Quick summary

It can be hard to decide when someone who has Alzheimer's should no longer live alone. With sufficient lifestyle supports and memory aids, some people with the disease live independently for years. The illness usually begins mildly, and it progresses at very different rates.

Eventually, though, you may have your doubts about how well things are going. Are you overreacting to ordinary problems? Or making excuses so you can postpone tough choices? It can be difficult to know. Confounding the issue is the fact that people with dementia are often able to conceal the severity of their problems, especially if you don't see them every day.

Here are some questions to help you decide whether the person needs more assistance. Each "yes" answer is a red flag that warrants a closer look.

Changes in communication

• Have letters and grandchildren's birthday cards slowed or stopped?
• Does she seldom initiate calls anymore (it's always you calling first)?
• Does she seem in a hurry to get off the phone, fail to ask you many questions, or seem unresponsive to your comments?
• Do you get nonemergency calls at unreasonable hours, or hear complaints from friends that they're receiving such calls?

As dementia progresses, she may find it difficult to follow the steps involved in writing, addressing, stamping, and mailing a letter. Phone conversations become difficult to follow. It can be worrisome when you can only get firsthand updates by visiting in person. And someone who can't write and mail letters may also have trouble completing the steps involved in cooking or driving. Odd communications in the evenings or at night can be characteristic of sundown syndrome, the worsening of confusion and other Alzheimer's symptoms that sometimes occurs late in the day.