The answer, I think, is to be direct!
For a great many years I was a master at avoiding being direct; a learned reflex. Coming out of that was difficult, but not insurmountable. Now-a-days I chose whether to be direct or not. The difference for me is that I am not hiding my indirectness (should I chose to be so) from myself, rather choosing it as a mode of action. There are times that I lapse into previous patterns, and there are times that i don't.
I rather like the choice that awareness of that gives me.
Of course.. it often depends on whom I being direct or indirect with!
I suppose it shouldn't really.. though often I am rather wary of the "well.. I'm just being direct" approach. Kindof like the "well.. I'm just being honest" approach.
This of course, relates only to my own experiences..
I don't know much about senility et al, and what effect previous patterns of behaviour have on that. What I have noticed though amongst the 'elderly' is a sort of 'concentration' of particular traits that remain when others may have gone; perhaps the traits are no longer in competition with each other and so the 'stronger' ones take hold?