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Posted July 3, 2008

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Elderly Behavior: Handling Mom's Memory Problems

Q. Should I help my Mom in remembering, or do I make her think? What do I do when she has bad dreams, often set up by relatives who want her in a nursing home and she wants to stay at home? She calls me hysterically and thinks I am going to force her out of her home. Also, she sees people in her home but they do not talk to her and just watch her (I have told her that they are not real and that they won't hurt her). She just started on a low dose of Aricept.

Jo Anne R., Racine, Wisconsin.

A. There is no one-size-fits-all answer to your question. In general, it is important to be honest with your love one to allow them to maintain the respect and integrity they deserve. 

However, occasionally for some people with dementia, reality orientation can be very stressful. For her hallucinations, if she is not bothered by them, your gentle reassurances should be adequate. If, however, she is frightened or disturbed by their presence, talk with her doctor about medications (such as low dose anti-psychotic medications) that may help decrease the hallucinations.  Some people with dementia realize the hallucinations are not real, for others those hallucinations are very real. 

Again, how you choose to reassure your mother will depend on how she reacts. If she can accept your explanation that they are not real, then this is adequate. If orienting her to reality is too stressful for her, this may be a situation where "playing along" is useful. Realize, however, that there may be a time when “playing along” doesn’t make sense.

It may be useful to have a daily calendar in your mother's house to help her remember the date and a large prominent clock in the room she uses frequently to remind her of the time. If she is forgetting family members’ names, you may choose to gently remind her who is who, but do not expect her to remember this later.  Engage your mother in talking about things she does remember. You may try to write (or record on audio or video tape) memoirs from when she was younger. Reminiscing is a great way to stimulate her thinking and give her confidence by focusing on what she can remember.

The issue of nightmares caused by family members who want to put her in a nursing home is more difficult. First, ask yourself who has authority for your mother’s affairs (for example, power of attorney or conservatorship). If it is you, then ask your relatives to discuss issues of nursing home and long-range planning with you. If it is a shared responsibility or someone other than you, sit down with the involved parties and discuss your concerns and your mother’s fears. Explain that your mother can not handle the stress of these discussions and that it is best to leave her out of them. 

If there is no one with authority over your mother's affairs, then I encourage you to go with her to an attorney to assign someone the power to take care of her financial and health concerns. 

This answer is provided by Dr. Vivian Argento, a trained geriatrician and member of the geriatric medical team at Bridgeport Hospital in Bridgeport, Connecticut.  Dr. Argento is an expert in memory and medical problems affecting the elderly and serves as a clinical instructor at the Yale School of Medicine at Yale University in New Haven, Connecticut. She’s also a consultant both in and out of hospitals and cares for patients in various locations, including nursing homes, assisted living facilities, and in their homes via a house calls program. Dr. Argento can be reached at pvarge@bpthosp.org.

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