Talk to someone about getting an assessment
Use the steps in this article to help you prepare for a conversation that might be difficult.
Early assessment for cognitive changes and a timely diagnosis (if indicated) usually leads to better treatment options and support.
However, talking with someone you think may experiencing changes which might be dementia is never easy. It is important to express your concerns and support the person to get an assessment and treatment.
The following five steps can help you think through and plan your approach to a conversation with someone you care about.
1. Consider – should I be concerned?
Everyone forgets things, but if you know someone is experiencing changes in ability, behaviour, personality, thinking or memory it might be dementia.
- Write down things that concern you or download and use the Checklist for Dementia Symptoms and Changes to reflect on how things have changed over the last couple of years.
- You may feel it is appropriate to talk with a family member or trusted friend about your concerns. Sometimes other family members may not spend as much time with the person as you do and may not have similar experiences or concerns. Some family members will seek to reassure you or suggest you are over-reacting. Read Get family support for an assessment for further advice.
- You can call the Dementia Australia helpline (1800 100 500) to confidentially talk through your concerns.
2. Anticipate potential reactions
Use your knowledge of that person to think through their potential reactions. Understanding how they may react can help you think about how you start your conversation.
How has this person reacted in the past to general conversations about their health or wellbeing? Their future? Or other sensitive topics like death or dying? Are they open to chatting about issues like this? Or do they get defensive or upset?
Consider if the person has expressed concerns about themselves. For example, have they mentioned:
- Difficulties with memory or thinking already? (e.g., I’m worried, I just don’t seem to be able to organise myself… I’m forgetting to pay the bills)
- Opinions about dementia? (e.g., there is no point seeing a GP as you can’t do anything for it)
- Fear for their future? (e.g., they may have had a parent with dementia)
Consider what may stop the person from going to the GP? (e.g., do they have a long-term/good relationship with a GP?)
3. Prepare for the conversation(s) and set the scene.
- There will probably be more than just one conversation. There may be many conversations over a period of time.
- Prepare for fear and negativity by understanding common misconceptions about dementia and be ready with positive information about the benefits of diagnosis.
Consider who, what, where and when
Who is the best person (or people) to have the conversation? Consider existing relationships, and family dynamics. Some family members might be better placed to raise the issue, or might be able to raise the issue with less conflict.
- For example, Reena always had a very trusting relationship with her husband Sandeep, but she knew he would not be open to discussing his memory problems with her. It was better for this conversation to be started by their son, Arjun. That way Reena could continue to be her husband’s main ally and support.
What to talk about
You might approach the topic by talking about your concerns for their well being. This might be more persuasive than pointing out mistakes which might make the person defensive.
Here are some potential conversation openers:
- “I’m worried because you seem to be having trouble with your finances”.
- “I’m worried because you’ve missed a few appointments”.
You might talk about seeing the GP about a health issue that the person themselves is concerned about:
- “You mentioned that you’re feeling tired and all the housework exhausting. I’ve also noticed that you’re not cooking like you used to. I wonder if we should go and talk to your GP?”
You might couch the conversation in terms of getting treatments and services:
- “There are medications that help with memory”.
- “Daphne’s GP gave her a referral for free bathroom rails and equipment.”
You might decide not to use the term “dementia” in these first few conversations. Wait for the doctor to give a diagnosis before using the term dementia.
- Try to spend more time listening than speaking. Ask about their concerns.
- Be aware when the person tries to shut the conversation down.
- Know when to stop (e.g., if the person becomes angry or very defensive).
Where is the best place to chat? (e.g., familiar, quiet, comfortable, place is usually best).
When is the best time of day to have the conversation? Ensure the person is not hungry or at a time their favourite TV program is on. Maybe you’re listening for when the person expresses concerns themselves, and then build on that conversation.
4. Be positive and supportive
- Use language carefully to show you want to support the person and you are on their side.
- Don’t insist you are right and don’t argue!
- Your body language is often more important that your words! Keep your posture relaxed, smile, make eye contact and use reassuring.
- Offer to go with them to the GP. If the conversation goes poorly, to change the subject or stop the conversation. You can learn from what went well or what went poorly, to change the approach to the conversation for a later date.
- Try to talk about changes and difficulties, not dementia. Know that some conditions might ‘look like dementia’ (for example depression can mimic dementia) and an assessment by a GP is needed.
- Know there are treatments, rehabilitation and support services for dementia and that many people live positively with dementia.
- Read about the experiences of others as well as the benefits of getting an assessment and benefits of a diagnosis.
5. Be prepared to keep trying
- Key is listening to the person and adapting the conversation as you go.
- Remember it is not the only chance and this may be the start of many conversations.
- If they do agree to an assessment, offer continuing support (such as making the appointment and going with them to see the GP).
If the person does not want to talk about their difficulties
For some people, dementia affects insight – their awareness and ability to recognise their own difficulties.
Other people will know they know they have difficulties but deny or minimise the difficulties because they are fearful about having dementia, or losing their independence. Visit Forward with Dementia to learn more about when the person who won’t talk about changes or potential dementia.
Keep communication open. The LEAP approach helps people with poor insight to accept hep. LEAP stands for Listen, Empathise, Agree, Partner.
Listen: Understand the person’s point of view and reflect back to them your understanding. Listening does not involve giving advice, trying to find solutions or offer your opinion.
Empathise: Let the other person know you really understand their thoughts and feelings. Acknowledge and reaffirm these thoughts and feelings, even if they are irrational.
Agree: It is important to reach agreement on the way forward. Ensure you work on aspects the other person sees as a problem. Highlight the benefits of seeing the doctor.
Partner: Find a goal that you can mutually work towards. The person needs to feel supported and, rather than that someone is trying to ‘take over’. If they are already worried about losing their independence, forcing them against their will may make these feelings stronger.
Sarah’s story shows how she used the LEAP approach to help her brother.
I have been concerned about my brother for a couple of years now. His house is falling into disrepair, I know there are unpaid bills and I am not sure what he is eating other than toast as he doesn’t seem to do any shopping or cook for himself.
I tried to talk with Gerald about how he was managing. I gently suggested we should get him to the GP who might be able to help with his anxiety and forgetfulness. Gerald got defensive and kept telling me he knew there was a problem but put it down to being stressed with repairs needed on his house.
Sarah describes how she listened and empathised with Gerald:
I tried the conversation again a couple of weeks later. I said I was worried about the state of the house. I just listened to Gerald’s complaints about being unable to find tradesmen who were honest or charged reasonable rates and how he could do a better job than a tradesman. I agreed with him that this situation was really very anxiety provoking. This time, Gerald didn’t get defensive. I think it was because I wasn’t trying to fix things. He appeared to know I understood how he was feeling.
Gerald was happy to acknowledge he was anxious – but nothing else. Because he was more relaxed with me, I felt this provided a ‘window of opportunity’ to suggest there were practical things I could help him with and also say the doctor could help with his anxiety.
Gerald eventually agreed that I could find a tradesman to help with the house repairs, but I would consult him every step of the way. With me emphasising the GP could help with anxiety and he might feel a whole lot better, we agreed to make an appointment with the GP the next week. Gerald was happy for me to drive, and I said I would be happy to support him at the appointment. We wrote this down together as I knew I would need to repeat this conversation a couple of times to make sure Gerald remembered what we agreed.
LEAP is adapted from the work of Dr Xavier Amador.
