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I Forgot — And Maybe That’s Okay

Age-friendly health care includes a focus on cognitive skills

By Terry Fulmer, PhD, RN, FAAN and The John A. Hartford Foundation
September 23, 2019
Credit: Adobe

(Editor's note: This content is provided by The John A. Hartford Foundation, a Next Avenue funder.)

"I have been forgetting things for years, but now I forget in a new way. I used to believe I could eventually retrieve whatever was lost and then commit it to memory. Now I know I can't possibly. Whatever's gone is hopelessly gone. And what's new doesn't stick."

This passage is just one of many favorites from Nora Ephron's final book, I Remember Nothing — a 161-page testament to the fact that as we age, our memories get worse and forgetting things becomes part of the daily routine. As I was rereading it this past weekend, the sentiment hit close to home, as I'm sure it does for millions of us:

"Where did I leave my keys?"

"Whose birthday was I supposed to remember?"

"Did I really just call the dog my husband's name?"

These moments pop up for all of us from time to time, and for the most part they are normal signs that we're getting older: forgetfulness comes with the territory.

When in the past doctors may have prescribed a medication to treat one condition at the expense of their patient's memory or cognitive function, now, if medication is necessary, more doctors prescribe drugs that do not interfere with mentation.

But what if forgetting things happens far more often than it used to, or far more frequently to you than others your age? It could be a sign of Mild Cognitive Impairment (MCI), which for many people is a precursor to Alzheimer's disease.

According to the National Institutes of Health, people with MCI should still be able to carry out their normal daily routines, but may experience some level of depression, irritability, aggression, anxiety or apathy.

Making Cognitive Health a Priority


The good thing is you don't have to manage these symptoms alone. Whether forgetfulness is simply a sign of normal aging or a symptom of MCI or dementia, you should raise any concerns you have with your doctor. Your health care team is there to help you maintain your cognitive health, or mentation, which is a top priority for most people.

In recent years, more and more hospitals and health systems across the country are making their older patients' mentation a priority, too.

When in the past doctors may have prescribed a medication to treat one condition at the expense of their patient's memory or cognitive function, now, if medication is necessary, more doctors prescribe drugs that do not interfere with mentation. Doctors are also increasingly on the lookout to prevent, identify, treat and manage dementias, depression and other mentation-associated conditions.

These include the 150 health systems participating in an initiative that my organization, The John A. Hartford Foundation, launched in partnership with the Institute for Healthcare Improvement, the American Hospital Association and the Catholic Health Association of the United States in 2015.

Through the Age Friendly Health Systems initiative, which we hope will reach 20% of all hospitals and health systems in the country by 2020, participating health systems are making sure that older patients' cognitive functions are top of mind whenever they come in for care.

Age-Friendly Health Systems focus on three additional aspects of care: promoting older patients' mobility, ensuring their medications don't interfere with quality of life and prioritizing what matters to patients themselves. Together with mentation, these "4Ms" of age-friendly care represent a major shift in the way health care providers serve older patients at all levels of cognitive and physical health.

Aging happens to all of us. My own memory lapses drive my kids crazy, and my husband and I have agreed to omit the phrase, "Don't you remember I told you…?"

That's why we at The John A. Hartford Foundation believe that caring for memory and cognition should be a normal part of our health care as aging is part of our lives. By asking "What matters to you?" instead of "What's the matter with you?," age-friendly health systems can normalize our worst fears about aging and empower us to live our lives the way we choose.

Terry Fulmer, PhD, RN, FAAN
Terry Fulmer, PhD, RN, FAAN, a Next Avenue Influencer in Aging, is President of The John A. Hartford Foundation in New York City, a national philanthropy dedicated to improving the care of older adults. Dr. Fulmer is nationally and internationally recognized as a leading expert in geriatrics and the topic of elder abuse and neglect, and her vision is catalyzing the Age-Friendly Health Systems social movement. Read More
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