Later-Life and Dementia-Related Care

Stories, signs to notice and what to do

Just Getting Old, Said the Family

Mr Hargreaves, seventy-two, had been a head teacher in Manchester. Since retiring two years ago and losing his wife last winter, he had stopped going to the allotment. He woke at four in the morning, ate little, and told his daughter on the phone that he was 'just tired, it comes with age.'

She had noticed more: he was irritable, kept asking whether his heart was alright, and once said, quietly, that the family would manage without him. She brushed it off at first. Everyone said old people get sad, and she did not want to make a fuss.

A neighbour mentioned he had stopped answering the door. His daughter drove over that weekend and found him in yesterday's clothes, the kitchen untouched. This time she did not say 'cheer up.' She asked, 'Dad, have you been having thoughts of death, or of not wanting to be here?' He looked at the floor, then nodded.

She stayed with him that night, then made an appointment with his doctor. The doctor checked his blood tests and medicines, assessed his mood, and explained that late-life depression is common, treatable and not normal ageing. A plan followed with talking support, gentle walks, a lunch club, and careful review of any medicine because older bodies are more sensitive to side effects. Six weeks later he planted onions again.

How to recognise it

• Persistent sadness, emptiness or irritability for weeks, not a passing mood.
• Loss of interest, poor appetite, early waking, fatigue.
• Repeated worry about health with no new medical findings.
• Neglect of self, home or usual routines.
• Any talk of death, being a burden, or not wanting to be here.

What this story explains

This story shows that despair in later life is depression, not normal ageing, and that thoughts of death in older adults need serious attention and treatment.

Probable root causes

• Bereavement and the loss of work identity after retirement.
• Loneliness, isolation and reduced mobility.
• Chronic illness or pain.
• Biological changes with age and sometimes other medical conditions.
• Ageism and the belief that nothing can be done.

What to do

1. Ask directly and kindly about mood and thoughts of death.
2. Stay with him if he has thoughts of ending life, and do not leave him alone.
3. Book a doctor visit and go together.
4. Bring a list of medicines and physical symptoms.
5. Rebuild small routines: a walk, a visit, a meal at fixed times.
6. Follow up at regular reviews, since treatment is adjusted gently for age.

Whom to consult

• Family doctor first, to check physical causes, medicines and mood.
• Psychiatrist or geriatric specialist if depression is severe or other illnesses complicate care.
• Counsellor or clinical psychologist for talking therapy.
• Emergency service or hospital if he speaks of ending his life or you fear for his safety.

Do and don’t

How to behave and communicate

• Say 'You matter to us. I would like to understand how you are feeling.'
• Sit down, face him, and listen without hurrying.
• Ask plainly: 'Are you having thoughts of ending your life?'
• Avoid arguments about how things 'should' feel.
• Use simple words, a calm voice, and speak at his pace.

Where Did I Put the Keys, Again?

Mrs Lakshmi, seventy-eight, lived with her son Arvind and his wife in Chennai. For the last year she had been repeating questions, leaving the gas on once, and getting lost on the lane to the temple she had visited for forty years. She covered it with jokes, but she cried when she could not recall her granddaughter's school.

Her family argued. Arvind said, 'She is just old.' His wife thought it was attention seeking. Then a neighbour found Mrs Lakshmi standing confused near the main road, unable to say where home was.

They took her to the family doctor, who listened to the story and also asked about mood and sleep. Mrs Lakshmi had been low since a friend died, was sleeping badly, and rarely left her room. The doctor said depression can mimic dementia, so proper assessment mattered. Blood tests, a memory screening and a visit to a neurologist were arranged.

The results showed early Alzheimer's disease, with depression sitting beside it. The family felt grief, but also relief at having an explanation. They treated the depression, started cognitive stimulation with photo albums and cooking, wrote the home address on a card in her bag, and put a safety lock on the gas. The first sentence the doctor said to Arvind was, 'Early diagnosis still helps, because there is a lot you can do.'

How to recognise it

• Progressive trouble with memory, such as repeating questions or missing recent events.
• Getting lost in familiar places, or confusion about time and place.
• Difficulty with words, calculations, or judgement affecting daily life.
• Mood change, withdrawal, or sleeplessness alongside the memory problems.
• Decline over months rather than a single bad day.

What this story explains

This story shows the chapter's point that memory change needs assessment, because depression can mimic dementia, and that early diagnosis and safety planning still improve life when dementia is real.

Probable root causes

• Alzheimer's disease, the commonest cause of dementia.
• Vascular, Lewy body or frontotemporal causes, or a mixed type.
• Depression, which can look like memory loss.
• Other medical problems such as thyroid, vitamin deficiency or medicine effects.
• Age, family history and heart or blood-pressure risk factors.

What to do

1. Note examples with dates: missed bills, lost routes, repeated questions.
2. Visit the doctor together, with a list of medicines.
3. Ask for a check of mood, blood tests and a memory assessment.
4. Make the home safer: gas, stairs, doors, identity card with address.
5. Keep routine, cognitive stimulation and social contact.
6. Plan early for the future, including legal and care decisions, while she can take part.

Whom to consult

• Family doctor first, for general health, mood and blood tests.
• Neurologist, psychiatrist or memory clinic for diagnosis of memory decline.
• Clinical psychologist or neuropsychologist for memory testing.
• Emergency service or hospital if she is lost, injured, or suddenly very confused.

Do and don’t

How to behave and communicate

• Speak simply, one idea at a time: 'Amma, let us have tea now.'
• Be patient with repeated questions and answer as if for the first time.
• Avoid 'I just told you'; say 'Let me tell you again.'
• Face her, make eye contact, and use a warm voice.
• Include her: 'What would you like for lunch?'

The Carer Who Forgot Herself

Grace, fifty-eight, had cared for her husband Tom in Cork since his dementia diagnosis three years earlier. He no longer knew the day, woke at night, and sometimes did not know her. She did not go to her book club any more. Her sister's offers of help were met with 'I can manage.'

Lately she had been snapping at Tom, then crying in the pantry. She slept in snatches, her back ached, and she had missed her own blood pressure check. At a family birthday, she said very quietly, 'Sometimes I think I cannot do another day.'

Her daughter heard the words and did not argue. She sat down and said, 'You have carried this for a very long time. You need rest too.' They arranged for a day-care service two days a week, a neighbour for Thursday evenings, and an appointment for Grace with her own doctor.

The doctor said carers need respite, not only instructions, and that her low mood and exhaustion deserved treatment too. Grace went back to her book club. She felt guilty at first, then lighter. Tom was calmer with a rested wife, and a carers' group gave Grace friends who understood. She was still tired, but she was no longer alone.

How to recognise it

• Constant exhaustion, irritability and tearfulness in the main carer.
• Giving up friends, hobbies, own health appointments.
• Feeling trapped, resentful, and then guilty about it.
• Hopeless statements such as 'I cannot do another day.'
• Rough handling, shouting, or neglect creeping in when the carer is overwhelmed.

What this story explains

This story shows the chapter's message that carers need respite and support, not only instructions, and that caring for someone with dementia can harm the carer's own mental health.

Probable root causes

• Round-the-clock demands and broken sleep.
• Isolation and loss of the carer's own life.
• Grief for the person as they were.
• Behavioural symptoms of dementia that are hard to manage.
• Lack of shared help and the belief that 'only I can do it.'

What to do

1. Ask the carer how she is, not only how the patient is.
2. Share tasks across family and book regular respite.
3. Look at day-care, home help or community support.
4. Ensure the carer has her own health checks and sleep.
5. Offer the carer a place to talk: a friend, a counsellor, a carers' group.
6. Seek professional help for distressing behaviour in the person with dementia.

Whom to consult

• Family doctor for the carer's own health and mood.
• Counsellor or clinical psychologist for support, grief and stress.
• The person's neurologist or psychiatrist for behavioural symptoms.
• Emergency service or hospital if the carer is thinking of self-harm or the patient is at risk.

Do and don’t

How to behave and communicate

• Say 'You are doing a great deal. How can I make today easier?'
• Listen without telling her what she should do.
• Name the feelings: 'It is hard to love someone and feel worn out.'
• Avoid 'you chose this'; say 'you deserve support too.'
• Offer a concrete time and task, not a vague 'call me.'

The Empty Flat on Raja Street

Mr Fernandes, seventy, lived alone in Mumbai since his wife died and his children moved abroad. He ate lunch at a different tiffin place each day only to hear other voices. Lately even that stopped because his knees hurt and the stairs felt long.

He began to worry about everything: his pension, his blood pressure, whether his son would call. He lay awake with a tight chest and kept going to the clinic for the same complaint. The tests were normal, but the worry was not.

A young neighbour, Farida, noticed his newspaper piling up. She knocked, accepted tea, and returned the next week. She did not give a speech. She asked about his old work at the port, and he spoke for an hour.

Farida suggested he mention the sleeplessness and worry to the doctor, and she walked with him to the clinic. The doctor treated his knee pain, discussed his anxiety, and suggested the parish senior group and a daily chair exercise routine. Mr Fernandes began to attend on Tuesdays and Fridays. He told Farida, 'I did not know I was lonely. I thought I was just old.'

How to recognise it

• Increasing isolation after bereavement, retirement or children moving away.
• Excess worry about health, money or family, with restlessness and muscle tension.
• Broken sleep, repeated clinic visits, and normal test results.
• Reduced mobility or pain that cuts off social life.
• Statements that suggest being forgotten or a burden.

What this story explains

This story shows the load of later life: bereavement, loneliness, pain and reduced mobility, and how anxiety in older people often shows up as worry about health, money and family, eased by regular social contact and meaningful activity.

Probable root causes

• Bereavement and the loss of daily companions.
• Physical pain and reduced mobility.
• Distance from adult children and community.
• Fear about health, money and the future.
• Ageism, which makes older people feel invisible.

What to do

1. Visit or call regularly, with a specific time each week.
2. Ask about his day and his past, and listen.
3. Check pain, hearing, eyesight and mobility with a doctor.
4. Connect him to a community group, faith group or lunch club.
5. Encourage gentle activity such as walking or chair exercises.
6. See a doctor if worry, low mood or sleeplessness continue.

Whom to consult

• Family doctor, for pain, physical health, sleep and anxiety.
• Psychiatrist or counsellor if worry or low mood is persistent.
• Physiotherapist for safe movement.
• Emergency service or hospital if he has thoughts of ending life.

Do and don’t

How to behave and communicate

• Say 'I would like to hear about your day. Would Thursday suit?'
• Listen to stories without hurrying him.
• Avoid 'you should get out more'; say 'shall we go together?'
• Show respect: use his name and title.
• Speak at an easy pace and keep eye contact.

When Dad Became Another Person

After two small strokes, Mr Okafor, seventy-six, was living in Lagos with his daughter, Chidinma. Over the last year he had become confused in the evenings, sometimes shouting and accusing the housemaid of stealing, and at other times sitting silent. His neighbours called it 'madness.'

Chidinma was ashamed and frightened. A relative suggested a prayer house where he could be kept 'in a quiet room.' She had almost agreed when her nephew, a nurse, said, 'Wait. A locked room is not care.'

They took him to a doctor. He was diagnosed with vascular dementia. The doctor explained that behaviour changes can be a symptom, that pain, thirst, noise and tiredness can make them worse, and that there are ways to help. Chidinma learned to keep evenings quiet, use the same routine each day, and treat his pain. She sat with him over old photographs and let him help with simple tasks.

The doctor also reviewed his medicines carefully, because older adults are sensitive to side effects. Chidinma stopped feeling that her father was a burden. She said to her sister, 'He is still Dad, only the road is different. He needs respect and dignity, and so do we.'

How to recognise it

• Evening confusion, suspicion, or agitation in a person with memory loss.
• Sudden changes in behaviour or personality after strokes or head injury.
• Behaviour that gets worse with pain, noise, thirst, or tiredness.
• Family shame, and talk of hiding or confining the person.
• Risk of falls, wandering or unsafe use of appliances.

What this story explains

This story shows the chapter's points on other causes of dementia such as vascular dementia, on behavioural symptoms needing professional help, and on respect, inclusion and dignity for older adults.

Probable root causes

• Vascular changes in the brain after strokes.
• Pain, infection, hunger, thirst or poor sleep adding to confusion.
• Noisy, unfamiliar or crowded surroundings.
• Medicine side effects, since older adults are more sensitive.
• Stigma and lack of information in the family.

What to do

1. Seek a medical assessment for sudden or worsening behaviour change.
2. Check for pain, infection, hearing, eyesight and medicine effects.
3. Keep a calm routine, quiet evenings and familiar objects.
4. Use meaningful activities that fit his ability.
5. Make the home safe and plan against falls or wandering.
6. Never lock or confine him; ask for professional help and carer support.

Whom to consult

• Family doctor or neurologist for assessment and medical management.
• Psychiatrist or geriatric specialist for behavioural symptoms.
• Occupational therapist or physiotherapist for safety and activity.
• Emergency service or hospital if he is injured, suddenly more confused, or at risk.

Do and don’t

How to behave and communicate

• Use a gentle voice: 'Papa, I am here. Everything is safe.'
• Do not argue about accusations; respond to the feeling: 'You are worried about your things.'
• Offer simple choices and short sentences.
• Avoid raised voices, rushing and crowds.
• Treat him as an adult with a full history.

This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.