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Posted October 5, 2006

Ask An Expert

Elderly Behavior: Keeping Mom's View of Reality in the Present

Q. At times my mother mixes reality with the past. She claims she can see and speak to a very personal friend who I know is deceased. When I tell her this person is deceased, she accepts it and says she knows. But a couple of days later she speaks of him again. I’m getting concerned. What is this? Is this a mental condition?

Jethro H., Wentzville, MO

A. There are a couple of possibilities that might explain your mother’s behavior. First, if she is spending a lot of time sitting by herself, it may be that she drifts into daydreaming about the past and the things she did with her friend.   She may even be dozing, half awake and half asleep, and the memories and thoughts of this person being with her and talking with her may seem quite real. Thus, although she can accept that her friend has died when you remind her, it may also seem as if her friend has actually been recently present.

You might try to notice if your mom is less likely to do this on days that she is active and doing things with other people that are enjoyable and engaging.

You do not mention your mother’s age or state of health. People who are at the end of their life (for example, when they have a terminal cancer), who have certain physical conditions such as severe vision loss or depression, or who are taking certain kinds of medications, can also be more likely to have these kinds of symptoms. If this describes your mother, you might talk to her doctor about whether visual or auditory hallucinations or misperceptions are known side effects to any diseases she has or medications she may be taking.

Finally, this could also be an early symptom that your mom is developing some form of dementia, such as Alzheimer’s disease. Time becomes quite “fluid” for persons with dementia, and they can easily confuse events of the distant past with the present.

Does she have any other changes in her memory or thinking that are interfering with her ability to care for herself? For example, have you noticed any deterioration in her cooking, cleaning, driving, or personal hygiene? Does she ever forget to pay her bills, miss scheduled appointments, or not recognize friends or family members? Has she been making decisions that are unwise or unlike what she would have done in the past?

If any of these questions describe your mom, she should be seen by her doctor. Some forms of dementia are caused by reversible medical conditions that can become dangerous if left untreated, so it is important to be evaluated when such changes in thinking occur.

This answer is provided by Susan M. McCurry, Ph.D., Research Associate Professor at the University of Washington, School of Nursing, and a licensed clinical psychologist. She is a fellow in the Gerontological Society of America and an expert in the development of behavioral interventions for the treatment of mood and behavior disturbances in persons with dementia and family caregivers. Her publications include the recent book, “When A Family Member Has Dementia: Steps to Becoming a Resilient Caregiver” (Greenwood Press). She can be reached at smccurry@u.washington.edu.

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