When Confusion is Confusing: Older Adults and Delirium


Delirium – Photo Credit: Angela G. Gentile

I have been a geriatric mental health clinician since 2010. One of the most complex and perplexing conditions that I have seen in those 65 and older is delirium. Of the troubling “3Ds” (Delirium, Depression and Dementia) often found in the geriatric population, it is easier for me to identify depression and dementia because of the psychological and behavioural features. To complicate matters, these 3Ds can also overlap.

Delirium (or “sudden-onset confusion”) has it’s own unique features, and it affects people in different ways. It is one of those conditions that doesn’t have a specific laboratory test, and takes at least 24-hours of observation to detect.

Watching a loved one in a delirious state can be very distressing. I have interviewed three women (Mary, Donna and Emma) and I will share their stories of delirium and their older family members. I hope it will help you if you or a loved one happens to be in a similar situation (I have changed all the names to protect privacy).

Delirium is often unrecognized and often misdiagnosed as depression or dementia.

Delirium is a common, serious and frightening brain disorder. It is also reversible in most situations. It can also be life threatening. I have seen how delirium affects people. I remember assessing a woman in a nursing home who was about 80 years old, “picking” at the air. It struck me how inattentive she was. Another man, about 90, was walking around in his apartment complex, oblivious to me as I was trying to get his attention.

Delirium is a medical emergency and requires immediate medical attention.

Delirium is a confused mental state that causes problems with thinking and speaking. A hallmark of the condition is “inattentiveness” with a fluctuating course. The cause of delirium can usually be determined (not always), and it is often medication side effects, infection or some other medical illness that causes a disruption in normal thinking patterns. It usually comes on quite suddenly. It often leaves suddenly as well. In some older people it is harder to detect, especially if the person already has an underlying cognitive impairment such as Alzheimer’s or another related dementia.

Delirium often comes on suddenly. Sudden changes in behaviour or mental functioning requires medical attention.

Some health care professionals also find it difficult to determine if the person is having a sudden-onset of mental problems because of dementia or a medical problem such as a stroke (like in Emma’s story, below). Sometimes it takes a bit of guesswork because there isn’t a “delirium blood test” that can be taken to determine if the person is experiencing delirium.

Health care professionals can be helpful, as in Mary’s story, or unhelpful as in Emma’s story. Delirium can come at the end of life, as you will learn in Donna’s story.

There are three subtypes of delirium: Hyperactive (restlessness, agitation, hallucinations), Hypoactive (drowsy, quiet, confused), and Mixed (both hyperactive and hypoactive).

“The Confusion Assessment Method (CAM) is a quick way to determine if the person in question may or may not be experiencing delirium:

Ask these questions, and answer to the best of your ability (scoring information below):

1. Acute (comes on quickly) change in mental status and fluctuating (tends to come and go) course:

a) Has there been a sudden change in the person’s thinking and usual behaviour?

b) Does the unusual behaviour fluctuate or change during the day? (i.e. tends to come and go, or increase and decrease in severity, periods of clarity mixed with confused episodes)

2. Inattention: Does the person have difficulty focusing attention or become easily distracted? (i.e. has difficulty keeping track of what is being said, can’t concentrate)

3. Disorganized thinking: Is the person’s thinking disorganized or incoherent (doesn’t make sense)? (i.e. rambling speech or irrelevant/unrelated conversation, unclear or illogical (nonsensical) flow of ideas, or unpredictable switching of subjects)

4. Altered level of consciousness: Is the person appearing as anything besides normal alertness? (i.e. vigilant/careful/watchful or hyper alert; lethargic/lazy/sluggish or drowsy but easily aroused, stuporous/lazy or difficult to arouse/awaken/excite, comatose/unconscious or unable to arouse).

Scoring: The diagnosis of delirium requires the presence of features 1 and 2 and either 3 or 4.

Mary’s Story – When Delirium is Diagnosed in Hospital

Mary’s mom and dad are up in years. Her mom is 87 and her dad is 97. Dad is a very healthy and active senior who still participates in many social activities, including driving. Mom has mild-to-moderate dementia. Dad is her primary support, while Mary and her sisters help with caregiving tasks.

One night, Mary stayed with her mom because her mom was experiencing pain due to compression fractures in her back (she also has osteoporosis). Her mom, who is a petite lady (112 lbs.), was taking one Tylenol #3 every four hours. In the night, her mom was unable to follow commands to walk with Mary’s assistance to the commode. She noticed her mom had a “blank look” on her face. Her mom was scared. Things didn’t seem right to Mary. She decided to call 911. The paramedics assessed her and Mom was transferred to the hospital via ambulance.

Delirium often occurs in people with other conditions such as dementia or depression. It is often difficult for health care providers to determine the reason for the changes in behaviour or mental functioning.

While in hospital, pain control was a main issue, so they gave her Percocet and Hydromorphone. These are strong painkillers, both in the opioid class of medications, also referred to as narcotics. Mary explained her mom’s behaviour:

  • Soon after, her mom was shrieking, her eyes looked “wild”, she was paranoid – but couldn’t really say what she was afraid of.
  • Her hearing was super-sensitive (hyper alert), although she had a hearing impairment.
  • She was hallucinating and saw a waterfall coming from the ceiling.
  • Her paranoia escalated and she asked her family members if they were afraid too.
  • Her hallucinations continued and she started picking at imaginary things in the air.
  • She took off her gown and her adult brief.
  • She had periods of lucidity (thinking clearly).

This went on for three weeks.

Mary says it is very hard, emotionally, for her and her sisters to see her mother, who is such a modest person, act in a way that is so out of character. She said she sees occasional glimpses of her mother, then she “disappears.” Her mom knows there is something wrong, but she can’t figure out what it is.

I asked Mary what the medical professionals told her about what was going on with her mom. Mary said it took a couple of days before she could convince them that this was not her mom’s typical behaviour. This was not how her mom usually acts, and it was different from her mom’s dementia-related behaviour. She says the hospital staff were very good, and explained that her mom was experiencing a delirium. They were also suspecting she may have had a small stroke.

Delirium can last days, weeks or months.

I asked Mary what advice she has to give others who are going through a similar experience. She told me she wishes she had advice. She is still trying to figure it out. She goes to see her mom, and they try to be there with her. Sometimes she’s mad at them. Sometimes she cries. Sometimes she fixates on things. She can be good in the morning, then confused in the afternoon. The hospital floor she is on has people that are calling out, screaming, walking the hallways and are agitated. This is not helping matters.

Mary says she advises family members to ask the health care team questions. How long will she be like this? What happens if mom doesn’t improve, then what? Unfortunately, they may not have all the answers either.

Sometimes the cause of delirium is never determined.

Mary said her dad has been very quiet throughout all of this. He visits as often as he can, and talks to her on the phone. He worries about her, but doesn’t talk about it to Mary and her sister.

Mary’s advice is, if your loved one has delirium, educate yourself on the subject. Read books, do some research and talk to the professionals. She says we “figure it out day-by-day, hour-by-hour.”

Both Mary and her sister Wendy say it’s so important to be an advocate for your loved one. She says it’s okay to ask the doctors and nurses what is being planned, or what medications will be given to your loved one. She says numerous people have told her such as her doctor, nurses and friends that she needs to look after herself, too. She says it’s hard. “It’s hard to find time for myself. Sometimes I wake up in the morning and I ‘hit the wall.’ There are some days where I just cry and sleep because I feel so overwhelmed.”

Both Mary and Wendy wonder why the emergency doctors don’t have more insight in terms of the best practices when working with the elderly, especially in terms of medications. They feel geriatric specialists should be consulted more and the emergency doctors may require more training in this area.

A few weeks later Mary is relieved as her mom’s condition is improving. She was transferred to a geriatric rehabilitation ward where she is receiving excellent care. She states her mom’s memory is perhaps a little worse than it was before her hospitalization. She is still a little delirious, and they think she may have had another stroke. But overall, “She is much more like our mom, and that is great.”

Emma’s Story – When Delirium is Not Diagnosed

Oftentimes even health care professionals don’t recognize delirium. Sometimes they don’t listen to family members as well as they should, either. In Emma’s case, her mother Nellie went to a long-term care facility due to complications from a stroke she experienced when she was 78. Her condition resulted in frequent trips to the hospital. Emma looked after her mom for over a year before she went into a long-term care facility.

Emma had negative experiences with both the long-term care facility and the hospital regarding how they handled her mom’s sudden-onset confusion while ignoring the concerns from family. Emma suspects many of the difficulties her mom was experiencing were related to delirium, although a doctor never diagnosed it.

“Hospital visits were painful, difficult, frustrating and sometimes harrowing experiences.”  – Emma

Emma accompanied her mom to the hospital on all occasions. Emma states her mom was “handled poorly once delirium began.” She explained the doctor or nurse would often assume her mom had “full-blown dementia” and they would “no longer consult” with either Emma or her mom regarding reasons for the visit. Doctors seemed to be indifferent for the cause of her mom’s sudden confusion and determined it was dementia-related behaviour. There was never a diagnosis of delirium given to Emma, her mom or other family members.

The delirium-related symptoms that Emma’s mom had while in hospital were:

  • Struggling to get out of the stretcher repeatedly/constantly
  • Seeming to have no idea where she was or why she was there
  • Attempting to get people to help her “escape”; i.e. she would say, “Let’s say we’re going to the washroom and we can leave.”
  • Crying and sobbing; high emotional distress
  • Indications of increased pain

Emma also mentioned what she believes to be misdiagnoses her mother was given. Her mom never had a psychiatric diagnosis in her 80 years. She was surprised to find out that her mother, now in her 80’s, had been diagnosed with schizophrenia and another time she was diagnosed with bipolar disorder by the doctor at the long-term care home.

“Be alert to sudden changes in behaviour triggered by new medication or change in environment or emotional distress and keep a diary to track patterns and common themes related to the changes.” – Emma

A social worker by training, Emma did her research and read up on drug interactions and the impact they could have on her mom’s mental health. She began looking at the causes of sudden-onset behaviour changes and discovered delirium as a possible explanation.

Emma suspects it was some of the psychotropic or mind-altering drugs that were the cause of her mother’s delirious episodes. Medications that were in the antidepressant, benzodiazepine/anxiolytic, antipsychotic and hypnotic categories were all used both effectively and ineffectively in her mom’s case. Her mom found one of the anxiolytic and hypnotics helpful, but not harmful, in the end. It’s also important to note that some pain medications such as morphine and oxycodone (also called narcotics) can also cause delirium (as in Mary’s story, above).

Emma states throughout these experiences it’s difficult for her to put her feelings into words, but the experiences stay with her. “I felt helpless, useless, ineffective, frustrated, maybe even a bit hopeless about our system of care.” The other family members felt overwhelmed and torn in terms of what the doctors were saying and how they directed care. The family members found it difficult to vocalize their legitimate concerns. Ultimately, the family did not want to “make a fuss” and felt confused, distressed and frustrated.

“If you ever find yourself in a similar situation, to seek out a professional who specializes in studying, treating and diagnosing delirium.” – Emma

Emma advises if you have a loved one in a facility, or are considering a move to one, it is “critically important to know the possible side effects and adverse events related to psychiatric drugs; and to know the rate and use of psychiatric medications” in long-term care centres or residential care facilities.

Professionals such as geriatricians (doctors who work with adults aged 65 and older) and geriatric psychiatrists are two types of specialists who can be consulted to help sort out behavioural and mental health problems in older adults. Geriatric Mental Health Clinicians, or those who specialize in psychogeriatrics are also helpful in these situations.

Donna’s Story – Delirium at the End of Life

Delirium is common at the end of life. Donna had experience with knowing three people who became delirious. She said the behaviours were consistent in all three of them: “Extreme agitation, taking sheets and clothes off, in and out of bed and expressing the need to go home.”

Donna lost her dad a few years ago. Near the end of his life, he experienced delirium. The symptoms he experienced were heightened restlessness and agitation, pulling at his sheets and clothing, and constantly trying to get out of bed to “go home.” Sometimes he spoke incoherently and often he believed he was in a different time in his life. He was a firefighter and also used to sell cars.

Donna explains, “One morning he asked me if that guy had come to pick up his keys for his new car. When I told him he had, he settled down. Another day he was fighting fires and that is how it went. Sometimes we could not understand what he wanted if his speech was not clear and had to do our best to figure it out.”

The following is Donna’s advice to others going through this experience:

“I would say to just go with what is happening depending on the circumstances and do not make the person feel bad for whatever they say. If they are in the past, you need to be in the past, this is not a time to create more anxiety for the person. Also, recognize that even though they are delirious, they are still often aware of what is happening around them.

One time we thought my dad was not really with it and an old song came on the radio. We were all trying to figure out who sang it and he suddenly blurted out ‘Patsy Cline.’ This type of thing happened often and showed me how aware a person experiencing this still is.

Even when he seemed to be in a deep sleep or delirious, if my mom would take her hand away, his hand would begin to move around looking for her. We saw many signs that dad was still there even when in and out of delirium or coma. It is so important to be there for them and continue to do the things that make them comfortable.

This is not a journey we wanted or that anyone wants, but none of us would have missed taking it with dad for anything. We experienced great sadness, moments of joy, tears and laughter. I would tell anyone to allow themselves to fully engage in the process and do not be afraid to laugh – it is not inappropriate and not an insult to your loved one.”

What I Have Learned About Delirium

Delirium can last for days, weeks or months. It can recur in people who have had delirium in the past. Medications, illnesses (such as a urinary tract infection), dehydration, or sleep deprivation are some of the risk factors. When delirium is superimposed onto a dementia, it can also be difficult to sort out what is causing the confusion.

Evenings can be more difficult for a person with delirium. They may be more afraid or agitated for example (also called Sundowning or late-day confusion). Being with familiar people and objects can help, but it won’t make the symptoms go away. This can be very hard on family members.

When a person has delirium, it is very important to try and determine and remove what caused the delirium in the first place. This is not always possible. The delirium can clear just as quickly as it came, without any notice. It is not contagious, but I see it like a “little intruder” that invades the brain for a bit, causing all kinds of problems. Once the intruder is eliminated, or “burns out,” then things get back to normal. Sometimes there is a bit of a step-wise decline and there is a bit of a change in the person’s new normal, or baseline functioning. The person plateaus in terms of his or her thinking and functioning, but at a slightly lower level. Sometimes s/he gets right back to where s/he was to begin with.

Recovering from Delirium

People who are delirious need to be taken off medications that could be causing the problem. They need to be kept comfortable, safe, hydrated with proper fluids and fed with proper nutrients. If they are dehydrated, intravenous fluid administration (and electrolytes) may be required until they can tolerate oral rehydration (drinking by mouth). Make sure they have their eyeglasses, hearing aids and someone to interpret if required. They need to get up and walk around and socialize. They need frequent reminders of their location, and orientation to the time. Involvement of friends and family is important. They need to sleep. Their sleep patterns may be disrupted, so they will need daylight and activity during the day to help keep them stimulated (as tolerated). They may benefit from relaxation techniques such as music, massage or breathing exercises. They will need lots of tender loving care and close supervision. Encourage them to safely walk and do self-care with assistance if required. Aim for a normal sleep-wake cycle, having them sleep in a quiet room with low-level lighting. Discourage daytime napping. Offer a non-caffeinated warm drink at bedtime. Treat pain. It can last days, weeks or months.

According to the 2012 Beers Criteria, the following list of medications should be avoided, especially for those older adults who are already delirious or at risk for delirium:

  • All Tricyclic Antidepressants
  • All Anticholinergic drugs
  • Benzodiazepines
  • Chlorpromazine
  • Corticosteroids
  • H2-receptor antagonist
  • Meperidine
  • Sedative Hypnotics
  • Thioridazine

A low-dose of an antipsychotic medication may be prescribed temporarily to decrease severity and duration of delirium. Antipsychotics should be reduced after the severe symptoms of delirium have resolved with discontinuation as the ultimate goal (Forsberg, 2017).  However, a study on antipsychotics and those who are palliative (dying) revealed they can increase the symptoms of delirium (Agar, Lawlor & Quinn, 2017).

Unfortunately, delirium can increase the risk for developing dementia. Therefore, it is important to diagnose and treat as soon as possible. Delirium can also increase the risk for death.

Delirium prevention in older adults includes keeping on top of risk factors that may trigger an episode. Medication side effects, withdrawal, surgery and illness are all factors that can lead to delirium. The symptoms of delirium can be lessened by removing the cause, supporting good sleep and nutrition habits, helping the person remain calm and orientated, and helping prevent medical problems or complications. For older people who need to go to the hospital, this brochure on Delirium that may help.

A special thank you to the three women who shared their stories here in hopes of helping others.

Angela G. Gentile


Angela G. Gentile, M.S.W., R.S.W. is a clinical social worker and author of the books, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival,” “How to Edit an Anthology: Write or Compile a Collectino that Sells,” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband, daughter and two lovable dogs. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

For further information:

Delirium – Mayo Clinic

For more information on delirium at the end-of-life, check out this article on Mental Confusion or Delirium from cancer.net.

For Health Care Professionals:

Canadian Coalition for Seniors’ Mental Health – Tools for Health Care Providers: The Assessment & Treatment of Delirium in Older Adults and the Delirium Tool Layout.

Clarifying the Confusion About Confusion: Current Practices in Managing Geriatric Delirium

Delirium Treatment and Management

Delirium Update for Post Acute Care and Long-Term Care Settings – A Narrative Review by Martin Forsberg (2017)

Delirium in Elderly Adults: Diagnosis, Prevention and Treatment

The “Confusion Assessment Method” is a fairly easy and commonly used tool that has been written in 14 different languages. It is often used by healthcare professionals.

Efficacy of Oral Risperidone, Haloperidol, or Placebo for Symptoms of Delirium Among Patients in Palliative Care: A Randomized Clinical Trial by Agar, Lawlor and Quinn (2017).

Supports and Services for Older Adults in Gravenhurst, Ontario


Image source: Muskoka Pest Control


I have aging relatives in Gravenhurst, Ontario. I went there for a visit in August 2016. While there, I was looking into the services and resources available to older adults. What I found, or should I say didn’t find, was quite alarming.

The Aging in Place Strategy for Canada is great in theory, but providing resources and services to meet the needs of the aging population is proving to be quite the challenge.

Gravenhurst is a small, pretty lake town located just 90 minutes north of Toronto. It has a population of 12,179 according to the Gravenhurst Community Profile 2013. A whopping 23% of the residents are 65 and older (compared to 14.6% in all of Ontario). This community is growing older, and the needs of this aging population are also growing.

In the summer the population swells due to the number of cottagers who escape the summer heat to their cool lakeside getaways. Some of the cottages on Lake Muskoka are huge! I took a tour with William of Big 3 Tours and he showed us some cottages that are 1-5 million dollar price range. Celebrities such as Martin Short own cottages in the area.

In terms of at risk seniors and meeting their needs, it seems like Gravenhurst is lacking in the basics. I was told to call “211” to speak to a nurse about health care resources. The lady on the line was very helpful. I ended up talking to a few very nice and well-meaning individuals and sometimes my conversations went full-circle without any definite answers. It seems like there is no one place for all the information I was looking for which proved to be very frustrating. I spent a few hours on the phone but came up with some answers and resources which I’ll share here.


Meal Delivery

There are no hot Meals on Wheels available in Gravenhurst due to the lack of available volunteers. There are services available in Bracebridge, a neighbouring community which is a 15-minute drive north. In Gravenhurst, the only option recommended to me is a company called Apetito.ca. They will deliver frozen meals once monthly. All of the information is online, so it can be difficult for those who do not have access to a computer, or do not know how to use a computer. It appears to me that the only meals on wheels available to older adults are the fast food restaurants such as McDonald’s and Tim Hortons which also conveniently have a drive-thru. I am also assuming that the local grocery stores have ready prepared meals, which may be a better option. For those with special diets (cardiac, diabetic, gluten free), this can pose a challenge.


Housekeeping and Yard Work (Home Support)


Image source: Closing the Gap Healthcare

In terms of housekeeping, the Ontario government does not offer any services. In Winnipeg, to those who cannot afford to hire privately. In Gravenhurst, I was given a few different private companies to follow up with:

Seniors for Seniors – 1-705-645-0199 (Tom)

Closing the Gap Healthcare – 1-877-560-0202

Happy at Home Support Services – 1-705-703-9980 (light housekeeping and yard work)

Bayshore Healthcare – 1-705-722-8993 (Barrie office)

Red Cross Community Support Services – 1-705-721-3313

Busy Lizzie Cleaning Services – 1-877-207-8718 or 1-705-687-6183




Image source: Muskoka Seniors

There are two taxi companies in Gravenhurst – OK Taxi (705-684-8294) and Gravenhurst Taxi (705-687-2246). I’ve been told that Red Cross will provide transportation to the nearest hospital  if needed (South Muskoka Memorial Hospital), which is in Bracebridge, at 75 Ann Street. There are two bus companies that serve Gravenhurst – Ontario Northland for service north or south, and the Corridor 11 bus which can take you directly to the front door of the hospital in Bracebridge for $7.00. OK Taxi will pick you up from the hospital and bring you back to your home in Gravenhurst for $25.00. (Prices from 2017 and subject to change without notice.)

Aging at Home Vans or Registered Volunteers are offered through Muskoka Seniors.


Housing for Seniors

In terms of seniors’ housing, there are a few options. There are “retirement residences” and a “long term care” facility.

The Manor at Gravenhurst (operated by Lifetimes Living Inc.) is a quaint little 40-bed retirement residence I toured in August 2016. It was originally a hotel, and there are studio apartments with attached washrooms, studio apartments with shared washrooms, and double rooms (two studios with an attached washroom). All meals, medications, housekeeping, laundry, recreation and parking are included in the rent which ranges from $1,900/month to $4,000/month. Residents are free to come and go as they please and the ages range from 60 to 100. 1-705-687-3356.

Granite Ridge Retirement Residence Assisted Care – 1-705-687-0007

Muskoka Shores Care Community – Transitions operated by Sienna Senior Living (formerly Leisure World) – 1-705-687-3444

The Pines Long-Term Care Home – 160 beds, located in Bracebridge.

Affordable Housing Programs

Social Housing (Low Income Housing) 


Other Important Resources

Your doctor. Physicians have access to and knowledge of resources that I may have missed here.

North Simcoe Muskoka Community Care Access Centre  (CCAC)- Accessing Home Care services. Office located in Huntsville, Ontario. 1-888-721-2222 or 1-705-721-8010

Seniors Assessment and Support Outreach Team (SASOT) – Operated out of the hospital in Bracebridge. I spoke to a very nice person there, and she says they “dig deeper” and all you need to do is get the doctor to make a referral to their team. 1-705-645-4400. ext. 3505.

Muskoka Seniors – Helping Seniors Live at Home. 1-705-789-6676.

Assisted Living Services for High Risk Seniors – Currently a six-month wait list. Services provided by The Friends (1-705-697-5100, ext. 22). It is a not-for-profit organization. There is also an Adult Day Program available for socialization and a meal. It costs $15 a day and $2 for transportation one way. There is a wait list of about six months. The wait list for homemaking is five years. They do not do yard work. For information on Assisted Living Services for High Risk Seniors, go through the CCAC case manager or call 1-888-721-2222 or 1-705-721-8010.

Long-Term Care Homes in North Simcoe Muskoka – 9-page document with information on long-term care homes.

North Simcoe Muskoka Healthline – Online listing of health services in the area.

The District of MuskokaSeniors Wellness Outreach Coordinator, 1-705-645-2412, ext. 444.



Image source: Seniors Centre – Town of Gravenhurst


Seniors Centre – The Town of Gravenhurst has an active seniors’ centre and there is plenty of socialization and things to do for those wanting to remain active and involved.


Working Towards Age-Friendly Solutions

As I was doing my research, I was happy to find out that the District of Muskoka is working on a Master Aging Plan with assistance from an Age-Friendly Community grant received from the Ontario government. Here is a link for more information on how you can get involved: www.muskoka.on.ca//AgeFriendlyCommunities. I hope that they will be able to fill in the gaps soon to enable the residents of Gravenhurst remain in their homes as long as possible.

Overall, I would say that it is a very complex and frustrating experience to get information on services for older adults in need in Gravenhurst. The Seniors Wellness Outreach Coordinator at The District of Muskoka was most helpful. Those who have limitations or who have limited family support will especially find it difficult to get the services they require. If you have any further information to add to this list, please let me know in the comments below.

If you are planning a trip to Gravenhurst, check out the travel guide on wikivoyage for more information. For current events, check out the Muskoka Region News.




Angela G. Gentile, M.S.W., R.S.W. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. For more information, visit: www.AngelaGGentile.com

Senior Moments: Should I Be Worried?


Although I don’t particularly like the term “senior moment,” most older people know what that means. When someone who is at middle age or beyond has difficulty remembering something such as, “Where did I put my reading glasses?” or “I can’t remember her name” he/she may find someone else responding in a joking fashion, “Are you having a ‘senior moment?'” The other person is replying with a joke about having a poor memory. I have heard people themselves make jokes about their own “senior moments” in hopes of making light of the situation. It’s true that as people age there are normally changes in memory and thinking skills. On one end of the spectrum there is normal aging that affects everyone. At the other end is dementia which is common but not normal.  In between is a condition known as mild cognitive impairment. I will touch on all three.

We all have memory lapses on occasion

It’s true we all have occasional lapses in our memory. I even see my teenage children doing it. I even remember walking into a room years ago, forgetting what I went in there for, having to go back to what I was doing in order to jog my memory. Little lapses in memory is common for everyone. We get distracted or side-tracked especially when it is something that is not really that significant. Forgetting names is a common occurrence for example.

I have been working with older adults for over 25 years now and I see all different types of memory and thinking problems. I also know many older people (including caregivers) who do not show any signs of cognitive (brain function) decline.

I often note increased anxiety in people who are struggling with the loss of cognitive abilities. It must be a scary feeling to know that they are losing their faculties.

One of the common fears people have is developing dementia. Declining memory skills are often one of the first signs of dementia. The good news is that memory problems do not always lead to dementia.

Normal aging, mild cognitive impairment and dementia

Slowed thinking and minor problems with remembering things is quite common and almost expected in our later years. There are some things we can do to help reduce our risks of further problems with our cognition such as exercising (to get the blood pumping to our organs including the brain) and doing brain exercises (such as crosswords and learning a new musical instrument). Normal aging causes us to slow down in more ways than one.

Sometimes our memory problems become more problematic and they are noticed by other people. If you are continuously forgetting someone’s name or miss appointments, this may start to interfere with your relationships and daily functioning. You may have to learn new ways of coping with the normal changes in your brain such as keeping lists handy and using your calendar more regularly. Memory and thinking problems that can be noticed by others but don’t really affect your day-to-day functioning is called Mild Cognitive Impairment (MCI).

By the way, it’s a good sign if a person is aware of or concerned about their changing memory skills as one of the skills lost in dementia is the ability to know they have problems with their memory. If you ask someone with dementia if he/she has memory problems, he/she will most likely say “No.” It’s true that long term memory may still be intact.  It’s the ability to remember recent events and learn new information that is lost.

In some cases your memory skills, thinking and cognitive functioning may be impaired to the point where you can no longer do things on your own. For example, you may need someone to give you your medication on a daily basis or else you will forget. Or you can no longer drive because your sense of direction is off. Dementia is a syndrome and can be found in a variety of conditions  that affect cognition (such as Alzheimer’s disease). In early stages of dementia you can  live on your own as long as you can enlist the support you need to keep yourself safe. Dementia can create a variety of problems. For example, sometimes people with dementia forget to eat, or think they have already eaten. In this case it’s important to have someone provide a reminder or stop by to ensure he/she eats. In the later stages of dementia, it is not possible to live alone.

Seek a memory assessment if you are concerned

If you are concerned about your memory skills or other brain-related functions (such as language, problem-solving or judgment skills), please speak to your doctor for a memory assessment. Let your doctor know if you are concerned your problems are beyond the changes seen in normal aging (such as slowed thinking, and the occasional difficulty remembering things). Only a skilled practitioner can diagnose and determine the difference between normal aging, mild cognitive impairment and dementia, and provide treatment and management solutions.

For more information, check out Aging, Memory Loss and Dementia: What’s the Difference? from the Alzheimer’s Association.

You may also like to check out Senior Moments Explained by Terry Hollenbeck, M.D.


Angela G. Gentile, MSW RSW



An Empowering Read for Women, Business Owners and Marketers


GeroFuturist Karen Sands’ book, “Gray is the New Green: Rock Your Revenues in the Longevity Economy” (2016) is THE book you need to read if you are a middle-aged career women, business owner or marketer and are looking for lucrative opportunities. This small but mighty book covers topics such as ageism in society, business trends, marketing, careers and entrepreneurial opportunities in the field of aging, unretirement, reinvention, and visionaries. Sands intersperses loads of great data and statistics and references other thought leaders throughout the book, providing convincing evidence and support to her thoughts and ideas on “gray is the new green.” She encourages a narrative “re-storying” approach to positively changing the way we think about aging, careers and business.

She uses some familiar and unfamiliar terms such as:

– Longevity Economy
– Ageless Women
– Ageless Technology
– Conscious Aging
– Positive Aging
– Educational Gerontologist
– Age-Friendly Workplace
– Boomerpreneurs
– Solopreneurs
– Grannypreneurs

Hopefully these terms will be defined in Sands’ online glossary (not available at time of printing).

The book is sectioned into three chapters. The last chapter repeats most of what was in the first two. There were many topics that stood out for me as a 50-year-old woman. Sands talks about “The Change” (menopause) and embracing our “Inner Crone.” She empowers the reader when she tells us we can “radically reframe the stories we tell ourselves about aging.” It jolted me a bit when she proclaims 50 is universally “Over the Hill” according to Human Resource (HR) directors.

Sands challenges marketers to get beyond the rampant “malevolent ageism” in corporate marketing. She gives a few examples of how advertisers are inadvertently turning off women aged 50 and up who are the “highest increasing-spenders” in the fashion and beauty industries by creating offensive ads that portray older women in a negative way.

For businesses to succeed in this “Gray Tsunami” era, Sands recommends that diversity, gender equality and work-life balance initiatives must be welcomed and incorporated. She warns businesses that don’t adopt and welcome these changes will be left behind.

For those interested in working with or for the aging population, she states the “field of aging is evolving at warp speed.” She gives a listing of up-and-coming careers and opportunities in the aging field such as “cutting-edge age-friendly technology and devices, home design…and adult education.”


Karen Sands, GeroFuturist

Sands sheds some light on the notion of retirement and how our extended middle-age is changing the way we view working in our later years. She says, “Aging does not mean retiring.” She discusses how people are reinventing themselves, or they are “unretiring.” Others are choosing not to retire. She predicts employees and leaders alike will be working until they die.

For those Boomer Women who want to reinvent themselves by starting up a new business, she provides lots of great advice and questions to think about in Chapter 2. She offers a great tip for a business idea, which is to offer a product or service that can help people save time. She tells women to “awaken their visionary voice” and states “it is never too late to be a visionary.” In Chapter 3 she states although some women may not be ready for this change yet, she encourages them to do the “prep work” now so that they can “leap with confidence” when they are ready.

Although there is not much new in Chapter 3, I love the advice she gives regarding aging. Sands writes, “Marketing, and society as a whole, need to understand that we no longer wish to be told that aging is something we need to be against. Agelessness is about embracing and enhancing who we are, not blindly following an outdated standard of who we should be.”

“Gray is the New Green” is an empowering book for women. It is a goldmine for those in business. It is a lifesaver for marketers and organizations.

The book is available at Amazon.com in paperback and Kindle versions.

Note: I was given a copy of this book in exchange for an honest review.

Angela G. Gentile, MSW, RSW

Aging with Grace is All About Acceptance and Attitude

Aging with grace logo

Aging with Grace Defined Survey Results


What does “Aging with grace” mean to you?

To help me get a sense of what this term really means, I surveyed 24 people of all ages (most aged 50-69) and asked them to define “Aging with grace.” I enjoyed reading through the responses and I’d like to thank everyone who participated. I’d like to share with you what I learned, and I will also include my own thoughts on the subject.

“Grace is a quality that many aspire to, but I think in the context of today’s society, what defines grace is somewhat elusive.” – Survey respondent, 49 or under

For the most part, aging with grace is one’s ability to accept growing older and all the changes that come with it. We could almost change the term to, “Aging with Acceptance.” Aging (or the passing of the years) brings many changes to our appearance and abilities (physically, mentally); it also brings changes to the world and our lives. Aging with grace means we are able to accept, adapt and accommodate these changes.

The attitude we carry into our later years will also influence our ability to age with grace.

People who are aging gracefully…

  • accept aging
  • are happy
  • are confident
  • are wise
  • live a healthy and active lifestyle

Regarding “healthy” lifestyle — as we age, our risk for developing age-related illnesses and diseases increases. I think it is important that even if we develop health conditions, we take care of ourselves and try to recover quickly or learn how to live well with chronic illness. I know many people who are aging with grace despite chronic illnesses. It all comes down to attitude.  For example, does arthritis become who you are or is it just something you need to live with and manage?

“Grace is an inside job with outside effects.” – Survey respondent, 49 or under

If we are able to practice self-love as we age, by “nurturing our bodies and minds,” (Survey respondent, 50-69) we tend to be happier and more at peace. It helps us improve our confidence, and live a life that is in line with our true and authentic selves. As we become more compassionate about ourselves we will become more compassionate about others. We can continue to be “gracious to others, and make people feel good”, no matter what their age (Survey respondent, 50-69).

“Aging with grace means aging with confidence, valuing the experience, knowledge and wisdom that comes with age, and rising above a youth-oriented culture.  – Survey respondent, 50-69

Harnessing the wisdom and personal power that comes with age helps us age with confidence. There is great significance in the realization of the value of knowledge and experience gained from years lived. Only then are we able to choose to live a life designed and driven by our own personal values. We realize that we are responsible for our own lives and decisions are made with the wisdom that comes with age and the personal power that we embrace and celebrate.

“Allowing the power and wisdom of aging to be apparent in one’s presence –      including the ability to break stereotypes of aging.” – Survey respondent, 50-69

Being present in the moment in the here-and-now, while focusing on the good things in our life will help us live and age with gratitude. Practicing mindfulness will help us age with grace.

The ability to re-frame our challenges and limitations can help improve our outlook and overall attitude. Being resilient in the face of adversity will also help us a great deal.

Living a conscious life, knowing that we have a finite time here on earth, enables us to focus on living a life that honours our individual values and goals.

I can also tell you what aging with grace IS NOT. It is not about complaining – such as “moaning upon standing” or “whining about wearing reading glasses.” Aging with grace is “void of anger, regrets and baggage from the past.”

The more we learn to accept aging as a normal lifelong process, make peace with it (not war), the happier and more confident we will be.

I’ll leave you with this: Only one person over 70 answered the survey, and gave me something to laugh about. When asked, “How would you define aging with grace?” the answer was:

“I don’t know anyone named Grace, but, I am aging.”

The survey will remain open for a few more weeks, so if you’d like to give me your definition of Aging with Grace, please go to this survey and answer three quick questions. Thanks!

Have your say – please comment below. I’d love to hear from you.

Angela G. Gentile


Angela G. Gentile, MSW, RSW is a clinical social worker who specializes in aging. She has helped hundreds of people who are struggling with the challenges aging can bring. Angela is passionate about challenging ageist myths and stereotypes and exploring what it means to age well. She considers herself a realistic optimist but she still can’t tell her left from her right. Find out more at http://www.angelaggentile.com.