When elders repeat their words
by Carol Bradley Bursack, Editor-in-Chief
It's heartbreaking to hear an elder repeat like a mantra the words, "I want to go home." Most caregivers of elders who have dementia, particularly dementia of the Alzheimer's type, know this refrain. They tell the person they are home. They try all kinds of stunts to comfort the elder, but the results rarely last. The reason? The elder wants to go to his childhood home, one that no longer exists. Caregivers need to learn techniques to handle this agonizing problem.
The first time a caregiver hears a parent say, "I want to go home," it seems to make sense. Dad is in a nursing home. He wants to go back to where he lived before. Sometimes it's possible to take him there. Then, surprisingly, the carer again hears, "I want to go home." Now real frustration begins. "You are home!" you insist.
It's natural to think your dad wanted to leave the nursing home and go back home to where he lived before. But this? This doesn't make sense. Even adult children who take care of their parent at home are subjected to this heartbreak. They still hear, "I want to go home."
The key is that the parent is asking to go to the home of his childhood. This home may or may not still be standing, but even if it is, it's not likely to look the same as it did 70 years ago. Everything changes. So how do you cope?
Short-term Memory Loss Takes Them Back In Time
As people increasingly lose brain function to dementia, they often return to the past. Short-term memory is what goes first when most dementias strike. It is thought that as the disease progresses the person goes further and further back in memory until in their mind they are a teenager or even a young child.
Some researchers think much of the inappropriate behavior of men who have Alzheimer's toward young women--sometimes a daughter-in-law or other female relative--stems from the fact that the man feels as though he's in his teens or twenties. Why, he's an attractive young man and this woman may be interested in him! He doesn't recognize the woman, so he sees nothing wrong with his behavior. Of course, inhibitions of all kinds are known to diminish in both sexes as Alzheimer's progresses, but this particular type of behavior may stem from a less generalized loss of inhibition.
The Stranger in the Mirror
People with Alzheimer's are often afraid of the "stranger in the mirror." That stranger is their own reflection because they no longer recognize themselves. That's not so hard to understand when we think of how, in daily life, we rarely look closely at our aging parents. Then, an event of some kind happens--an illness or other stressful occasion--and we actually see our parents. Then we may think, "Man, they are getting old!"
We do the same thing with ourselves. We see the same face in the mirror everyday and don't notice that each day we age. But, from time to time, an event may happen and we realize, yes, we have aged.
Take that normal behavior and look at it through the confused eyes of a person with dementia. People in this stage feel they are young, so how could this old face in the mirror be them? That doesn't make sense to them, so they think the person is a stranger and why are they in the house? Many caregivers keep mirrors in the home covered so the elder with Alzheimer's isn't upset by each glance. This is much the same thought process that makes them want to go home, meaning their childhood home, which is the only home they remember. They think of themselves as young.
Approaches to Get You Through It
You likely can't take them to the home they want to go to, so:
- First, you accept the fact that you can't give them what they want.
- Then you learn about distraction and redirection. They are tools used by professionals and they are just what the words imply. You distract the person by redirecting him to something else. For example, if your elder is in a nursing home and he likes birds, gently guide him to a window and ask him to help you look for birds. Talk about the birds and how pretty they are. Talk about what the birds are doing. If the elder is interested in the birds, he may, for a time, stop his plea to go home.
- Next, you accept the fact that even if redirection and distraction work--and they don't always--this solution will be temporary.
- After accepting you can't give the elder what he wants, you then move on to realizing that this is not a problem that will soon go away. It is part of life as you live it right now. The next stage of the disease may be different, but right now, you need to accept the truth. The truth is that you are not a failure as a caregiver if you can't make the person happy. The elder is requesting the impossible and you can't deliver. That is just a fact.
- Last, you figure out how you will handle this. Will driving the elder around the block work? Some people do this and then get out of the car declaring that, "We are now home." Don't laugh. Sometimes it works. Often it doesn't, and even if it does it is a temporary fix. It's all about distraction and redirection. You may distract, redirect and probably cry a lot. But you must realize that this is going to be a part of your life and you need to learn to detach or your heart will break. Kindly go through the motions to see if you can temporarily cheer up the elder, then emotionally move on, knowing you did your best.
This is one more of those heartbreaking stages of dementia that the best caregiver in the world cannot change. Photo albums from days gone by can help. Music and DVDs of old TV shows or movies may help. Any kind of distraction may help. But in the end, you'll hear it again. "I want to go home."
You will blink back the tears and get on with life. This, too, shall pass.