Memory and Communication
Mr McDonald’s wife used to drop him off at the day care centre at 9 o’clock and almost as soon as she had left he would go and sit near the door waiting to be picked up. Employees at the centre thought that he was unhappy at the centre but it turned out that he simply felt that it must be 5 o’clock already.
One day I was sitting in the living room with my husband when he asked me when we would be heading off back home. I automatically answered that he was at home, but he insisted that he was not. In a way, I felt hurt that he did not recognise our home, but I now realise that he must have felt bad. It is no use trying to convince him that he is at home when he says things like that, so I just try to make sure that he feels at home and distract him when he worries.
People with dementia often become disoriented in time and space. This may be the result of confusion caused by changes in the brain, memory loss or perhaps due to difficulties recognising people and objects. The “internal clock”, which enables people to know roughly when it is time to eat or sleep also tends to be disrupted. You may find it difficult to believe that someone could get lost in their own home or really think that you have been gone for hours, when you were just out of the room for about five minutes. Nevertheless, such behaviour is fairly common, and is perhaps not so strange if you bear in mind the consequences of memory loss.
For the person with dementia, the main problem is not so much being unaware of what time it is or recognising a place and finding different rooms, but more the anxiety that this causes. Indeed, most people would feel anxious about not being able to find their way around their own home. The knowledge that it is midday is not particularly important, but the possibility of having missed lunch, a favourite television programme or the fear of having been deserted might well be. Even if the person with dementia is not fully aware of being disoriented in time and space, they may still be anxious due to the fact that there appears to be no structure to the day, or they may feel uneasy in a seemingly strange environment where anything could happen.
How to cope with disorientation
You will probably find that the person with dementia feels more reassured if you explain that there is nothing to worry about, rather than if you simply state what time it is or where they are. For example, they may seem anxious about whether it is 10 o’clock yet (the time at which the bus arrives for the day centre). In this case, it would be better to reassure them that you will make sure they do not miss the bus, rather than simply stating that it is only a quarter past nine. The person with dementia might not believe you if you insist that they are already at home, but you might be able to relieve some of the worry by explaining that they are among friends and family. Some carers have found that drawing attention to the feel of something familiar such as an armchair helps.
Try to find ways to help the person with dementia to understand time
You may find that the person with dementia does not really understand what you mean by “at five o’clock” or “in ten minutes”. But, there are other ways to express the passing of time. You could, for example, use a kitchen timer or an old-fashioned hourglass. It has been found that some people with dementia can make sense of an old fashioned hourglass, even if it is not something they are used to. You might also be able to find other ways, based on daily life, e.g. when everyone has finished their coffee or when the washing machine has finished, etc.
How to prevent problems due to disorientation
As it becomes increasingly difficult for the person with dementia to keep track of time, it helps if you stick to a regular routine with several events to break up the day, thereby providing some kind of structure. If there are enough events occurring throughout the day, there are more opportunities to realise roughly what time of the day it is and even what is going on. A regular routine prevents the day seeming like a continuous series of surprise events and this may reduce anxiety. One idea is to write down a plan of the day’s routine at breakfast time with the person with dementia. You could then go over it again at lunchtime. Otherwise, you could stick to more or less the same basic routine every day, without actually writing it down.
Adapt and then maintain a stable environment
It is a good idea to try to maintain a stable environment, always putting things in the same place and not making too many drastic changes. Fitting signs on doors with either a picture or words may help the person with dementia to get around their home, even when it no longer seems like a familiar place. (Please refer to the chapter on communication for guidelines on using signs.) This will not relieve them of the feeling of being lost or in the wrong place, but it will help to reduce the anxiety caused by not knowing their way round. Labels or signs on cupboards and drawers can help someone with dementia to find their way around without having to ask and draw attention to the problem.
Moving the person with dementia from one place to another is likely to increase disorientation. Therefore, if other family members share the caring, it is better for them to visit, rather than move the person with dementia from one home to another in rotation. The more familiar the surroundings, the easier it is for the person with dementia to feel at home and comfortable. On the other hand, as long as the person has confidence in the family or in another person, there should not be a problem taking care of them in another place, e.g. a day care centre.
Last Updated: Thursday 06 August 2009