Freda has been active in her local community, however, and has frequently raised money for a local children’s charity, despite never having any children of her own.

Arthur has lived with a diagnosis of dementia for 5 years. He has regularly seen doctors and faced his illness with admirable stoicism.

Arthur appears to accept his lot in life despite having some episodes of illness that have set him back considerably. The last episode resulted in him returning from hospital and requiring regular nursing input to keep him stable. His mental faculties are good when he is at his best but this is highly dependent on his physical state and he can be very confused when he is tired or ill.

Arthur is very protective of Freda and does not feel she should be burdened with household duties he views as being his role, including their financial affairs. He does accept that at some point she may need to do this but is putting off making any decisions at the present time. Freda does not feel confident about broaching the subject with Arthur, not wishing to increase his stress levels.

Arthur and Freda have a specific problem: Arthur either does not understand or is finding it difficult to admit that he has lost some of his skills. This is not uncommon in early stage dementia.

It is dangerous enough in the context of managing financial affairs but it can become a more immediately urgent problem in people who want to drive or to work with dangerous equipment, at a stage when it is actively dangerous for example.

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Freda is clearly sympathetic in her relationship with her husband and will probably not have much trouble in understanding how difficult it might be to acknowledge or admit loss of skills in areas where Arthur has been strong during the course of their marriage.

It is unsurprising both that Arthur may want to avoid thinking about the loss of an ability that he valued, that he may feel Freda will struggle to cope – and that he doesn’t want to lose an ability to give some reciprocal help to Freda when she gives so much help to him.

However, Freda and Arthur have little real choice: the situation will have to be managed. Freda, a mutual friend or someone who Arthur respects (or any combination of the three) will need to find the right time and the right environment in which to talk to Arthur about the problem.

They will have to be gentle in their approach and allow Arthur to speak about his feelings. They might try to find some other area in which Arthur can help Freda, and suggest people who might be able to help if Freda finds it difficult to cope.

It might also be an appropriate time to talk to Arthur about granting Lasting Power of Attorney for the future – an arrangement for ensuring that responsibility for various life areas (including finances and management of property) will be transferred to a trusted individual if it becomes necessary.

It will be important to accept that Arthur may need time to think about the issues and that he must make his own decisions: he will feel better about having to relinquish responsibilities if he does and might well resent it if he feels he has been pressured.

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