Divorce is never easy. As a geriatrician, I obviously can’t discuss every single factor that leads to it later in life. What I can discuss, however, are the issues that I’ve personally seen in patients that cause challenges for them, their marriages, and their families.

It’s worth noting that the likelihood of someone over 65 having dementia is around 10%, and that number jumps to nearly 45% if the elder is over 85. Changes in brain function complicate all relationships, but none so much as a marriage.

Now, I’m not saying that all problems in marriages pop up after 65. Maybe there were decades-long patterns of less-than-healthy behaviors: Verbal abuse, controlling behavior, coldness. Perhaps it was years of just “hanging on” until the kids leave for college. I’m a huge fan of family therapists and talking out some of those issues. Therapy can sometimes resolve those unspoken hurts that have festered for years. Things may improve.

However, don’t expect elders to change their behaviors or viewpoints late in life and suddenly become, say, open-minded to topics they haven’t warmed to in the past. In other words, if there isn’t improvement after therapy, then they probably aren’t going to change. And harping on an unhealthy behavior or particular problem won’t make your relationship with that elder better.

The elephant in the room is undiagnosed dementia. Has an elder’s mood or behavior changed significantly over the last few years? Have they lost the ability to assess risk? Have they become inexplicably rude or cruel? Have they fallen victim to scams?

Particularly, if an elder has lived a life wherein they’ve been wealthy, powerful or in-charge, then they’ll likely resist being evaluated. This is the challenge, and I address it extensively in my book, Living in the Moment: Overcoming Challenges and Finding Moments of Joy in Alzheimer’s and Other Dementias.  

To put it bluntly, the family doctor doing a Mini Mental or MOCA 30-point exam is rarely sufficient to rule out dementia. And that potentially undiagnosed dementia will continue to affect the elder’s behaviors, relationships and ability to make financial and medical decisions — much less emotional and family decisions. If things are going south, behaviors are strange, scammers are circling like vultures, or dad is just thought to be an angry old man — then geropsychological testing is needed. This is more expensive and can take several hours, but the information is invaluable to understand what’s really going on.

If divorce is ultimately contemplated, and an elder eventually goes through with divorce proceedings, then it’s often my wish that they have their medications adjusted. It’s important to remove medications that can make them seem demented or angry (Tylenol PM, Xanax, Keppra are all good examples) or use medications that will take the “angry edge” off. Things can get better.

Additionally, when dividing the estate, significant assets need to be allotted for ongoing care of the elder with dementia. It’s beyond my scope to say how much, but assisted living and caregivers aren’t cheap.

Yes, this is all scary, especially when it happens to the patriarch or matriarch of the family. Lifelong family dynamics are turned upside down. However, it’s important to know what’s going on and protect the elder. The result is a happier family dynamic in whatever form that takes.

There is help.