I just went to visit my father-in-law. He is diagnosed with Azheimer's Disease, but continues to be a good companion and we spent several very enjoyable hours playing dominos with some of the other residents of his home.
He has been there for four years and we have developed positive relationships with many of the other residents. Anya has been there for two years and, like my father-in-law, is kind-hearted but confused. She told me about her attempts to get money from her bank and her pleasure at finding someone who would do this for her -- and her dismay that the money disappeared after he gave it to her. She repeatedly observed, "He must be a magician."
Her concerns matched my father-in-law's when he opened his wallet only to discover that he didn't have the money he needed to pay for dinner: "Someone must have taken it." After his wife's death five years ago he repeatedly worried about where she had gone. While he could understand why she might be angry with him, he said he didn't understand why she wouldn't come by when we came to town. Other residents have held my hand and cried as they told me that their family doesn't visit them any more.
Each of their comments were part of an attempt to explain something important that had been lost. How else could they explain the lost money, his wife's absence, or their loneliness?
When I forget something, I shrug my shoulders and say, "I don't know." Sometimes I say, "Perhaps I left it on the counter." In the process of either explanation I admit that I am aware of the failure in my memory. On the other hand, people with Alzheimer's Disease often use confabulations in these same types of places, especially places that are very important to them. Rather than say, "I don't know why I don't have any money," they create a story that explains their loss.
Confabulations are very difficult for the families of people with Alzheimer's Disease. We often like Truth and are very uncomfortable around people who are "lying." Often confabulations have a perseverative character about them: people with Alzheimer's Disease will repeat the story over and over again despite reassurances to the contrary. These stories can be very hurtful to family members who have been visiting as often as they can: "Why should I visit if she doesn't appreciate it?"
Saying, "We were here just last weekend," while right, rarely changes grandma's belief in her own story. What is helpful?
Remember their stories are part of the disease. When your child throws up, you take his fever and treat him gently. Remind yourself that your parents or grandparents aren't being "mean" or "cruel," but that you're seeing the confusion that's part of Alzheimer's. Even when they don't remember your name, they can get real enjoyment out of spending time with you.
Acknowledge the feeling. It feels like no one is visiting. They feel confused. They may not understand why people who are important to them aren't around. Acknowledge the feeling at the center of the story, "Grandma, it sounds like you have really been lonely this week."
Find little ways to address their concerns. Sometimes little things can be helpful for both people with Alzheimer's and their families. Giving choices in the places where they can make them can be very useful. Giving them small amounts of money so they can pay for supper helps maintain their self-esteem and autonomy. Maintaining a diary of visits in Grandma's room can remind her of visits and reduce some of the anger and guilt that caregivers may experience -- and remind you if you haven't visited in a while.
Take care of yourself. Having a family member with Alzheimer's Disease is difficult and stressful. You can do a better job if you do things to handle your own stress.
Page by Jeanne M. Slattery jms
URL= http://psy1.clarion.edu/jms/confab.html
Last modified January 24, 2001.