unsettling memory loss that also often occurs.

This primarily manifests itself in ways such as not being able to recall names even of people that the individual knows well. For example, suddenly forgetting the name of a grandchild or calling a grandchild by the parent’s name without realizing it. Another example is not being able to recall having completed a task even if it is something routine. By the way, this isn’t the same thing as leaving the house and wondering if you set the alarm. This is more like not being sure if you took your required medication that day. This type of memory loss is disturbing for both the individual and those around her or him, but in general, it can be coped with. Being honest about it is very important, however. Let’s use the medication piece as an example. Labeled medicine boxes are a great solution for this, but someone may need to assist in filling the box and quite probably have a note somewhere that says, “Medicine Box filled for the week. If unsure, call _______”. That will be the name and telephone number of whomever filled the box.

Perhaps the most important thing when facing memory loss in another individual is sympathy and patience. It is incredibly common for an individual to tell the same story or repeat the same question multiple times (and I mean multiple) as her or his brain is trying to lock in that the information has been passed. It can be frustrating for the listener, but it is frightening for the individual who feels the inability to remember. Once this type of memory loss sets in, it won’t normally improve and finding the means to work around it will be highly individualized. The key is to find a method that works for the person with the memory loss. In one case I am familiar with, a lady used a calendar and left a note on her bedside lamp, one taped to her bathroom mirror, and another taped next to the telephone. “Check calendar every day”, was pretty simple to follow. For example, garbage pick up was Thursday. So on Wednesday, she would write, “Get garbage ready for pick-up tomorrow”. For every appointment she had, she would write a reminder one-to-two days prior that she had the appointment. A couple of close friends who often drove her places as she cut back on driving knew about this technique and would wait patiently as she carefully filled out the calendar.

I recently used the analogy of:  “Consider this type of memory loss to be like a dripping faucet. It’s annoying and you constantly lose water because of the drip. If you place a bowl under the faucet, it catches the water and you can at least recover that and use it to water plants or whatever. It’s isn’t an ideal solution, but it does work. Having memory aids that work (whatever those are) are the ‘bowl under the dripping faucet’.”

In Part II, I’ll discuss Partial Impairment, although that post won’t be until Wednesday.