Talking with your aging parents about the potential of dementia or growing memory loss and their implications on the parent and the family is one of the toughest jobs adult children have. It’s rarely clear-cut; there may be no formal dementia diagnosis. It may be a simple case of forgetfulness.

This article, and a following piece, explore how adult children can approach each other and their parents when family members fear the onset of dementia or severe memory loss.

After all, diagnoses can be difficult to arrive at. Clinicals are reliant on cognitive testing, sometimes imaging, and family history. There’s no simple test that settles it, if it’s ever settled at all. Frankly, a diagnosis isn’t always as important as the reality on the ground. And that reality might be surrounded by denial.

If the parent is suffering neurological impairment, stepping in early can give you a head start on how the family faces the coming crisis.

The challenges of cultural stigma further complicate matters. Many families hail from countries or regions with traditions where illness isn’t ever discussed. Moreover, shame and embarrassment can keep everyone silent.

But there’s nothing embarrassing about getting older, and mental issues are part of this reality. Millions of families walk this path. The sooner we talk about it the better we can plan for it.

But how should you begin this hard conversation?

Start with your siblings. Face it – not all adult children deal with reality with the same clarity or in the same manner. If you’re convinced of your parent’s or parents’ declining mental acuity and that it needs addressing, take your concerns to the sibling you consider likely to be most receptive. If they’ve had similar observations and share your concerns, compare notes. Gather specific examples (missed bills, repeated stories, medication mix-ups, or getting lost while driving or walking the neighbourhood).

Next, agree on goals. Primary amongst them should be your parent’s care, safety, dignity, and preserving as much independence as possible.

Seek professional guidance early, but wisely. If your parents already have directives in place giving you or your siblings power of attorney and health-care surrogate status, visit with the parent’s trusted primary-care doctor. This may help distinguish age-related forgetfulness from cognitive impairment or loss. If necessary or advised, get a referral to a neurologist or memory clinic for further exploration.

Then, look at the home setting and the care your family member may require. A geriatric care manager can assess the home, coordinate services, and diffuse the potential for family tensions.

It cannot be stated strongly enough: It’s imperative for adults of all ages to put in place advance directives, including powers of attorney and health care proxies, before they’re needed. A time of crisis is too late to put legally binding plans in place, at least without the courts getting involved, which will create additional and costly delays.

The next article in this series will address what happens once family members have found alignment in their efforts to address their parent’s or parents’ failing mental health.

If you need help addressing the family, financial and health care concerns brought on with aging parents – or at any stage of life, let’s talk. I’ve faced this in my life and have helped other families bring clarity to confusing – even scary – situations.