Criticising older adults over forgetfulness may worsen anxiety levels

By Ahmet Taş | Wise News Press

ISTANBUL, TÜRKİYE — Criticising older adults for forgetting names, appointments or recent events can intensify anxiety and discourage disclosure, while memory changes that disrupt daily life warrant early medical and psychiatric assessment.

Assistant Professor Firdevs Seyfe Şen, a psychiatrist at NPİSTANBUL Hospital, said newly emerging social withdrawal, marked personality changes and increasing forgetfulness should not automatically be dismissed as normal ageing. Such symptoms may be associated with depression, cognitive difficulties, medication side effects or other medical conditions. NPİSTANBUL’s official staff profile confirms that Şen has worked at the hospital as a psychiatrist since 2022.

Do not dismiss personality changes as normal ageing

Şen said families frequently seek advice after noticing that an older relative who was once sociable no longer wants to meet people, has become unusually sensitive or irritable, or has started expressing suspicion toward others.

Some changes in habits and social routines can occur with age. However, a new and pronounced change that differs significantly from the person’s previous behaviour should be examined more carefully, Şen said.

Rather than confronting an older relative with statements such as “You have changed so much,” families should try to understand when the change began, how it affects everyday life and whether the person is experiencing distress.

Şen recommended using questions such as: “I have noticed that you have been more withdrawn recently. Is there something upsetting or worrying you?” This approach can create space for the person to describe difficulties that may otherwise remain hidden.

The timing of a behavioural change can also provide useful information. Bereavement, loneliness, chronic pain, hearing or vision difficulties and disruptions to established routines can all affect emotional well-being. Families should therefore consider not only what has changed, but also what may have happened before the change appeared.

Not every memory lapse means Alzheimer’s disease

Occasionally forgetting a name, misplacing keys or struggling to retrieve a particular word does not, by itself, indicate Alzheimer’s disease. As people grow older, recalling information may sometimes take longer.

The US National Institute on Aging says mild forgetfulness can be part of normal ageing. More serious memory problems, however, may make everyday activities such as using a telephone, managing responsibilities or finding the way home increasingly difficult.

Şen said warning signs can include repeatedly asking the same question within short intervals, clearly forgetting recent events, struggling to manage medication or money, becoming unable to perform familiar tasks, or getting lost in a well-known place.

With normal age-related forgetfulness, the missing information is often recalled later and the person remains able to carry out everyday responsibilities. Consistently confusing bills, making unsafe decisions, being unable to follow a conversation or failing to find the way home may indicate declining daily functioning.

No single sign establishes a diagnosis. The pattern, frequency, progression and effect on independent living all need to be considered.

“Not every case of forgetfulness is Alzheimer’s disease, but recognising the signs early can make life significantly easier for both the older person and the family,” Şen said.

Replace criticism with calm, practical support

Statements such as “Did you forget that too?”, “You have forgotten again” or “You never remember anything” can cause substantial anxiety in an older person, Şen warned.

Critical language may also make someone conceal memory problems out of embarrassment or fear of being judged. This can prevent families and healthcare professionals from seeing the full extent of the changes.

Relatives can instead offer reminders calmly, support a predictable daily routine and record significant changes with dates and practical examples. Calendars, written notes, pill organisers and telephone reminders may help with appointments, medication and important tasks, although these tools do not replace professional assessment.

Providing support does not mean taking control of every decision. Older adults should retain a voice in matters affecting their lives and be encouraged to complete tasks they can still manage safely. Help can then be offered in the areas where it is genuinely needed.

Short and clear sentences, patient repetition and avoiding arguments over forgotten details may make communication easier. Sudden confusion, rapidly worsening memory or an abrupt behavioural change should be assessed promptly because these developments may also have an underlying medical cause.

Withdrawal may signal late-life depression

Late-life depression does not always present as obvious sadness, Şen said. It may instead appear as loss of interest, reluctance to see other people, fatigue, sleep or appetite changes, reduced energy, physical complaints and increasing difficulty with memory or concentration.

The US National Institute on Aging emphasises that depression is not a normal part of ageing. Loss of interest, low energy, sleep disruption and difficulty thinking, remembering or making decisions can all be symptoms.

The World Health Organization also identifies loneliness and social isolation as important risk factors for mental health conditions in later life. Meaningful social contact and appropriate support can help protect well-being and quality of life. 

Depression can slow cognitive functioning, leading a person to say, “I cannot think as clearly as before” or “I cannot learn new things anymore.” Such complaints may be attributed to age, delaying professional help.

Symptoms that persist for more than two weeks, progressively worsen or interfere with daily functioning require assessment. New social withdrawal accompanied by rapidly increasing forgetfulness should be evaluated for depression and other possible conditions.

Expressions of wanting to die, indications of self-harm or an inability to meet basic needs require urgent professional help. If there is an immediate risk to the person’s safety, local emergency services should be contacted.

When inpatient psychiatric care may be needed

A recommendation for psychiatric admission can be frightening for both an older patient and their relatives. Şen said hospitalisation does not necessarily mean that an illness is irreversible or that the person will remain in hospital indefinitely.

Admission may be used to protect the patient, organise treatment and provide close observation for a limited period. It may be considered in cases of severe depression, suicide risk, psychotic symptoms, or when the person can no longer manage nutrition, personal care or medication safely.

Şen advised explaining the process in calm, reassuring language. Rather than saying, “You are being admitted because you are very ill,” relatives and professionals might say: “We would like to monitor you more closely for a while and organise your treatment.”

Clear communication can reduce fear, improve cooperation and help the patient understand that the purpose of admission is safety and treatment.

Early assessment can identify treatable causes

Dementia is not the only possible cause of memory problems. Depression, anxiety, sleep disorders, medication side effects, thyroid conditions, nutritional deficiencies and other medical problems can also affect memory and concentration.

Depending on the person’s needs, an initial assessment may involve a family physician, geriatrician, neurologist or psychiatrist. The clinician may review memory and attention complaints, emotional symptoms, sleep, medical conditions, daily functioning and all medications being taken.

Cognitive screening, laboratory tests or additional examinations may be recommended when appropriate. The purpose is not to label the person, but to identify the reason for the change as early and accurately as possible.

Families can assist by recording specific examples, bringing an up-to-date medication list to the appointment and ensuring that the older person remains included in the conversation. Early assessment can make it easier to identify treatable conditions and develop an appropriate support plan.

This article is intended for general information and does not replace individual medical assessment, diagnosis or treatment.

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