Activities that bring quality to our lives change over time. They just do.

When does quality of life decline to the point where prolonging life in dementia become unacceptable to an individual?

This question is the core of many palliative care conversations I had over my career. In people with mild to moderate Alzheimer’s Disease and their families, this decision becomes increasingly stressful over time. It is pretty common in my family for me to be asked about whether or not someone with dementia should go forward with a medical procedure that corrects a non-dementia related medical problem.

I learned a long time ago that asking someone if they are experiencing good quality of life is too broad. Might as well ask them if they are happy.

No one is happy or has great quality of life all the time.

Being a big Julia Cameron fan, I began to think in terms of an individual’s “capacity for delight.” See my previous posts on that here and here.

I am 68 years old. Four and a half months ago I had a small stroke. Initial imaging looked like it was more than one and they were on different sides of the brain. Hospitalized for three days, outpatient physical therapy, massive workup to understand why this happened. Not high cholesterol. Blood vessels wide open. No blood pressure issues.

And then, they found a patent formamen ovale or PFO—a small whole in between the two upper chambers of the heart that everyone has when they are born and most close automatically at birth. Apparently many adults have this and never know they have it.

The fact this happened after I ran full bore nine city blocks trying to catch a ferry home late at night probably shook something loose. Yeah. Not doing that ever again.

There was never a real debate about doing the procedure to close it. I’m not even close to ready to checkout but it did prompt me to look at the “Capacity for Delight” tool that I worked on with my husband.

Here is the one I filled out for myself in a 2025 post.

Here’s the one I just did this week (June 2026).

Well my mornings still start with a perfect cup of coffee cause in the Pacific Northwest that is mandatory. These medical issues I’ve had over the last six months, along with regular torrents of grief since my soulmate died in 2023, have impacted my quality of life. The things I have been able to do “all the time” or “often” in this list has dropped from seven to three over a year. When I think about my experiences over the last year generally, that fits. Do I still think life is worth living? Of course.

So what does one do? Make a new list.

Let’s take soaking in the tub. Well I’m on blood thinners and my worst fear is falling and breaking a hip. Do I love to soak in the tub. Oh for sure. But now the risk of doing that every day seems outsized to the degree of delight. I love kayaking but now I am a solo kayaker and a little more skittish. I expect that will change this summer. So I need a new list for the next year, and maybe I should do this every six months as I recover.

Here’s a rough draft of my new 10 things that bring me delight.

Having deep grandkid conversations—they are older now and have opinions on many things. This is part delight for spending time with them and part delight from getting to know them.

Writing my memoir—this has been on hold but I am back at it now. I love our story and even the difficult parts are so meaningful.

Perfect cup of coffee—natch.

Volunteering in my community—this is meaningful and provides purpose. Definitely brings me delight.

Meditation every morning—self care has gone from nonexistent to sacred time. I literally pat myself on the back.

Trail walks 3 times a week—nature is so easy to delight in. I do the 5 senses thing on these walks: what do I see, hear, feel, smell and taste? Okay, I cheat—coffee is always what I taste.

Having meals with family—their lives are super busy so if I can get an hour with all of them at once it’s a joy.

Actively socializing with other humans—socialization is known to be good for your brain and although I sometimes think about weaseling out, I do feel refreshed afterward. Sharing and learning are the delight here.

Doing fun brain-workout puzzles/games—I have come to really enjoy these.

Family genealogy—this turns on my British Detective whodunit fixation and now breaking through roadblocks is easier than ever with online databases. Bonus is my kids and grandkids will inherit it.