As the workforce ages, dementia is a concern. Here are ways to help those affected.

Families often discover during the holidays that loved ones are struggling with dementia and memory loss, and these cognitive issues are becoming yearlong concerns for employers, too, as they encounter an aging U.S. workforce.

The Alzheimer’s Association collaborated this year on its first report on dementia in the workforce, calling it a “hidden but growing concern” now that seniors make up 19% of U.S. employees. That rate has doubled through four decades.

“As our population and workforce ages, the possibility of having employees who experience cognitive impairment is real,” said Katie Evans, the association’s chief programs and mission engagement officer.

Some workers conceal cognitive declines because they fear their employers demoting or firing them. Or they might adjust their workplace routines on their own to compensate. Others, such as surgeons and pilots, are obliged to disclose serious changes in cognition for safety reasons.

Bank of America collaborated with the Alzheimer’s Association on the report to encourage “dementia-friendly workplaces,” where conversations about changes in workers’ cognition levels are nonthreatening. Companies that overlook this challenge risk costly mistakes and lawsuits, the report stated.

“An empathetic company culture increases the chances that a worker will disclose cognitive concerns, allowing critical conversations to occur and employees to get support earlier,” said Cynthia Hutchins, a director of financial gerontology at Bank of America.

Here is some expert advice for workers, employers and caregivers on how to manage an aging workforce:

Someone who forgets words or names but recalls them later doesn’t necessarily have dementia. More concerning is someone who loses track of conversation midsentence, asks the same questions again and again or loses something and then can’t retrace steps to find it.

People can gauge their level of impairment with the association’s list of 10 early signs and symptoms but should also bring their concerns to their doctors, partly to rule out other reversible causes of cognitive impairment before diagnosing dementia. Depression also can produce symptoms that mimic dementia, such as withdrawal from normal activities and mood changes.

Healthy sleep, diet, exercise, social contact and daily cognitive challenges can slow the onset of dementia. Berries have offered the strongest dietary links in research so far to better brain health, but clinicians also encourage whole grains, nuts and fish. They discourage red meat, cheese, sweets and fried food.

Dementia can hasten if early symptoms push people out of the workplace, and they don’t find other pursuits to stimulate their brains, said Jenna Fink, associate director of community services for the Minnesota chapter of the Alzheimer’s Association.

”The workplace absolutely challenges the brain,” she said. “So it would be important for someone who is exiting the workplace that has a diagnosis of dementia to continue with social activities, continue to challenge your brain, continue to do things that you enjoy to keep the brain and the body active.”

The Americans with Disabilities Act (ADA) is not a list of conditions included or excluded from federal protection against discrimination. ADA protections apply whenever a medical condition significantly limits major life activities, which can often be the case for people with Alzheimer’s and other causes of dementia.

Nor does the ADA only apply to disabled people. Spouses or other caregivers also have protection from discrimination, such as bosses who think their employee’s caregiving role will result in too many absences.

Employers under the ADA must make reasonable accommodations for workers when their disabilities affect their performance. Examples often involve specialized equipment, which in the case of someone with dementia could involve tools that increase organization or aid memory. But they can also involve changes to the daily work schedules or modified assignments.

“There is always a point where someone can’t do a job that requires a certain level of cognitive skill. That’s understood,” said Joseph Gaugler, director of the Center for Healthy Aging and Innovation at the University of Minnesota School of Public Health. “But how can we accommodate people so that they can remain productive and, from a social perspective, people can live as high a quality of life as possible with necessary support?”

Workers might need to press for their accommodations or offer suggestions. The Connecticut Supreme Court dismissed a lawsuit in December 2023 because a worker declined opportunities to suggest accommodations for her Alzheimer’s disease before her employer fired her. The woman had been an account manager for Sinclair Insurance Group for 26 years but lost accounts and had negative performance reviews before her termination.

“Dementia is a dirty word. People don’t want to use it. Its highly stigmatizing, and that certainly carries over to the workplace,” he said.

The Alzheimer’s Association is trying to change that perception and make employers more responsive. Fink said the organization has conducted trainings at numerous workplaces across the Twin Cities to make them dementia-friendly. Workers should explore whether their employers have participated in this training.

“The workplace is becoming more understanding and more accommodating,” she said, “but of course, there is still a fear, a worry.”

Sen. Amy Klobuchar, D-Minn., appeared publicly at a Minneapolis senior-living complex in November to celebrate the federal reauthorization of the BOLD program, which funds opportunities to prevent, detect, diagnose and care for dementia in addition to providing support for caregivers.

Gaugler said he is excited about a new option under the federal program called GUIDE, which will pay participating clinics to coordinate medical care and nonmedical services for people with dementia and their unpaid caregivers. Under the program, caregivers can also find help so they take breaks and receive training on how to provide dementia care.

Gaugler’s center is one of three the BOLD program funds and works to spread awareness about the needs of caregivers and services available to them.

Some companies offer more support than others, he said, and often it varies by whether executives have experienced Alzheimer’s or dementia among family.