The world is ageing rapidly. About 10% of the global population is now over 65, a share expected to rise sharply by 2050. India, though younger, is following the same path, with 7% of its population above 65 and a growing 60+ demographic.
Alongside this shift, dementia is increasing. Over 55 million people worldwide live with dementia, and India alone has an estimated 4–9 million. Loneliness adds a profound social burden, affecting 20–40% of older adults globally and nearly half of India’s elderly. Caring for people with cognitive decline and dementia is very challenging for caregivers.
Recently, a few of us, in our early and mid-sixties, met and took a cognitive assessment test. This stemmed from a need to determine whether we were experiencing age-related memory loss, mild cognitive impairment, or the early onset of other dementia syndromes.
Age-related memory loss (normal ageing) involves a slight, gradual decline in processing speed and memory, such as occasionally forgetting names or appointments but remembering them later.
In contrast, mild cognitive impairment (MCI) represents a stage between normal ageing and dementia. It features noticeable memory and thinking problems that are more severe than normal, but not yet severe enough to disrupt daily independence.
On the other hand, early-onset dementia presents symptoms such as severe memory loss, confusion, or behavioural changes that appear before the age of 65.
The Unspoken Fears
There were three underlying issues that we did not openly express as we started the process, though they surfaced later.
One was the concern that all of us were experiencing some memory loss, but we were not sure whether it was something more sinister than normal ageing.
There was also unexpressed anxiety (at least for me) regarding what the future would look like if something more serious emerged.
And there was a fear, arising from a desire, that we should not become dependent on others at any stage of life. For me, this was real because close members of my family had gone through serious dementia syndromes.
These are legitimate concerns, anxieties, and fears. I have encountered this with many others of my generation. Some may not express it, but it is legitimate and acceptable to have such concerns and fears.
Three Struggles in Dementia Care
Having had the opportunity to care for close family members with advanced dementia and having accompanied others, there are three struggles that stand out.
We struggle with the question: How can the person whom I care for know God if he or she can no longer contemplate God?
1. The Question of Identity
One is the issue of changed “identity.” The person who “has lost their mind” or whose “thinking is impaired” does not look and feel like the one you knew. Has his or her identity changed? In the book Dementia: Living in the Memories of God, John Swinton says we see people from what they communicate to us. Identity is linked to their mind. Calling someone lost or of impaired mind assumes we can judge their mind, that the mind exists only in the head, and that clear thinking defines a person.
All these assumptions are doubtful. People with dementia are not simply “losing their minds,” and the term “dementia” itself is misleading.
2. Knowing God Beyond Cognition
The second issue is their knowledge of God and expressions of faith. We look at faith through expressions of intellectual knowledge and declarations of experience, emerging from contemplation. But when one can no longer remember either oneself or God, or contemplate who God is (as we understand it), we face a challenge.
We struggle with the question: How can the person whom I care for know God if he or she can no longer contemplate God? Does he or she really know God?
3. The Pain of Challenging Care
The third issue is unexpected and challenging reciprocations when care is provided. Many caregivers find it difficult to “love unconditionally” because the person they care for might respond with no gratitude or even resentment. This may be explained as part of cognitive decline, but experiencing it is neither easy nor pleasant.
How Then Shall We Respond?
How can people of faith respond to these issues—whether facing potential memory loss, living through it, or caring for someone with dementia?
1. Embracing Uncertainty
As Oswald Chambers puts it, “certainty is the mark of the commonsense life–gracious uncertainty is the mark of the spiritual life.” There are many things we know for sure at an early age; they become grey as we grow older. Logical explanations will not suffice for many questions. But one thing remains sure: God will be with us, whatever cognitive or other decline we may experience (Deut. 31:8).
2. Bringing Questions Honestly to God
As we go through what we do not understand, it is okay to ask God questions. He is near to us when we feel far away and confused, reaching out to us (Ps. 34:18). He welcomes such questions (Jer. 33:3). What makes the difference is often not explanation, but compassionate presence.
3. Rediscovering Dependence
Absolute dependence is the true state of all human beings. We live as if we have moved from dependence in early years to independence in adulthood. Yet even then, we remain dependent and interdependent on others and on God. This has important implications for how we view cognitive decline—both in others and in ourselves.
But knowing about God is not the same as knowing God—and knowing God is not limited to memory or intellect.
4. Reframing Identity in the Imago Dei
A person’s identity is not linked to what he or she can articulate. Identity and humanness emerge from the imago Dei bestowed upon each person (Gen. 1:27). John Swinton reminds us that modern thinking often equates humanness with cognitive ability. But knowing about God is not the same as knowing God—and knowing God is not limited to memory or intellect. God knows us at all times (Ps. 139).
5. Being Known by God
If true spirituality lies not in knowing God intellectually but in being known by Him, then neurological decline cannot separate us from his love or our vocation. If God knew us in the womb (Ps. 139:13) and holds purposes for our lives (Ps. 139:16), that remains true even in cognitive decline.
Finally, we must recognise that in Jesus we are recipients of God’s lavish love and grace, which we did not deserve (Eph. 1:6-8). Our responses to God have often been inconsistent, yet He forgives and receives us (Ps. 103:10-12). Having received such love, we are called to extend it—even when it is difficult (1 John 4:11).
We cannot face cognitive decline, death, or caregiving on our own. In her book The Lost Art of Dying, L. S. Dugdale reminds us that, “To die well, we must learn how to live well.” Living well comes through accepting decline and finitude, journeying with community, and holding onto the sure presence of God—whatever we may be experiencing.
