By Jafar Novruzov, MSN, APRN Board certified psychiatric mental health nurse practitioner and founder of Future Psychiatry
Someone calls with a question about their mother’s care. You explain the plan. They seem reassured. An hour later, they call again.
It is easy to feel frustrated. We already discussed this. What else do they need? This is often where families first bump up against cognitive decline and caregiver burnout, two related concerns that shape the questions I hear most in my psychiatric practice. Recognizing early signs of cognitive decline in a loved one, and caregiver burnout signs in the family member holding everything together, tends to change the entire conversation.
But I want to know why the conversation keeps happening.
Is there something wrong with the care? Have different professionals given different instructions? Or is this person exhausted, frightened, and trying to make decisions they no longer feel able to manage?
These were some of the questions behind my recent presentation, “Beyond Memory: Recognizing Hidden Signs of Decline and Caregiver Burnout.”
On September 15, I had the opportunity to speak for the National Aging in Place Council’s New York City chapter at Inspir Carnegie Hill, following an invitation facilitated by Arkady Nitkin. The presentation brought together concerns relevant to elder law attorneys, care managers, home care professionals, senior living teams, and others supporting older adults and their families.
My work in psychiatry and complex care management gives me a particular interest in these conversations. I think about what might explain someone’s symptoms, but also about what happens after the appointment. Who understands the plan? Can the person follow it? Who notices when something changes?
A recommendation can sound reasonable in an office and still be difficult to carry out at home.
What Has Actually Changed?
When a family mentions cognitive decline, the conversation often starts with memory.
But I also want to know how the person is managing their usual life.
One question I find useful is:
“What could your mother do six months ago that she is having trouble doing now?”
That is more informative than asking whether she seems forgetful.
If someone never managed the household finances, needing help with bills tells us very little. If they handled everything reliably for decades and now has repeated unpaid bills, I want to understand why.
The same applies to familiar activities, appointments, and medications. We are looking for a change from that person’s usual abilities, especially when it begins interfering with everyday life. A pattern deserves assessment, even when nobody knows the diagnosis yet. MedlinePlus explains how memory problems can affect daily functioning.
For families, it helps to bring specific examples to an appointment. Tell the clinician what happened, when it started, and whether it is becoming more frequent.
“She seems different” is a starting point. “She has missed several appointments she would normally remember” gives us more to work with.
I Want to Understand the Symptom Before Giving It a Label
When someone tells me, “My memory is terrible,” I want them to walk me through an example.
What were they trying to remember? What else was happening? How have they been sleeping? Have they been feeling depressed or overwhelmed? What medications are they actually taking?
Memory complaints can have several contributors, including depression, medication effects, and medical conditions. An assessment helps determine what needs further investigation. MedlinePlus reviews potential causes and the evaluation process.
The timing matters enormously.
A gradual change over several months and major confusion that began yesterday require different immediate responses. Sudden confusion needs immediate medical assessment, including in someone who already has dementia. It should not wait for a routine psychiatric appointment. Read more about sudden confusion and urgent evaluation.
Clinical judgment includes recognizing when another type of care needs to come first.
The Person Answering Every Call May Need Help Too
Now think about the daughter who knows every medication, every appointment, and every caregiver’s schedule.
Everyone calls her because she always has an answer.
But when did someone last ask how she is doing?
Being capable does not tell us whether someone is coping well. A person can keep meeting responsibilities while sleeping poorly, missing their own appointments, and feeling increasingly overwhelmed. Caregiver stress is one of the most consistent public health concerns in aging populations (CDC on caregiving).
During the presentation, I used the phrase “family anchor” to describe the person everyone relies on to keep care organized.
My concern is what happens when all that responsibility sits with one person.
I would ask:
“How are you sleeping?”
“Who is helping you, and what do they actually take care of?”
“If you were unavailable tomorrow, who would take over?”
That last question makes the situation very concrete. A family may have several involved relatives, but nobody else may know how to arrange the next shift or contact the medical team.
The response should be practical. Identify what someone else can take responsibility for. Make sure they have the information to do it. Check whether the caregiver actually gets relief.
And listen to the complaints. Sometimes a family member keeps calling because the care is inconsistent or the explanation is unclear. We should address that before assuming the problem is anxiety.
What Happens After We Notice?
Recognizing a concern is only the beginning. Someone still needs to act.
I shared the ANCHOR framework to help organize that process:
- A means Ask what changed.
- N means Notice specific changes in function, judgment, or behavior.
- C means Check the circumstances, timing, and safety.
- H means Hear how the caregiver is doing.
- O means Organize the next step.
- R means Reassess whether the plan happened and helped.
This is a communication framework, not a validated screening test.
The part I would emphasize is ownership. If we say, “The family will follow up,” everyone may assume someone else is making the call.
I would rather leave the conversation knowing who will contact the clinician, who will confirm the arrangements, and when we will check back.
That is where collaboration becomes useful. Different professionals see different parts of someone’s life. We need to make those observations understandable to one another, with appropriate consent and respect for privacy.
Where Future Psychiatry Fits
At Future Psychiatry, I work with adults in New York who are experiencing concerns such as persistent sleep problems, anxiety, mood difficulties, burnout, and complicated medication histories.
Sometimes the person seeking help is an older adult. Sometimes it is the family member who has spent months taking care of everyone else.
My approach starts with understanding the full situation. I want to know what the symptoms feel like, how they affect daily life, what has already been tried, and what the person wants to change. Treatment may include medication when appropriate, attention to sleep and daily habits, and coordination with other clinicians.
Care is primarily provided through telehealth, with limited home visits when appropriate.
Thank you to Arkady Nitkin for connecting me with this opportunity, and to NAIPC New York City and Inspir Carnegie Hill for bringing this conversation to the professionals supporting older adults and families.
The question I hope people carry into their next conversation is simple:
“What has changed, and who needs help now?”
Frequently Asked Questions
Does forgetfulness always mean dementia?
No. Occasional forgetfulness can occur with aging, and memory difficulties can have other causes. Repeated changes that interfere with familiar activities deserve evaluation. The person’s usual functioning and the timeline are important.
When should a family seek urgent help?
Sudden confusion or a major acute change in awareness requires immediate medical assessment. Stay with the person while arranging help. Call 911 when emergency assistance is needed.
Can a caregiver seek psychiatric care even if their loved one is not your patient?
Yes. A caregiver can seek an evaluation for their own sleep, anxiety, mood, or other mental health concerns. Their care is separate from their loved one’s treatment. They deserve attention to their own well being.
When might psychiatric care be appropriate?
An evaluation may be helpful when persistent sleep problems, anxiety, mood symptoms, or medication concerns are affecting everyday life. Psychiatric care can work alongside primary care, other specialists, and practical caregiving support.
How can I connect with Future Psychiatry?
Adults seeking care in New York and professionals exploring a referral can visit Future Psychiatry to inquire about an evaluation and whether the practice is an appropriate fit. You can also contact us here to get started.
This article is for educational purposes and does not constitute medical advice. If you are concerned about your own or a loved one’s mental health, please consult a qualified healthcare provider.
About the author: Jafar Novruzov is a board certified Psychiatric Mental Health Nurse Practitioner and the founder of Future Psychiatry PLLC, a psychiatric practice serving adults in New York.
Future Psychiatry is a concierge practice in New York City specializing in integrative psychiatry, anxiety treatment, and holistic mental health. Founded by Jafar Novruzov, PMHNP-BC, the clinic provides luxury, evidence-based psychiatric care designed for long-term wellness.