So my dad calls me from the nursing home quite often. He gets really upset because they won't let him leave. I ask him where he wants to go? He has no idea. He just says he wants out and he will figure out where he is going after he leaves. I also try to tell him that we will have to talk to the doctor and see what he says. This doesn't calm him either. So I say to him that for now he needs to stay there so I know where he is and I can visit. This doesn't even calm him. So now I am running out of ideas. Anyone have a suggestion?
I don't know if you've seen any Teepa Snow videos; she is the quintessential "dementia whisperer".
I think I'd talk to the staff about what might be agitating dad; do these calls happen at a certain time of day consistently? Is her hungry, or tired or in pain?
Is he being seen by a geriatric psychiatric for medication management.?
Answer From Jonathan Graff-Radford, M.D.
The term "sundowning" refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning can also lead to pacing or wandering.
Sundowning isn't a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer's disease. The exact cause of this behavior is unknown.
Factors that may aggravate late-day confusion include:
Fatigue
Low lighting
Increased shadows
Disruption of the body's "internal clock"
Difficulty separating reality from dreams
Presence of an infection such as urinary tract infection
Tips for reducing sundowning:
Try to maintain a predictable routine for bedtime, waking, meals and activities.
Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
Limit daytime napping.
Limit caffeine and sugar to morning hours.
Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.
In the evening, try to reduce background noise and stimulating activities, including TV viewing, which can sometimes be upsetting.
In a strange or unfamiliar setting, bring familiar items — such as photographs — to create a more relaxed, familiar setting.
Play familiar gentle music in the evening or relaxing sounds of nature, such as the sound of waves.
Talk with your loved one's doctor if you suspect that an underlying condition, such as a urinary tract infection or sleep apnea, might be worsening sundowning behavior, especially if sundowning develops quickly.
Some research suggests that a low dose of melatonin — a naturally occurring hormone that induces sleepiness — alone or in combination with exposure to bright light during the day may help ease sundowning.
When sundowning occurs in a care facility, it may be related to the flurry of activity during staff shift changes or the lack of structured activities in the late afternoon and evening. Staff arriving and leaving may cue some people with Alzheimer's to want to go home or to check on their children — or other behaviors that were appropriate in the late afternoon in their past. It may help to occupy their time with another activity during that period.
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It is not uncommon for a person with dementia in residential care to say they want to go home. This can be distressing for everyone. Below are a few considerations on what to say to someone in this situation who wants to go home.
5 things to remember when someone with dementia is asking to go home
1. Avoid arguing about whether they are already ‘home'
For a person with dementia, the term 'home' may describe something more than the place they currently live. Often when a person with dementia asks to go home it refers to the sense of home rather than home itself.
‘Home’ may represent memories of a time or place that was comfortable and secure and where they felt relaxed and happier. It could also be an indefinable place that may not physically exist.
It’s best not to disagree with the person or try to reason with them about wanting to go home.
Try this instead:
Try to understand and acknowledge the feelings behind the wish to go home. Find out where 'home' is for them - it might not be the last place they lived. It could be where they lived before moving recently or it could be somewhere from their distant past.
Often people with dementia describe 'home' as a pleasant, peaceful or idyllic place where they were happy. They could be encouraged to talk about why they were happy there. This can give an idea as to what they might need to feel better.
Continued.............
The desire to go home is probably the same desire anyone would have if we found ourselves in a strange and unreasonable place.
Try this instead:
Reassure the person verbally, and possibly with arm touches or hand-holding if this feels appropriate. Let the person know that they are safe.
It may help to provide reassurance that the person is still cared about. They may be living somewhere different from where they lived before, and need to know they’re cared for.
3. Try diverting the conversation
Keep a photograph album handy. Sometimes looking at pictures from their past and being given the chance to reminisce will ease feelings of anxiety. It might be best to avoid asking questions about the picture or the past, instead trying to make comments: 'That looks like Uncle Fred. Granny told me about the time he....'
Alternatively, you could try diverting them with food, music, or other activities, such as a walk.
4. Establish whether or not they are feeling unhappy or lonely
A person with dementia may want to 'go home' because of feelings of anxiety, insecurity, depression or fear.
Is the person with dementia happy or unhappy now? If they are unhappy, it may be possible to discover why. If they cannot tell you why, perhaps a member of the staff or another resident knows why.
Like other people, someone with dementia may act out of character to the people closest to them as a result of a bad mood or bad day.
Does the person with dementia keep talking about going home when people are not visiting them in the care home? Does he or she seem to have settled otherwise? The staff in the home may know.
5. Keep a log of when they are asking to go home
Certain times of the day might be worse than others. What seems to be the common denominator about these times? Is it near meal times (and would a snack perhaps help)? Is it during times when the environment is noisier than usual? Is it later in the day and possibly due to ‘sundowning’?
If you see a pattern, you can take steps to lessen or avoid some of the triggers.
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I hope some of these tips for Sundowning & saying "I Want to Go Home" or wanting to leave the Care home are helpful.
Best of luck!