Women in Pain: Our Risk of Dementia and What We Can Do to Prepare
Approximately one-third of those over age 85 have dementia. Everyone should plan for the possibility that they may be afflicted if they live long enough. And for many the risk is even higher. Women are slightly more likely to develop dementia than men, even after accounting for their longer lifespan.
Other risk factors are having an immediate family member with dementia, midlife hypertension, midlife obesity, a sedentary lifestyle, diabetes and high cholesterol. Childhood trauma is a risk factor. Having had a traumatic brain injury or even a history of mild concussions increases risk. Excessive use of alcohol does your brain no favors. Certain drugs, such as antihistamines, antidepressants, anti-seizure, anxiety or pain medications can take their toll on cognitive health. Chronic pain and chronic stress (which often go hand in hand) are also known to accelerate cognitive decline. Social isolation heightens risk.
I have many of these factors. I’ve been in pain, accompanied by significant anxiety, since the age of 30 (I’m now 63). Pain limits my ability to exercise, as well as engage in social activities. As a child, I had many head knocks from falling off bicycles, horses, playing sports. This was pre-helmet days. I can only imagine how many mild concussions I’ve had! I’ve also had significant childhood trauma, and through age 45, when I stopped drinking and began taking better care of myself, I often abused alcohol or ate poorly. My mother was diagnosed with dementia a few years ago at age 84.
We are all at risk as we age. We women in pain are at heightened risk, not just from the toll of living in pain, but from the likely accompanying factors of stress, anxiety, pain medications, childhood trauma, a sedentary lifestyle and social isolation.
We cannot just hope or assume we will not develop dementia. And we cannot “cross that bridge when we come to it,” at which point it will be too late. This is what happened to my mother. She had made no arrangements for her long-term care, insisting she was going to “age in place”(i.e., remain at home). As her memory loss began to alarm others, she insisted it was just “a little brain fog”, quickly adding, “But it’s getting better.” It wasn’t. When I pressed her to plan for long-term care, she’d respond, “I might not live much longer.” Not living much longer is fine if it happens. But it’s not a plan.
She needed to move into a memory care facility imminently when she was finally diagnosed with dementia. But still she resisted, lost in the delusion that she was coping just fine. So the burden fell to friends and family. We had to quickly find a facility, strong-arm her into moving and take full responsibility for the move, down to the last detail. If she had not had others to pick up the pieces, her fate would have been very different. She would have declined quickly or slowly at home until social services intervened, or possibly even died alone at home from medical neglect, lack of nourishment (she was eating very little), a fall, kitchen fire or getting lost outside.
Even if you have friends or family who can mobilize to save the day should you decline precipitously, most of us do not want to offload that stress and burden onto others. Consider, too, do you trust your next of kin? Those with dementia are vulnerable to fraud or other forms of malfeasance. Designate those you want in charge of your health and finances before you lose the ability to make such decisions.
We all need a plan. First consider your social support. If you have a partner, you can rely on them up to a point. But unless they are significantly younger than you, they, too, may become disabled physically or mentally, or pass before you do. Children do their best to help aging parents, but a dementia patient needs 24/7 care, which few children are able to provide.
Assess your finances. Medicare does not pay for assisted living or memory care. The nationwide average assisted living cost is $5,400/month; memory care costs $6,700/month (as of 2026). If you run through your money, then you will have to apply for Medicaid. If your current place does not accept Medicaid (many private facilities do not), then you will have to move to a place that does.
My husband and I have arranged to move into a facility that offers a “life plan”. This requires that we pay a hefty entrance fee and that we move in while we are still both “independent”, i.e., able to take care of our basic needs. We cannot wait until one of us becomes demented or otherwise unable to live without daily hands-on assistance. Since we cannot know when this might happen, we are planning to move into the facility by our late 60s. This is early for assisted living. But the benefit is that, once we are residents, the facility will care for us right through hospice and death, even if we outlive our finances.
If you cannot afford a life care or assisted living facility and have no family that can care for you, then in the event of dementia or disability, you (or your power of attorney) will have to apply for Medicaid and enter a place that accepts Medicaid. The more you know about this process and are familiar with the available facilities (quality varies), the smoother the transition and better your care will be. There are many resources for planning and learning all you need to know. Many people, like my mother, don’t want to think of this daunting change, learn about their options or implement a plan. But the consequences of not having a plan should you develop dementia will be terribly stressful at best and possibly devastating.
We go to great efforts throughout our life to make sure that our basic needs (food, housing, medical care) are met. We certainly don’t want to drop the ball at the very end of the game when we are at our most vulnerable. Take steps now to ensure that you will be safe and cared for through the end of your life. We all deserve that.
