Brian, I'm Starting to Forget Things

I spent years as the caregiver. I learned the pill schedules, tracked the lab values, built the coordination documents that told every ER team in Texas exactly who they were dealing with. I was, by most measures, pretty good at it.

And then someone close to me introduced me to a different kind of caregiving. Watching a sharp, funny, deeply present woman in her nineties sometimes lose track of what day it is, whether she's eaten, whether her pills happened — something shifted for me.

That could be me. That will be some version of me. I'm retired — I forget what day it is sometimes and there's nothing wrong with me. But you, Brian, will be the one on the other end of the phone when it stops being a joke.

So this is me doing the thing I always told other caregivers to do: plan before you need to. Write it down before the fog rolls in. Don't make your kid figure it out from scratch while they're also trying to hold their own life together.

The families that handle this well are the ones who had the conversation before the crisis.

What actually goes wrong

The problems at 90 — or 85, or sometimes 75 — aren't usually dramatic. They're quiet and cumulative. A missed pill here. A meal skipped because no one prompted it. A doctor's appointment on a Tuesday that felt like it might be Wednesday. The day disappears and nobody knows it happened.

The person themselves often doesn't know what they've lost. That's the cruelest part. Cognitive drift doesn't announce itself. You just start living in a slightly different version of reality than everyone else, and the gap widens slowly.

The things most likely to go wrong, in order of consequence: medications, orientation to date and time, calendar events. Meals are probably not my problem. My personal philosophy — developed over decades of rigorous field research — is that you never know when you're going to eat again, so you treat every meal accordingly. The pills are where it gets dicey.

The daily card

Every morning, I write a card. Not type. Write. Pen on paper.

There's a reason for that. When you write something by hand, your brain encodes it differently than when you read it off a screen. Researchers call this the generation effect — information you produce yourself sticks harder than information you receive. The evidence spans decades. It costs nothing to apply. A pen. A piece of card stock. Same spot on the kitchen counter every morning.

The card has two parts. First: orientation. I write the day, the date, the year — myself, from scratch, every single morning. Not fill-in-the-blank on a pre-printed form. I write it. Below that, one line for what's on the calendar.

Second: the task list. Mine covers my morning medications taken together, my evening medication, and a few other daily items. Build your own — you know your medications and your patterns. Check each one off when it happens. No app to open. No password to remember. A pen and a box.

I'm 66 and my memory is fine. But I'm building the habit now, while building habits is easy, so it's already routine if I ever really need it.

The text to you

Twice a day, I send you a text. Morning and evening.

The morning text is simple. After I fill out the top of the card — the day, the date, what's on the calendar — I take a photo and send it to you. Or just type: Good morning. It's Tuesday the 8th. Doctor at 2. Six words. You know I'm oriented. You know the system is running.

The evening text is the completed card. All boxes checked, or not. You don't need to respond unless something looks wrong. It's not a conversation. It's a signal: I'm here, I did the things, the day happened.

If I miss a morning text by 10am, you call. Not because something is necessarily wrong, but because that's the agreement. Behavioral researchers call this a commitment device — when you make a plan visible to someone else and attach even a small social consequence to breaking it, follow-through improves dramatically. The card is the generation effect. The text is the commitment device. Two tools, two different jobs, same problem.

The reminder layer

An Alexa announcement works great if you're in the living room when it fires. But let's be realistic. I'll be in the bathroom. Or napping. Or in the garden. Or — let's just say it — hard of hearing by then. An announcement nobody hears is just noise in an empty room.

So the reminder system has two parts working together. The Alexa piece handles audio announcements. You set these up in the Alexa app from your phone — scheduled, automatic, pushed out at fixed times whether I'm thinking about them or not. I don't ask Alexa anything. Alexa tells me. The distinction matters because asking requires me to remember I might forget something — which is exactly the capacity that may be degraded. You don't design a seatbelt that only works if the driver remembers to worry about car accidents.

The watch piece handles everything Alexa can't reach. At the same time each reminder fires, my Apple Watch buzzes on my wrist. Not a sound — a physical tap. I feel it in the garden. I feel it half asleep. The watch face shows the reminder. I tap dismiss to acknowledge it.

Here's the part that matters for you: if I don't dismiss within 15 minutes, you get a passive notification. Not a panic call. Just a quiet flag that the reminder went unacknowledged. The system tells you something before I have to tell you myself. This runs through Apple Shortcuts on the iPhone — set it up once, it runs. An hour of any reasonably tech-savvy person's time. Worth every minute.

The watch also quietly solves something else: it tells you I'm moving. Apple Watch has activity tracking running continuously. If a morning goes by with no movement and no reminder acknowledgment, that's information worth having before it becomes an emergency. You don't need a medical alert button I'll never remember to press. You need a watch I'm already wearing.

Why I'm writing this now

I'm 66. I played tennis this morning. A few weeks ago I took the Cirrus up — one of my favorite ways to clear my head and remember what matters. My memory is, as far as I can tell, intact.

But I watched caregiving from the inside for years. I know how fast the landscape can change. January to July can be a very long distance. And seeing what cognitive decline looks like up close — even in someone else's family — has a way of clarifying your priorities fast.

You were the best thing your mother and I ever did. You were there for me in ways that cost you real time and real energy, and I see that, and I'm proud of the man you've become. The last thing I want is to add to that load without giving you every tool I can to make it lighter.

So here's the tool. A card. A text. An Alexa that talks whether I ask it to or not. A watch that buzzes when I'm out of earshot. A quiet flag to you if the whole thing goes silent. And two iPhone features that have been sitting in your pocket this whole time.

When the time comes — and I intend to make it far away by staying in motion, staying curious, and playing tennis until someone carries me off the court — this is what I want in place. Not a crisis call from a neighbor. Not a nursing home conversation out of nowhere.

A morning text with a photo of a handwritten card that says Tuesday and has all the boxes checked.

That's the whole system. Now you have it.

I love you.

— Dad

Casey King spent over two decades as a caregiver for his wife Lonna, who lived with scleroderma and underwent a double lung transplant in 2023. He is writing The Caregiver's Trap: A Roadmap for When the Caregiver Needs Care.

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