“If I Ever Got Dementia, I’d Be Outta Here”

Having heard this many times, I know it’s common for folks to say, “I’d off myself” or “I’d check out”. There seems to be a belief that if we ever did develop this sad disease, we would find a way to eliminate ourselves from it.

That we would never want to lose our minds is probably a universal desire. But is it realistic that we could just stop living if we did develop dementia? The truth is that dementia in any form, Alzheimer’s disease being the most common, has a gradual onset. People who are in the early stages of the disease often do not realize that they have any impairment at all. “I feel fine” they say. Physically, they may be otherwise fine, but their brains are not. And reasoning, planning, and looking ahead are functions of that brain that is losing ground. There is no clear marker for when one can definitely say, this is the moment I got dementia. It doesn’t work that way.

A frequent reason people seek advice at AgingParents.com, where we consult and strategize with families, is that they have an aging parent with dementia. The care and legal management of an impaired aging loved one presents a complex struggle. Those who have cared for a relative with dementia are often heard saying they’d never want to put their own families through this and they could not live with it. But in truth, there may be no realistic way to plan for what to do if any one of us actually does develop dementia.

Some people who show early signs of dementia in any form experience difficulty remembering simple things. They forget that you were coming to visit. Or they forget appointments even after being reminded. And the short-term memory loss issue grows progressively worse over time and begins to interfere with daily life. They don’t see this happening. The impaired person neglects grooming, hygiene, cooking, managing bills and other activities. Eventually the person is not able to remain independence. Many people are terrified of having to depend on anyone else to care for them on a daily basis. They don’t want to be that kind of burden. They don’t want what they see as humiliation. That is why we hear them say they’d end their life if they got dementia. But they can’t identify when they would know if they got it.

What Is The Risk Of Ending It All For Elders?

The subject of ending one’s own life is highly controversial, and fraught with religious, moral, ethical and legal considerations. Essentially, our society wants to prevent suicides. Elder suicide has been studied and is a matter of concern, often arising from a sense of hopelessness, grief, loneliness and depression. It’s not typically about dementia. However those with mild cognitive impairment are sometimes considered to be in the earliest stages of dementia. According to the National Council on Aging, this group is at higher risk than the already high risk group of elders likely to commit suicide. But that assumes that the person at risk is capable of looking ahead, planning and choosing an option. For many persons in the middle or later stages of dementia, the ability to carry out a plan has totally eroded.

Couldn’t You Get Someone Else To Help You End It All?

Assisted suicide, legal in ten states, requires following strict legal rules. Among them, one must be declared by a physician to be terminally ill. There’s the dilemma with dementia. It can last 8-20 years. When is it “terminal”? And it is very critical to understand that where assisted suicide is legal, one must be fully mentally competent to have a physician prescribe a lethal drug cocktail. Dementia, by its very nature, means that in the terminal stage, one is definitely not fully mentally competent. The brain is too far gone by that time. Essentially, the idea that if you got dementia, you’d end our life may not be at all realistic. You certainly would not be able to do so legally with a physician’s assistance.

The Takeaways:

1. If you ever did develop dementia, there is certainly no guarantee that you would realize it at the earliest stages or that you would be able to form a plan as to what to do.

2. Elders do have a high risk of suicide compared with the general population most often from multiple factors that include grief, hopelessness, loneliness, depression, and loss. These can exist in anyone who does not have dementia. We simply do not know when, if at all, a person with these other factors would also realize they have developed dementia.

No one wants to lose independence later in life. Most people are very afraid of losing our minds. We are well served to consider that we are not helpless to prevent dementia, or to at least forestall the onset. The very same advice doctors give us about preventing heart disease is similar to the advice about dementia prevention. Every day-to-day decision we make to adopt or continue healthy habits contributes to prevention. We have more power to maintain our healthspan (the time we are in reasonably good health until the end) than many realize.