Kevin Kawamoto
Special to The Hawai‘i Herald

As we age, there are normal physiological changes that occur, although not everyone is affected the same way at the same time. Changes in hair color, skin elasticity, muscle tone, fat content, vision, hearing, taste, smell and other conditions commonly occur. It is not unusual for people to put on weight between the ages of around 30 to 75. After 75, caloric intake may decrease and a person’s weight is likely to decrease, as well.

While these changes may not always be welcome, they are normal changes associated with getting older. Some of them can be improved through treatment or with technology. For example, many people use eyeglasses or contact lenses long before they reach old age as a way to improve their less-than-20/20 vision. If cataracts become a problem later in life, surgical options are often available.

Hearing aids have long helped the hard-of-hearing, and advanced technology has resulted in hearing devices that are barely visible and with less distracting extraneous noise. The inability to hear what is going on around you can be alienating, making a person feel alone even in a room of friendly people. A hearing aid or a cochlear implant, which involves surgically implanting a small electronic device into the ear to directly stimulate the auditory nerve, are usually worth considering.

Close attention to lifestyle choices is also extremely important, including getting regular health care, eating nutritious meals, managing stress levels, pursuing positive social relations and activities, maintaining a healthy weight through diet and exercise, and not smoking or drinking alcohol excessively. Many older adults find that having a meaningful spiritual life is also beneficial and can help in coping with life’s difficulties, but spirituality can take many forms. Cosmetic surgery, hair coloring, and assorted health and beauty products are also used to mask or mitigate the signs of aging.

As far as one’s mental capacities are concerned, there are normal declines that affect most older people. However, there may be other things that are of greater concern and should be reported to a primary health care provider. Let’s use “Betty” as a hypothetical example based on a number of real-life people.

Betty has always been a meticulous person, mindful of her appointments and obligations. Now widowed at age 78, she lives alone and manages her own affairs. Last week, her dentist’s office called, looking for her. She was supposed to be there for a routine check-up, which she had scheduled six months earlier. Betty had noted it in her appointment book, but had forgotten about it. She apologized profusely to her dentist’s receptionist and was very upset after hanging up the phone. On the day of her dental appointment, she was preoccupied with so many other things that she completely forgot about it. After hanging up the phone, she remembered that, yes, she was supposed to be at her dentist’s office.

This isolated incident of forgetfulness does not mean that Betty is developing Alzheimer’s disease, especially because there was a reason she forgot — and remembered later — that she had the appointment. However, if these missed appointments become more frequent and Betty does not remember that she even had the appointment, it would be cause for more concern.

Betty has never had to rely on anyone to balance her checkbook. She always took care of the household budget and paid her bills on time. However, she recently received a letter notifying her that she had failed to pay a utility bill on time. Betty went through her records and, sure enough, that one had slipped by.

Again, an isolated incident like this may be no reason for serious concern. Many younger adults also forget to pay bills on occasion. There is reason for concern when bills are regularly not being paid anymore and checkbooks are no longer being balanced. Also, if Betty can no longer perform the simple math she has always been able to do, this is a sign that there may be something more serious going on than simple forgetfulness.

Any changes in patterns of behavior are important to note. For example, if a person was always a “loner” in his youth and continues to be a “loner” later in life, it might not be as significant if a person who always enjoyed socializing with friends starts isolating himself more and more. The reason may not be Alzheimer’s disease, but it’s something that should be mentioned to a health care provider because it is a noticeable change in that person’s normal pattern of behavior.

The Alzheimer’s Association lists 10 “warning signs” of Alzheimer’s disease. These are things to look out for in yourself or loved ones. If you suspect a problem, see your doctor soon to discuss your concerns. If you are a caregiver and notice these signs in a care recipient, take notes of what you observe and share them with a loved one’s health care provider. Here are the warning signs:

  1. Memory loss that disrupts daily life.
  2. Challenges in planning or solving problems.
  3. Difficulty in completing familiar tasks at home, at work or at leisure.
  4. Confusion with time or place.
  5. Trouble understanding visual images and spatial relationships.
  6. New problems with words in speaking or writing.
  7. Misplacing things and losing the ability to retrace steps.
  8. Decreased or poor judgment.
  9. Withdrawal from work or social activities.
  10. Changes in mood and personality.

(See the Alzheimer’s Association website,, for a more detailed description of each of the above signs.)

When you go to the doctor for yourself or with a loved one to voice concerns about any of the above symptoms, try to be as specific as possible with your observations. Simply saying, “I’m having memory problems,” is not going to help as much as saying, “In the past three months, I have missed three scheduled appointments, and I can’t remember ever scheduling those appointments.” Or, “My daughter tells me that I am asking the same questions over and over again.” Or, “I was coming home on the bus one day last week and couldn’t recognize where I was supposed to get off. This has happened before and somebody had to help me get home.”

If you are caring for a family member, you might say, “Dad took a walk around the neighborhood last week and couldn’t find his way back home. He has been walking around the neighborhood for years without any problem. Also, he is becoming confused about a number of things. He asked why his sister hasn’t been over to visit in a long time, even though he used to be well aware that she passed away two years ago.”

It’s probably going to be difficult to remember all the concerns you have about changes in your memory, behavior or personality, especially if you have memory problems. It’s a good idea to jot down in a notebook all of your concerns as soon as you think of them and then bring the notebook to the doctor’s office. Do the same if you are a caregiver. Again, the more specific the examples — with dates, times, places and circumstances — the more helpful it will be to a doctor or specialist.

If the doctor feels that further tests are warranted, he or she will do them or order them. This may consist of taking a patient history, administering a mental state exam (which is conducted face-to-face in a professional setting), referring the patient for more extensive neuropsychological testing, having diagnostic images taken of the patient’s brain and so forth. It may be that your concerns are not signs of early Alzheimer’s disease, but may be due to other medical problems that can be resolved. If you or a loved one is diagnosed with early stage Alzheimer’s, you can consider the treatment options and plan for the future early on rather than waiting until further cognitive decline sets in.

But don’t jump to conclusions until a qualified, professional assessment is done.


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