Get into their world!

When the Alzheimer victim or family member that you are caring for, alludes to an incident or person incorrectly; or seems to be engaging in an imaginary world – resist trying to bring them back to reality! In some circles this statement may be considered politically incorrect, but, were I to choose between the peace of mind of a person for whom I am caring – and PC, I would always choose the former. Do we really want them to grieve anew every time we correct them? Do we wish to sow the seeds of confusion and frustration each time we contradict their misconceptions – I think not! So how should such incidents be handled? An example  is as follows:

Waiting for a new body

One morning while working as manager in the SAVF old age home in Pietermaritzburg, I was astonished to discover one of our residents, an Asian gentleman – Mr. Patel, sitting quietly in the resident’s lounge. What was more surprising was that he was stark naked.

Mr. Patel, normally a wonderful, dignified person, suffered from dementia. Fortunately the hour was early, so no other residents were yet around. I was however concerned that his nude presence might offend some of the early-risers (although for some of the more sprightly female residents his revelations may have relieved some of the tedium inherent in Care Homes?) The sight of him sitting alone in the lounge was bizarre! He had covered his loins with a dish cloth, and his clothes were neatly folded and stacked on the table in front of him.

Determined to restore a modicum of dignity to the situation, I approached him and enquired what he was doing? Touching his chest he responded… “I have a heart problem and I am waiting for a new body from Grey’s Hospital.” What should I do? I left the lounge and, returning 5 minutes later, I informed him that I had phoned Grey’s Hospital but the bad news was that their stock of bodies, both new and reconditioned, was entirely depleted – they had none left. I added that they had promised to phone us immediately a suitable one became available.

Then succumbing to my insatiable, yet oft times insensitive curiosity, I added… “But they do have some white bodies available… would you like one of those? “ I was interested in ascertaining his reaction to their magnanimous offer… living in a Rainbow Nation, I was keen to find out if he suffered from colour blindness. Mr. Patel turned to me with a slightly disdainful expression on his face and responded “Oh all right then!” (He was obviously not enthralled at the prospect!). I then had no recourse but to again excuse myself from the room and, returning a few minutes later, inform him that regrettably they had even run out of these – adding that they would contact us immediately some became available; whereupon Mr. Patel got dressed and left the lounge. I guess that the prospect of being supplied with a white body was akin to some form of alternative or homeopathic curative (or could it perhaps be shock treatment?… as his heart condition was immediately cured and he never again disrobed in public).

Conclusion

Whilst in the early stages of the disease, assisting a patient or loved one, to engage with reality may be both acceptable and even desirable, in later phases this is often no longer the case. In the earlier phases such reality checks even assume the form of answering questions posed by the AD sufferers themselves, as they struggle to cope with their confusion. I.e. the truth is told at their request, as they desperately seek explanations and clarifications.

In the later stages this no longer applies – it is kinder to join them in their world. By then the degree to which they have become immersed in their imaginary world precludes their accepting truths without the accompanying pain of realizing how far they have strayed off course (if they are by then even capable of once more embracing reality?). When the Alzheimer victim or family member that you are caring for, alludes to an incident or person incorrectly – don’t try to bring them back to reality! And very often the reality checks are motivated by the needs of family or carers, rather than those of the patient themselves.  Trying to reason with someone who has Alzheimer’s often merely ends up a frustrating experience for both parties!

“The world of reality has its limits; the world of imagination is boundless?” – Jean-Jacques Rousseau

Henry Spencer