[Two Pronged] Dealing with my uncle’s cognitive decline and his living with my family

Amy is experiencing stress living with her uncle, who has cognitive decline, and is concerned about the impact on her family, especially her children. Mr. Baer advises Amy to consider professional caregiving options and possibly relocating her uncle to alleviate the burden on her family. Dr. Holmes discusses the genetic factors related to cognitive decline, emphasizing that lifestyle choices can significantly influence the risk of developing conditions like Alzheimer's. This is AI-generated and may have errors. For context, always refer to the full article. Report issues here. Rappler’s People section runs an advice column by couple Jeremy Baer and clinical psychologist Dr. Margarita Holmes. Jeremy has a master’s degree in law from Oxford University. A banker of 37 years who worked in three continents, he has been training with Dr. Holmes for the last 10 years as co-lecturer and, occasionally, as co-therapist, especially with clients whose financial concerns intrude into their daily lives. Together, they have written two books: Love Triangles: Understanding the Macho-Mistress Mentality and Imported Love: Filipino-Foreign Liaisons. Dear Dr Holmes and Mr Baer, I am 41 and my husband and three children (ages 12, 4 and 2) live on the second floor of my parents’ home. When we got married, my parents renovated the house to ensure we were completely independent, and on a separate floor so we did not need anything on the ground floor where my parents live. They did everything so we would stay with them forever. It works for us too. We eat dinner with my parents every night except if we have an event. Then it is only the kids who eat with them. We get the best babysitters that even money can’t buy and they have the kind of joy that cannot be bought either. Things were perfect until my uncle (the brother of my dad) came to live with us because he is in what the doctor calls cognitive decline. He can no longer live by himself, which is how he has lived for the last 52 years. He is now 71. It is so stressful living with my parents now. My Dad didn’t used to mind his younger brother living with us, but even he gets annoyed much more quickly than he used to. The rest of the family, especially my mom who never liked this particular brother-in-law, are also annoyed and not as patient. He is no longer independent and someone has to go with him whenever he steps out. He refuses to accept this and sometimes sneaks away. He then gets lost for 3-4 hours each time. Twice he fell and once he hit his head. The maids and driver are all afraid of him. He shouts at, and insults, them when he is in a bad mood. You never know what sort of mood he will be in from minute to minute. I am so depressed and want to live somewhere else. The house is toxic. I do not know if my Dad will turn out like him; if this decline runs in families. It is hard enough to live with my uncle. How much harder will it be if my Dad becomes like this too? I think my kids deserve a better childhood than this. Any ideas?– Amy Dear Amy, Advancing old age is frequently accompanied by the onset of issues such as ill health and the need to make and take difficult decisions. For some there is little choice but to accept the hand they have been dealt. For others, there is the comparative luxury of possessing resources to mitigate the consequences of what fate has in store. These resources are primarily financial but also include time, space, staff, etc. In your case, Amy, it would appear that your family possesses the necessary funds to confront all the issues that cognitive decline present. You have the flexibility to configure your house so that your uncle has his own room, your family has its own separate space, you have staff who can take on limited caregiver roles, at least in the short term. Your family’s desire to look after your uncle is certainly laudable but it means taking on a huge burden which could wreak terrible damage on everybody concerned. You already say it is taking its toll. You are effectively faced with choosing between the in-house care of your uncle and the wellbeing of your own family. The sad reality is that this is typical and it will not get any better, so now is the time to plan for the immediate future. The stopgap measures need to be replaced professionally which means trained full-time caregivers and possibly moving your uncle to a separate residence. This will both benefit him and release the rest of the family from the ‘toxicity’ of the current situation. In the longer term it may be necessary to consider moving him into an appropriate facility. As for the genetic component of cognitive decline and the likelihood of your parents following your uncle’s path, I leave it to Dr Holmes to address this. All the best, – JAF Baer Dear Amy, Thank you very much for your letter. Mr Baer has practically ordered me to talk about the genetic components of cognitive decline, so that is what I will do. However, I will talk even more about epigenetics, a new body of knowledge which, praise God, has grown exponentially in less than a hundred years (which is when epigenetics started). This body of knowledge was a game changer not only for cancer, but also for dementia, which we will get to in a couple of paragraphs. Most dementias are not passed on within families; i.e., it is not inherited. However, there is one pretty well-known gene, the apolipoprotein E (APOE-e4 ) that greatly increases the risk of late-onset Alzheimer’s (the most common form of dementia). Some researchers go so far as to say between 40-65% of people diagnosed with Alzheimer’s have the APOE-e4 gene. We all inherit a copy of some form of APOE from each parent, but it is not necessarily the APOE-e4 gene. You get one copy from each parent. Having the APOE-e4 version is the strongest known genetic risk factor for late-onset Alzheimer’s disease. If you inherit one copy of the APOE-e4 gene, your lifetime risk of developing Alzheimer’s disease by age 85 is about 20% to 25%. Your risk jumps much higher if you inherit two copies of APOE4, which gives you a 30% to 55% chance of developing Alzheimer’s. Even then, however, having 2 APOE-e4 genes does not guarantee you will get Alzheimer’s. The opposite is true too: many people with no APOE-e4 genes still get Alzheimer’s, and many with the APOE4 gene live long lives without the disease. This is where epigenetics comes in. We used to think that genes determined our destiny. As it turns out, as epigenetics research has grown, we now realize that it is not genes per se that matter in terms of health but whether these genes are turned ON or turned OFF. Thus, even if you inherited two APOE-e4 genes, you can STILL avoid Alzheimer’s. How do you do that? By having a healthy lifestyle. “Epi-” is the Greek prefix that means “above,” “over,” or “on top of”. If you use the principles of epigenetics, your chances of getting Alzheimer’s will be greatly reduced. Thus, embracing lifestyle habits like a heart-healthy diet, regular physical exercise, keeping your blood pressure and cholesterol in a healthy range, getting enough good quality sleep, lowering your stress levels considerably, and having good relationships with others, can help lower your risk of cognitive decline (CD). When Chris Hemsworth, the actor who plays Thor in the Marvel movies, found out he had 2 APOE-e4 genes, he decided to quit acting in order to do as much as he could to avoid Alzheimer’s. However, hopefully because he found out more about epigenetics, he went back to acting, realizing that he could still diminish the risk of cognitive decline by having a healthy lifestyle. Dearest Amy, I know that you are under incredible stress at the moment. Among other reasons, you are a member of what is called the “sandwich generation.” You take care of your children, but when your parents reach a certain age, you have to take care of them too! Another reason is that seeing 3 people in your house at roughly the same age, with the youngest already in CD, you do not need a great imagination to predict that perhaps your parents might experience CD as well! I am so sorry. But I hope knowing more about epigenetics gives you some hope. It has not only instilled hope in others, but has proven time and again that it actually works! All the best,– MG Holmes