Michael Avery:

Welcome to Life Chapters, Money Choices, the podcast where we look at the big transitions in life, the financial decisions that come with them, and the conversations that families often leave far too late. Today’s episode takes us into probably one of the most difficult later-life chapters: dementia. It is a word that carries enormous emotional weight. For many families, it almost begins unnoticed. Maybe a missed appointment, a misplaced set of keys. We all misplace our keys. Maybe it is just a strange lapse in judgement. They say, well, we are getting older. Then, over time, it can become one of the most complex intersections of healthcare, money, family responsibility, legal planning and dignity.

Because dementia really changes the very architecture of a family. It affects who makes the decisions, who pays for care, who becomes the caregiver, who feels guilty and who feels overwhelmed. All of us hope that it will never happen to us, but the risks are increasing as we live longer. That is certainly what the research is telling us.

To help us have this conversation with compassion and clarity, I am joined by Dr Ryan Fuller, specialist geriatric psychiatrist and founder of the Memory Care Group. Ryan works with older patients with complex mental health conditions, including dementia, using evidence-based approaches within family systems. And, as always, Kim Potgieter of Chartered Wealth is with us as well. Ryan, it is great to have you in the studio. This is a very difficult conversation. It was interesting when Jannie Mouton wrote a letter to shareholders, first coming out with his early dementia, how it changed that conversation in boardrooms. But we are taking this into the family, and I think it is a word many people use very loosely. So maybe just from a clinical perspective, when we talk about dementia, what exactly is dementia?

Ryan Fuller:

Firstly, thank you very much for raising this awareness. We desperately need more platforms like this. It is a real pleasure to meet you, and thank you, Kim, for the opportunity. You have already hit many of the main areas that we live with day to day, trying to help people with memory challenges. As you said, dementia is a bit like the word cancer. It is extremely emotive. Part of our work is how to demystify that and then work with what we call pre- and post-diagnostic counselling, no different to oncology or cancer.

What we mean by dementia is chronic brain failure, as opposed to acute brain failure, which would be delirium or a confusional state. If, for example, someone was hit on the head, had malaria or had any infective cause, there is a long list of causes where the brain, like any organ, can misfire and not function properly. Hopefully, with delirium, you would then get through that, but delirium is a medical emergency. The mortality rate is up to 10%, similar to a heart attack. It is a very serious condition.

Dementia is chronic brain failure, meaning it is not a short episode of a week or a month. It is typically over a couple of years. Ultimately, what most people intuitively know is that it is a progressive decline in brain function. We see it as memory, but there are also other functions in the brain, including decision-making, behaviour and emotional responses.

As a psychiatrist, most of my work is what we call non-cognitive or challenging behaviour when it becomes a crisis. It is not just memory-related. About 50% of people with a dementia syndrome will have intense challenging behaviour through the course of the disease, and we can perhaps touch on how we manage that risk later.

The typical dementia syndrome is called a syndrome because there is no single cause. It is a group or collection of illnesses. Any condition that affects the brain can cause a dementia syndrome. We have to look at function. Most people understand heart failure: the body’s pump is declining, and there are consequences. You can see the heart, there are clear pictures of it, and intuitively you understand it. The brain is harder to conceptualise. If there is declining brain function over time, we then ask what is causing it.

Most people have heard of Alzheimer’s disease. It is the most common type of dementia syndrome. Probably 70% to 80% of all dementias are caused by Alzheimer’s. There are other types too. We see a lot of vascular dementia, as well as frontotemporal dementia, Lewy body dementia, Parkinson’s-related dementia, alcohol-related dementia and rarer conditions that we do not tend to see as often.

Unfortunately, we do not know what causes Alzheimer’s disease. We have a lot of evidence that it is caused by an amyloid build-up of a toxic protein normally found in the brain. There is a great deal of research into how this toxic protein can be cleared by the brain, but even that strategy has not yet produced reliable disease-modifying treatments. That is not to say we do not have options. We can talk about what we do to slow down memory loss and how we identify it.

Another way of thinking about dementia is psychosocial incompetency: people struggle to manage and make decisions in their life, socially and psychologically. One of the original definitions described someone not being competent in their later-life years, with a legal requirement to help that person be safe, to prevent poor financial decisions or exploitation.

As you said very accurately, it is one of the conditions in medicine with a very strong medico-legal component. All the patients we see also see a social worker, for example, to protect their rights. There is an occupational therapist and a team-based approach. As a psychiatrist, I also work with neurologists and geriatricians. We have to exclude medical conditions that can affect brain function. So, yes, there is a lot to talk about.

Michael Avery:

That is a great start, and you have summarised such a complex syndrome in a nutshell. Kim, it reminds me of a conversation from the medico-legal side that we had around power of attorney, which I am sure we will come to. Just to stay with you for a while longer, Ryan. How do you distinguish between so-called normal ageing, the familiar “I walked into the room and forgot what I was going to do here”, versus something that should prompt concern? Are there signs or red flags that an individual or a family member might be able to look for to say, right, maybe this requires further treatment, observation or a visit to the doctor?

Ryan Fuller:

Absolutely. You are correct that there is age-appropriate cognitive decline. If the brain is a car, your Ferrari is going to slow down in terms of mental processing, but it does not always break down. We tend to say that although cognitive processing speed slows down, it is hopefully replaced at the same rate by wisdom. You begin to understand how to make decisions based on your life experiences.

There is some research that suggests the fastest your brain will operate is at about age 20, and then there is a slow, steady decline from there. But what you compensate with is wisdom and life experience, so it is not all demoralising.

The Alzheimer’s Association in the US has a useful four-question checklist, and it is really a functional description. Misplacing personal items does not necessarily mean you have dementia. But if all four of these are present, there might be a concern: confusion or disorientation with the date and time most of the time, repetitive questions or stories, getting lost when driving, and difficulty managing finances.

It is important to say there might be a problem, because the commonest thing I see, aside from Alzheimer’s, is depression and late-life crises. As a psychiatrist, so much of it is about loss and grief. We often find that when people retire, there is a grief process. There is a mourning of one’s career that is not always attended to, and that can look almost indistinguishable from a dementia syndrome.

We can loosely say that manifests as depression or anxiety. If we treat the depression and anxiety, help someone find purpose and meaning, and bring structure to their life, we can see improvements in memory function. The problem is that if this goes unchecked, it is a risk factor in itself for dementia. Depression, existential angst and social isolation all matter.

Michael Avery:

It is fascinating, Kim, because you so often speak about being intentional about the transition from being employed, which is often a core part of our identity. If you are a senior executive or CEO in an organisation, and then overnight you lose what was really your primary sense of identity, that can be incredibly difficult. Without a managed transition, one can slip into depression. It is fascinating to see the interplay there as well. Take me back to what you see when you have this conversation with clients. It is one of those topics families often avoid because it feels frightening, perhaps final and emotionally loaded. From your perspective, why do families struggle to start these conversations early? Do you think we avoid this because of the fear of what it may mean financially and practically?

Kim Potgieter:

I am not sure it is only because of what it means financially and practically. I find people avoid the conversation more out of respect for each other. We see many couples where one partner has early-stage dementia, and when we bring it up for the first time, it is one of the most difficult conversations we ever have. I always say money is that taboo topic, but when we bring up this topic and say, “We have noticed…” it is very sensitive.

What Dr Fuller mentioned about the financial part is exactly where we start seeing it. We talk about which investments clients need to go into, and then we notice the risk. They can become very risk averse. We talk through simple calculations and start to pick up that they cannot relate. Then, in the next meeting, they repeat themselves, and then in the next meeting, they repeat themselves again.

Now think about our role. Who do we go to? Do we go to the person who is repeating themselves? Do we contact the spouse? Do we ask in front of each other? Sometimes they come in on their own and their children may have emigrated. Legally, we should not simply pick up the phone and call the children overseas. So we sit with many situations where we are concerned, we know something is happening, but to bring it up, we really need a process so that we do not offend anyone.

I have had people in meetings where we have brought it up gently and they have said they are going to leave us. If they leave us, we know they may now be open to being taken advantage of by somebody else. There are so many layers to this, Michael.

Michael Avery:

Given that experience, when you sit down with clients who may be a little younger and less at risk early on, do you have that conversation and say, “We want to be your planner for the next 30 or 40 years. If we pick anything up later in life, do you give us permission to approach another family member?” How does one start to structure this?

Kim Potgieter:

I think it is a great idea, and perhaps Dr Fuller can add to it. If we could have something in our documents that we give people, where we say that if we pick something up, this is what we may do. I always use this as one of the reasons why you need a planner. Many people we meet are very good at running their own money, and they are phenomenal at investing. But what happens when you are not? How will you know? Who will be watching you? Who will be your partner in it?

The conversation is coming up earlier, but it is not something we have documented yet. It is more about trust.

Ryan Fuller:

Absolutely. I had the privilege of working in the UK, where they have been wrestling with this in Europe for a much longer time. They have a specific Mental Capacity Act. We do not have that in South Africa. It creates a legal requirement where, if there are concerns from a spouse, family member or professional, not only medical professionals but financial advisers too, those concerns must be raised in a structured way.

The key requirement in that system is that if you are concerned about someone’s ability to make a decision, you need a process to assess that decision. Capacity is not a blanket judgement. Someone may have capacity to decide what they want for lunch, but not capacity to enter into a major financial transaction. It is decision-specific and time-specific.

The presumption of capacity is also important. We cannot simply assume that because someone has a diagnosis of dementia, they cannot make decisions. The starting point is that they can, unless there is a clear reason to assess otherwise. But once there is concern, the response needs to be careful, documented and multidisciplinary where possible.

In South Africa, this is where things can become complicated. A power of attorney depends on the person having capacity. If capacity is lost, that power of attorney may no longer be valid, and families may need to consider other legal routes, such as administratorship or curatorship. That is why planning early matters so much.

Kim Potgieter:

My daughter has asked me for one, just by the way. She wants me to write down my wishes.

Michael Avery:

No, but she is clever. I think it is eminently sensible. While we are having this conversation, and while you are of sound mind, even if your 20-year-old might disagree, you do have a little more greying wisdom. Putting something together can take a lot of the painful and difficult decision-making away if this does happen. The risks are increasing, are they not, Doctor? Are you seeing a rise because we are living longer? Do you think it is lifestyle-related, or is it multifactorial? What are you seeing?

Ryan Fuller:

There are two points there. The first is prevalence. The number of people living with dementia is increasing because people are living longer. The important and sobering statistic is that about 5% of people aged 65 and older, anywhere on the planet, will have Alzheimer’s disease, not just dementia. Alzheimer’s is the most common type. Every five years, that prevalence doubles. By the age of 70, it is about 10%. By 75, it is about 20%. By 80, it is about 40%.

So you are absolutely right that people are living longer, and we are seeing more people affected. There is a lot of work around what is sometimes called the silver tsunami. The problem is that many people are living longer than their retirement planning allowed for. In practice, we unfortunately see people in real poverty who did not plan to live this long, or who did not know how to accumulate enough wealth simply to have a home and afford to live.

The other point is technology and mobile phones. Nearly every patient we now see has been a victim of fraud using mobile technology. We know in the banking sector that syndicates often target people by virtue of age. They take the oldest customers, who may have accrued some wealth, and start targeting them. You do not even need to have dementia to be defrauded.

We had one case last week where a very civilised-sounding person phoned a woman and said, “You have been hacked. Do not worry, I have closed your account and opened new accounts at various other banks.” They even sent her a screenshot.

Michael Avery:

Ryan Fuller:

All she needed to do was click on the one-time PIN. Fortunately, her daughter was with her and she did not. There is a real need for senior online services, or SOS. It is a terrible name, but that is the concept.

Michael Avery:

Ryan Fuller:

How do we help teach people of a certain age how to engage sensibly with technology? It is not easy. Often phones get lost, and linked to the phone is identity theft. There are also real safety concerns if someone is driving, gets lost, and then we need to find them. A lot of our work is about how we safeguard people’s risk in general, and financial risk is one part of that.

Michael Avery:

It is so scary. You can imagine someone ticking off ID numbers that start before a certain date and then targeting those people, especially with AI. I just want to add one happy story.

Kim Potgieter:

We had a client the other day who, in her 40s, was targeted by fraud. Her mom, who is a client of ours, pointed out that she was about to pay something fraudulent because we have been running talks on exactly what Dr Fuller is talking about, just to help clients. So she helped her daughter, and we could see that what we are doing is working.

Michael Avery:

I am glad to hear that. I like the idea of a specialist senior online service approach. I think many corporates need to start thinking along those lines as well. It would be a fantastic value-add and a useful differentiator in a competitive banking system.

Kim Potgieter:

You are speaking about the banking industry, but they all want us on their apps and they do not want to talk to us anymore.

Ryan Fuller:

Exactly. I know of a European bank, I think in Estonia, that won an award for doing door-knocking welfare checks. The bank employed people to visit older clients and check on their wellbeing. Is she still alive? Who is she living with? Does she know she has a bank account? Does she have a mobile phone? It was a simple checklist.

By doing that, they cut down fraud enormously because they were looking at the welfare of their customer base. As you say, it came from the bank, not from the healthcare sector.

Michael Avery:

Yes, a big opportunity there. As we wrap up and think about ways to reduce our risk over time, I know it is difficult because dementia is so complex. You mentioned earlier that there are ways we can think about strengthening our brain health. I try to do lots of protein shakes, as you do, Doctor, and as we age, I was reading in The Economist recently that lifting weights has become much more prevalent. We have GLP-1s giving us all kinds of fantastic side effects, although I see you are saying maybe not. So what can we do to stave off the dementia wolf?

Ryan Fuller:

If there is one resource I would recommend, it is The Blue Zones, which is worth reading. I think there is also a Netflix series. Dan Buettner went around the world asking where people live long, and not just live long, but also have lower rates of dementia and depression. He identified these zones around the world, including Okinawa in Japan, Sicily, and, interestingly, a community in California. He asked what these people were doing, because it is not only genetics.

Much of it is common sense. The number one factor is exercise, by a country mile. People who do not exercise do not live as long, and they have higher risks of dementia, depression and nearly every health problem. People have to move their bodies. They do not have to run and win the Comrades Marathon. They need to move, and we half-joke that it must be done without falling, getting lost or being mugged. Safe walking, even five to ten minutes a day and ideally up to 20 minutes a day, can matter.

You are also spot on about resistance training. There is good research showing that supervised resistance training is important as people age. It is not only about exercising generally. It may mean getting into a gym, or if that is not affordable, lifting some weights safely and under supervision.

Sleep is critical too. There is more research now showing that disrupted sleep, whether from technology, stress or other causes, is not good for the brain. We need natural sleep, not sleep induced by a sleeping tablet or alcohol. Deep REM sleep cycles help the brain clear stress, toxins and the residue of the day’s overstimulation.

Then there are the common-sense things: what is good for the heart is good for the brain. That means limiting alcohol, not smoking and managing weight. GLP-1 medications are very popular now. I am not an expert on them, but intuitively I think in life you cannot cut too many corners without there being a possible side effect somewhere. For the right patient with morbid obesity, diabetes and cardiovascular problems, absolutely. But for an otherwise fit person to interfere with insulin metabolism may be something to approach carefully.

So it is exercise, weight management, getting out of your home and social stimulation. Celebrating your culture is also important from a psychodynamic point of view.

That might include engaging with spirituality, not necessarily religion, but finding ways to quiet the mind. Meditation can be important. Prayer may help some people. It is about finding balance, and these are common-sense things.

If I can leave you with this: Freud apparently said that for most people to be happy, you need three things: someone to love, to be loved, and something to do. Jung said that the thing you do must have purpose. Viktor Frankl said that, in order to find your purpose, you have to suffer. That is harder in life, but the point is that life is not a bed of roses. There will be crises you have to work through.

Through each crisis, if you find the right people to help you, it is possible to survive life and live longer. It is important to invest in human relationships, make peace with the past and not hold on to grudges. We find that people who do not have a belief system may struggle, and people who do not have family may struggle too. There is a lot about healthy ageing that is intuitive, but we often do not do it because it is not very appealing to think about ageing later in life. A lot of mental health work is about that.

Briefly, there are medications that can help improve memory or slow rates of decline in established Alzheimer’s disease. Medicines such as donepezil and memantine aim to reduce the impact on the brain. They do not reverse dementia, but we have seen that they can slow things down if the other foundations we have discussed are also in place.

So I think people need to be cautious about experimental medicines. There is one called lecanemab, which costs around half a million rand a year and dissolves amyloid plaques, but it can also cause complications such as strokes. There is no quick fix in this space.

It reminds me of what Atul Gawande wrote in Being Mortal. We often approach medicine and health from a very Western-centric lens, but we are complex beings, with drivers, desires and purpose tied to identity, as we have mentioned. Taking a pill or injecting yourself with something as a shortcut does not sit well with me either, because it does not address the underlying human being.

It is also interesting that we see this rise of almost nihilistic atheism in the world. Again, I am not judging, but we do need something anchoring us in life. Kim, just to give you the final word here, we developed this podcast to talk about these life transitions, and I think this is probably one of the most difficult to talk about as a family. What techniques, tips or advice can you give families on how to address this early, build that letter of wishes or framework, and avoid this becoming such a fraught conversation later on?

Kim Potgieter:

I think it is about having the discussion before it is in the room. If we can, as a family, be open to talking about the what-ifs and the unexpected things that may come, we give ourselves a better chance. We are not inviting those things to happen. It is similar to estate planning, when we talk about one day not being here. This conversation is about asking: if this did happen, what would it look like, and what would we be able to do?

In that way, you give everyone permission to bring it up. Otherwise, it gets pushed down and not spoken about, and then we end up dealing with it when it is exploding. Everyone is emotional, nobody is making the right decisions, and suddenly choices are made that may not be respectful to the person because everything gets taken away from them. I would encourage these conversations before the crisis, and to anticipate them as part of planning. Let us call it risk planning.

Michael Avery:

Yes, I think we are going to have to leave it there. Certainly not the end of this conversation. Dr Fuller, we would love to have you back. There is so much we did not get to talk about, but in the 30 minutes we had, we managed to have a very important conversation about dementia, the rising risks, the underlying causes, the impact on our finances, and what we can do as individuals and families to prepare and do some risk planning, as you said, Kim, around the possibility of dementia in later life.

That was Dr Ryan Fuller, specialist geriatric psychiatrist and founder of the Memory Care Group, and Kim Potgieter, helping us understand dementia not only through the diagnostic lens, but as a profound life chapter where care, money, dignity and family dynamics all come into play. Have the conversation while it can still be a conversation. That is certainly the take-home for me. Get the assessment, put the structures in place, protect the caregivers and respect the individual at the end of the day. You have been listening to Life Chapters, Money Choices. Until next time, plan early and speak up.

Optional Beacon Article

Before Dementia Becomes a Crisis

Dementia is one of the conversations many families hope they will never need to have. It sits quietly behind everyday life until a missed appointment, a repeated question or an unusual financial decision makes everyone pause. At first, it may be easy to explain away. People are busy. Stress affects memory. Ageing brings changes. Yet sometimes these small signs point to something that needs careful attention.

The difficulty is that dementia is not only a medical issue. It can affect judgement, behaviour, emotions, care needs, legal authority and money decisions. It can also change family roles in ways no one feels ready for. A spouse may become a caregiver. Adult children may need to step in. Financial decisions may become harder to understand. The person at the centre of it all may feel exposed, frightened or misunderstood.

This is why early conversation matters. Waiting until a crisis can leave families trying to make emotional, legal and financial decisions under pressure. Speaking sooner allows the person to share their wishes while they can still participate fully. It also gives the family a chance to agree who should be involved, what kind of care may be preferred, how financial decisions should be handled and what support structures need to be in place.

There are practical considerations too. Families should understand the limits of power of attorney, especially where capacity becomes a concern. They should consider documenting wishes, trusted contacts and crisis plans. They should also pay attention to new risks, including online fraud, confusion with digital banking and the vulnerability that can come with isolation.

Most importantly, these conversations should be held with dignity. The goal is not to take control away from someone too soon. It is to protect their choices, respect their independence for as long as possible and make sure loved ones are not left guessing when the pressure is greatest.

The kindest planning often happens before it feels urgent. It gives families language, structure and confidence. It also gives the person who may one day need help the best chance of being heard.

Meta Description: Why families should discuss dementia, capacity, care and money before a crisis, with practical steps to protect dignity.

Primary Key Phrase: dementia planning for families

Secondary Key Phrases: dementia care planning, family conversations about dementia, capacity and decision-making, power of attorney South Africa, protecting dignity in later life

Optional Midlife Money Conversations Article

Suggested hook: Have you spoken to your parents about what happens if they can no longer make decisions?

The Family Conversation That Belongs in Midlife

Midlife is already full. Careers are demanding, children may be studying or leaving home, parents are ageing, homes need maintenance and money often feels pulled in several directions. In the middle of all this, it can feel easier to avoid one of the hardest questions: what would happen if a parent began to struggle with memory, judgement or decision-making?

These conversations are not only for retirement. They belong in midlife too, because adult children are often the ones who step in when a parent needs help. That may mean understanding where documents are kept, who has authority to act, what support a parent would want and how the family would manage care if circumstances changed.

Starting early does not mean assuming the worst. It means creating space for clarity while everyone can still contribute. It may be as simple as asking your parents who they would trust to help with financial decisions, whether their wills are up to date, what kind of care they would prefer and what they would want the family to know if their health changed.

It is also worth thinking about your own future. Midlife is often the stage where flexibility becomes important. You may be supporting children, helping parents, managing work pressure and trying to protect your own wellbeing. The clearer the family plan, the less likely everyone is to make rushed decisions in a crisis.

A good conversation can begin gently. You do not need to solve everything at once. Ask one question. Share one concern. Find out where the important information is. The point is not to take control, but to make sure love has a practical plan behind it.

Meta Description: A midlife guide to talking with ageing parents about memory, care, money decisions and future planning before pressure builds.

Primary Key Phrase: midlife conversations with ageing parents

Secondary Key Phrases: ageing parents and money, family care planning, dementia conversations, midlife financial pressure, planning for parents’ care

Social Media Posts

Facebook or Instagram Caption

Some family conversations feel too difficult to start, until not having them becomes harder.

In Before Dementia Becomes a Crisis, Dr Ryan Fuller speaks about dementia, dignity, care and the decisions families can make before pressure and uncertainty take over.

Listen to the episode here: [insert link]

Short Teaser Options

• When memory changes, who gets to make the decisions?
• Dementia is a family conversation, not only a medical one.
• Have the conversation while it can still be a conversation.
• Planning early can protect dignity later.
• Memory, money and care are deeply connected.

Additional Ways to Use This Content

• Create quote cards: Use 3 to 5 standout lines from Dr Fuller and Kim, especially around capacity, dignity and early conversation.
• Develop a family conversation checklist: Turn the key lessons into a simple downloadable guide for clients.
• Create a short client email: Share the episode with clients who may be caring for ageing parents or planning for later life.
• Make a carousel post: Use five slides covering warning signs, capacity, money decisions, family roles and planning early.
• Record a Kim video intro: Use the spoken script as a short video for LinkedIn, Instagram or the website.
• Create a planner discussion prompt: Give advisers a gentle question they can use with clients, such as: “If your decision-making changed, who would you want us to speak to?”
• Build a companion article: Turn the Beacon or Midlife Money article into a newsletter feature with a clear link back to the episode.
• Add a website download: Offer a “Before Dementia Becomes a Crisis” planning checklist alongside the episode page.