Sarah was always an independent, brilliant, engaged woman. Her sons joyfully share stories of how growing up their home was welcoming and where everyone hung out.
She was a whiz in the kitchen, the best homework helper, perpetually punctual, and appeared to be in more than one place at once when her active children had conflicting activity schedules. These attributes continued well into her 80s with family gatherings, church activities, community engagement, and volunteer work.
Changes That are Out of Character. But something appeared to have changed not long after Sarah’s husband, Richard, passed away. While she was noticeably shaken and grieving the loss, she was frequently repeating herself, disengaged from her usual activities, and barely eating. She was unaware of the changes. This was out of character for her.
Her kids were all nearby and regularly checking in. But the repetition of questions, her inability to track conversations, and noticeable disinterest in food and activities concerned her adult children deeply.
Mark, the eldest, and the one Sarah depended on the most, approached his mom about what he and his brothers were seeing that was of concern. Sarah listened and was casually dismissive, gently waving him away with a chuckle. Her typical response, with a smile, would be “I am perfectly capable of taking care of myself. I raised you kids, didn’t I?”
For a time, her sons assumed that their mom was depressed, missing their father, and needed time to heal from the loss. Afterall, they’d been married for close to 60 years and never spent a day apart until his death.
Signs That Something Has Changed. A red flag was raised, however, one afternoon, about one month after Richard’s passing. Mark got a call from the Estate Planning attorney who was managing his parents’ estate. Sarah was the executor. She’d missed two important appointments. When the attorney had followed up with Sarah, she didn’t recall the appointments or recognize their importance.
It all started to make sense: the forgetfulness, the dismissiveness, the repetitiveness. Mark recalled seeing this when his father was still living — his parents seemed to have fallen into a comfortable pattern of compensating for one another over the years. Richard would lovingly complete Sarah’s sentences, gently answer the same question repeatedly, help her in the kitchen during family get-togethers, and slowly took on more household responsibilities.
Anosognosia. Mark sought the counsel of his brothers. His father-in-law had experienced similar symptoms. He had been diagnosed with probable Alzheimer’s disease and anosognosia, also called “lack of insight,” when a person is unaware of their condition and unable to accept it. That seemed to be what was happening with their mother.
This lack of insight is one reason an older adult may be resistant to accepting help and support. They simply don’t see the need. They are not aware of their changes and deficits.
With anosognosia, the frontal lobe of the brain is impaired. The frontal lobe is responsible for higher cognitive functions such as memory, emotions, impulse control, problem solving, social interaction, and motor function.
It’s not unusual for family members to misinterpret their loved one’s lack of insight or awareness as denial. Denial is a coping mechanism, a psychological response to something that is uncomfortable or difficult to accept. It is not anosognosia, though on the surface, they do resemble one another in how someone reacts to certain situations.
Tips for Supporting a Person Experiencing Anosognosia
- Listen carefully. Don’t interrupt, contradict, or correct. Listen to learn about how your parent is feeling, what they need, and how to approach these conversations in future.
- Be supportive, gentle, and calm. It will only make things worse if you’re angry or stressed.
- Remember: it isn’t possible to persuade someone to accept their condition if they are experiencing lack of insight. Don’t confront or attempt to convince them of their diagnosis.
- Seek supports and services that can help people with dementia come to terms with their condition, such as support groups, talking therapies, and creative engagement.
- It may help to point out the benefits of doing things differently. For example, if a person is no longer able to live alone safely, it may help to talk about the benefits of moving to a retirement community. You could focus on the joy of no more house cleaning or lawn maintenance, the treat of chef-prepared meals, and access to amenities such as a beauty salon and craft room.
- Think about your parent as an individual and what might persuade them to accept support if they need it. Some people who think they don’t need help might accept visits from a professional caregiver if they feel it would benefit someone else in their home, such as a family member.
- Engage the support of an Aging Life Care Professional (AKA a Care Manager). As professional Care Managers, we are an objective third party with the knowledge and expertise to guide you and your loved one to the best options for your personal situation. You can find a Care Manager near you through the Aging Life Care Association.
Still challenged by a loved one’s resistance to accept support? We can help.
Give us a call at 206-456-5155.
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