A reader of the Alzheimer's Reading Room asks a question.
We need to send him for respite care so my mother who is his carer can have a rest but we cannot get him to go outside at all.
I know he is frightened and cannot think of a way to do it without making him angry or confused.
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By Rita Jablonski-Jaudon
Alzheimer's Reading Room
I get this question frequently in my clinical practice. The first thing I do when asked about this problem is to get more information.
1. Does time of day play a role in the refusals?
2. How is the family trying to “convince” Dad that he needs to leave the apartment? Logic never works. Instead, come up with reasons that would make sense to Dad.
Bob, you call this Alzheimer’s World. I call it Dementia Land. Either way, we enter their reality and see things from their perspective.
3. What types of activities did Dad enjoy prior to, and earlier in, his illness?
Once the family and I figure out what could be going on, we now have some options for creating a pleasant and positive reason for wanting to leave the apartment.
Here is one option that often works. Ask for help. Other dementia experts use often use this strategy.
Ask for help so that the person with dementia has a sensible (to him/her) and pleasurable (to him/her) reason to leave the apartment.
Some scenarios could be: “Dad, this box is heavy. Could you please help me carry it to my car?” The daughter then presents dad with a box (preferably light and empty) for him to carry. Once she gets her father to the car, the next request is, “Can you come with me to the post office (or to another destination), and help me?”
A second scenario is “the fix.” Dads liked to fix things, and many continue to see their role as the “fixer” of problems. “Dad, my car sounds weird. Can you help me?”
“Dad, I think my tire is flat. Can you help me change it?”
My family caregivers, because they know their loved ones so well, often run with this train of thought and then come up with a scenario that mirrors situations that Dad handled in the past.
A third scenario involves pleasant activities. One family caregiver brought over his dog, and asked his mother to help walk the dog. That got Mom out of the house.
My mother-in-law, Mary, loved craft stores. No matter how much she wanted to stay in the house, any trip involving a craft store worked. Craft stores even trumped church.
Fear, not necessarily of leaving the apartment, but of other things, may be the underlying reason why her father will not leave the house.
I had one patient who was terrified of falling and refused to leave the house. Her grand-daughter showed up one day with a walker, and the patient was willing to leave the house and go for a walk as long as she had a walker.
By the way, this patient had never fallen and had never used a walker. We don’t argue, we just roll with it.
I hope this is helpful.
Rita Jablonski-Jaudon, PhD, CRNP, FAAN is an internationally recognized researcher and expert on non-drug ways to handle dementia-related behaviors. She is an Associate Professor at the School of Nursing at the University of Alabama at Birmingham and a nurse practitioner in The Memory Disorders Clinic at the Kirklin Clinic, UABMC, Birmingham, Alabama.
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