What’s Next Depends on the Circumstances

If you are the witness of behavior changes in a client or colleague, what actions should you take? The person you are concerned about “may not be the Joe I used to know.” Should you bring this up with the client or his or her family?

Karlawish believes you have an obligation to say something to Joe. “I’ve noticed you repeated a few things in a single conversation with me today. That’s different from our discussions of just a few months ago. Have you been noticing anything different?”

Regardless of the answer, you want to know if Joe is aware of changes and has sought help. (Some people normalize the changes, so they may not perceive an incentive to get a diagnosis, explained Karlawish.)

“You should look into that, Joe. Have you talked with your doctor about a referral who is good at assessing ‘mild problems’?”

Karlawish suggests adding in appropriate circumstances, based on the relationship: “I’d like your permission to relay my concerns to the doctor.”

As a follow-up, in a subsequent meeting, ask: “Joe, how did the assessment work out? What did you learn?” Is this overstepping boundaries? Karlawish said no; however, you will have to make that judgment call yourself.

It will be up to the doctor making the assessment to take a history, talk with family members and others who observed the behavior, and to reach a diagnosis. The result of the physician’s assessment will reveal whether there is a diagnosis of cognitive impairment and importantly, the stage of severity: how much impact is there on daily life? Some cognitive impairments are treatable, depending on the cause. For example, it could be medication, a medical illness, or depression or anxiety. A lot of these problems can be addressed, explained Karlawish.

What If the Diagnosis Is Dementia?

If dementia is diagnosed, that puts into motion getting educated about safety, care, and receiving a prognosis for the particular impairment. The future needs to be better understood, and a plan for handing the future needs to be put in place.

Hopefully, the impairment is discovered early enough for the subject to be involved. “Over time, the symptoms of Alzheimer’s and related dementias will make it difficult to think clearly. Planning as early as possible enables you to make decisions and communicate those decisions to the right people,” quoting “Planning for the Future After a Dementia Diagnosis” https://www.alzheimers.gov/life-with-dementia/planning-for-future#financial-planning. That resource sets out necessary actions.

It’s time to prepare for future incapacity while “Joe” is still able to do so with cognition. The many techniques to consider are set out in a comprehensive and well-thought-out book, “Don’t Let Dementia Steal Everything: Avoid Mistakes, Save Money, and Take Control” by Kerry R. Peck and Rick L. Law (American Bar Association, 2018).

ABA Senior Lawyer Division

Julie Jason