Denial and the Patient: “It’s not intentional. It’s brain damage.”


Adult children often contact us here at ElderConsult and complain, “I just can’t get my Mom/Dad/Grandparent/Uncle/Aunt to see that their mental facility is really a problem.”

It’s so, so important for those us who care for people with dementia to remember this: Their behavior may be strange. It may be exasperating. It may be confusing. It may be painful. But it’s not intentional! It may seem intentional. It may feel intentional. But it’s not. Your loved one with dementia has brain damage.

Every time you feel at the end of your rope. Every time you feel hurt, or out of patience, whisper this to yourself: “It’s not intentional, it’s brain damage.”

So how do you get someone with brain damage to acknowledge there’s a problem?

• First of all, approach the problem with compassion. You may feel angry or frustrated, but try not to let that show. Remember the mantra: “It’s not intentional. It’s brain damage.”

• Sometimes, a ruse helps: intentionally make a mistake. Pretend to lose your keys. Pretend that you completely forgot about an appointment or forgot to pay a bill. Do this in front of your elder, then say something like, “We all make mistakes! Have you been having trouble with mistakes like this Mom/Dad/whomever?” Hopefully, this non-threatening way of introducing the topic may lead to a deeper conversation.

• Try to encourage your elder to get a cognitive evaluation with a neuropsychologist. You don’t need to call it that. Just call it a checkup. Say that it’s important for everyone to get a “baseline” reading on their mental status as they age. Get one yourself, if you think that will help.

• If you really, really cannot get your elder to face the problem, accept that you may have to wait until things get really bad before you can step in. Elders often try to hide their confusion because they’re afraid of being “put away” or “labeled.”

• While you wait, try to check in on your elder regularly, just to make sure things are not running completely off the rails. If you live far away from your elder, ask neighbors to check in every few days. Or consider hiring a case manager to do so.

The early days of dementia are never easy. Be patient, but also be vigilant. Eventually, your elder will have no choice but to accept help.

Elizabeth Landsverk, MD Specialist in Geriatrics Board Certified in Geriatrics, Internal and Palliative Care Medicine