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…….this person with dementia is looking for yesterday

Bob is a resident at Memory Care Manor. Bob cannot remember how he got here, or even why he lives here. He is in middle stage Alzheimer disease. Most days, Bob wanders the hallways of the Manor, not recognizing the caregivers or other residents who live here. Somedays Bob has no memory of his wife, Margaret or his family.

This morning, Bob has only one shoe on and he is aimlessly pushing the linen cart down the hall. The nurse attempts to move the cart back to its position; however, Bob assumes his task of pushing the linen cart. A short time later, Bob is seen pushing Marjorie, who is one of the residents at Memory Care Manor, in her wheelchair into the dining room. This upsets Marjorie a great deal. Loud screams are heard from the dining room,

“Let me go, let me go!”

When Bob sits down to eat his breakfast, he takes only two mouthfuls of the cereal, then rises to leave the table, once again resuming his wandering pattern. When he sits down in the lounge, Bob sits in the chair for a short time, then he moves to the next chair for a short time. The caregivers cannot encourage Bob to finish his breakfast.

Bob’s wife arrives for a visit this morning. Margaret and Bob have been married for over fifty years, and she has cared for Bob at home for three years prior to his admission to Memory Care Manor. This morning Margaret has found Bob’s one shoe which he had left in one of the other resident’s rooms when he was wandering.

“Good morning Bob,” she greets her husband with a kiss and a smile.” Bob smiles a greeting of recognition.

The nurse tells Margaret that Bob has been pushing the linen carts and wheelchairs around the unit this morning and causing some of the residents to be upset. She says this right in front of Bob.

Margaret replies, “ I feel that if Bob is not hurting himself or anyone else, that the behavior should be allowed.”

Bob now sits in the chair, with rounded shoulders, eyes downcast, fists tight. He is no longer responding to his wife.

The interview with Bob’s wife, Margaret, follows:

What message do you think Bob is trying to deliver by pushing around the linen carts?
Bob has worked for twenty-seven years at the airport as the night watchman. Part of his job was to walk throughout the airport monitoring the security. Bob always likes to be busy. He may be trying to let the nurses know that he wants to help them.

Yes, but sometimes when Bob pushes the other residents around, this may frighten them. Do you have some suggestions for how the caregivers can focus on Bob’s remaining skills?
Nothing with Bob lasts very long. However, he does like to keep busy. Perhaps the girls could allow Bob to push an empty linen cart around the unit. Or he could help to move the tables and chairs in the dining room, for cleaning purposes. Or he even could assist wiping the tables following meal times.

I am so sorry that he is upsetting some of the residents. Talk about some ways that you are involved in Bob’s care. And do you wish to be more involved in planning his care?
I took care of Bob for several years prior to his admission to Memory Care Manor. I trust that the girls are doing a great job caring for Bob. I do appreciate very much being invited to the conference when Bob’s care is being discussed. I like to be involved in decision making around Bob’s care, for example if his medications are being adjusted, I would very much appreciate being notified. Not that I could, or would change the outcome, but this helps me to understand Bob’s behavior. The girls are really good about telling me if Bob needs anything, or about how his day has been.

How do you handle it when Bob’s things go missing?
This is an everyday thing with Bob. One week we lost his eyeglasses, dentures, one slipper, and hearing aide. These items all have Bob’s name on it. Bob lives in the moment now and he needs very little ‘stuff.’

I know that Bob goes wandering into others’ rooms, and also that others come wandering into his room. I no longer get upset about these things if they go missing. Bob’s comfort and happiness is far more important to me.

It is evident that you care for your husband. What information do the caregivers need to better understand Bob’s needs?
Bob has always loved dogs. We have a collie dog, named Sammy. If ever the girls are having a hard time with Bob, they only need to bring Bob his photo of Sammy; it’s sitting right beside his bed. This might even help when Bob goes wandering.

The other thing that works really well is to talk to Bob about his work at the airport. Bob loves to talk about airplanes and flying. This always brings him happiness.

What things bring you happiness?
That’s a tough one. Bob and I have been together for over fifty years. This Alzheimer disease has taken away the Bob I once knew. I want to hold him to the same standard of what he was before the illness.

Having said that, now that I understand this is an unrealistic expectation, I can accept and love Bob just the way he is. And being with Bob is all I want right now. I love him and I always will.

What works best for Bob when he becomes restless?
Bob likes to be busy and he loves to walk. Especially in the morning and again at early evening, Bob loves to walk. When I was caring for Bob at home and I could see he was becoming restless, I would just grab our jackets and say, “Okay, Bob, let’s go take Sammy for a walk.”

ANALYSIS

Getting Started

Persons with dementia love to wander. To the outside observer, this wandering may seem to be serving no useful purpose. However, to persons such as Bob, there is indeed a purpose. He may be looking for something, something he may no longer even be able to remember. Bob is searching for yesterday. When caregivers face this situation, they need to first assess who is this person? Although the individual may not be speaking, their body language is alive with feelings. Is the person happy, sad? Are they moving around in an agitated manner? Both family and professional caregivers will be empowered in Bob’s care as they share information about who Bob is.

Adding Flavor

This can be a time of extreme confusion and chaos in the long journey of dementia. Bob becomes easily agitated because he doesn’t understand what is happening. Bob’s wife is struggling because she no longer knows the person she has lived with all these years. And professional caregivers may be struggling as well. They need to understand who Bob was, before he became a resident at Memory Care Manor. In joining Bob’s reality, caregivers appreciate that Bob is in the moment, and this moment for him is that he is night watchman at the airport. He needs to be busy and may be trying to tell the nurses that he wants to help them.

Putting it all Together

A large part of caregiving is related to ‘the knowing.’ Knowing who this person was prior to the dementia. Margaret knows that Bob likes to be kept busy. She knows about Bob’s personhood, and his sense of self? When caregivers have this information, they are then able to embrace who Bob is, and to understand his emotions so much better. This truly enhances the quality of life for Bob, empowering both family and professional caregivers.

What Works
• understanding what is Bob’s reality
• joining Bob on his journey
• keeping Bob busy

What Doesn’t Work
• talking about Bob in front of Bob
• preventing Bob from wandering
• encouraging Bob to sit for long periods of time

Gwendolyn deGeest RN,BSN,MA is the author of “Bathing Sparky” She has been working in dementia care for over two decades and has witnessed the joys and sorrows of families struggling to maintain a quality of life for themselves and their loved ones. Gwendolyn’s thesis, “The Relation Between the Perceived Role of Family and the Behavior of the Person with Dementia” is published in the American Journal of Alzheimer’s Disease, May/June, 2003. This work was presented at The International Congress of Gerontology, Vancouver, Canada. Gwendolyn resides in Vancouver, with her family where she is a professor.

Gwendolyn welcomes your questions/comments at gmdegeest@cruiserespite.com