Validation verses reorienting Mom with dementia. Distraction is only working for a moment. Any advice?

What worries me the most is that Mom is able to leave despite the Wander Guard and the door alarms. Does she actually get outside? That’s frightening and needs to be addressed immediately. Mom needs to be in a locked unit.

I think Mom believes there is a lost child. Is your sister the youngest? That may be why your mom has named this lost child after your sister. There is no rhyme or reason to the hallucinations and delusions of people with dementia. It’s whatever happens to work at that moment, whether it’s reorientation or validation.

Do not remind her. You cannot reason with dementia. My mom did the same thing, always thought her children were missing, even me, standing right in front of her. What worked the best was telling mom that sis was spending the night with a childhood friend. A friend that mom knew the parents well. Told mom sis would be back in the morning. Most of the time that worked pretty well.

Is mom taking anti anxiety meds? Seroquel was a wonder drug for my mom, but she could not take ativan, completely opposite effect.

I'd consult with her doctor immediately. Once a person with dementia wanders, it's a whole different agenda and that is keeping her safe. Once my LO wandered, her doctor wrote order for a Secure Dementia Unit. It's just too risky, plus, I would think the facility would be all over this. They are responsible for her welfare, so, if they are aware of the wandering, why are they not concerned? I don't get it.

I'd also discuss something for mother's anxiety and delusions. She sounds very mentally distressed. I'd explore medication and maybe a sleep aid.

It sounds like regardless of what you say, it's not going to really affect her beliefs about her troubles, so, I'd discuss it with her doctor, ask about meds and secure unit, and try to comfort and soothe her as best you can. Disagreeing really isn't productive, from what I have seen.

Nancy safety is the priority now. No matter how much you try to keep her in reality & pull her out of it she will go back to what she believes is true for her. Its very hard to accept. I go thru this with my mom a little talking about her past. She talks about her deceased siblings as though they are still alive then come back to the present. Frustrating. Let her talk & talk. Learn to listen as best you can but the facility must watch her a little more. To talk to her doctor. She may need a nursing home. She won't be able to go outside so easily.

My mom used to wander quite a bit, which I call "the crazies" -- because they can't direct their thoughts. The body still has energy, but the mind cannot focus. I take my mom to the park daily and walk her and when she gets restless I just take her back to the park and walk her some more--and when she comes home she's very calm. Now with very end stages of Alzheimer's I still walk her, but all she wants to do is sit all day--so I do so with a lot of difficulty but still do it with a specialized walker that cost me nearly $600 (used for stroke patients--because it keeps her back straight).

Medications (psychotropics and narcotics) will increase risk of FALLING considerably. I never had my mom on anything other than her routine diabetic and blood pressure meds which she needs. I manage her very well behavior-wise with simple walking exercises in the park. Plus going in and out of the car is a very important skill to retain so I can take her to the dentist and doctor still.

If I did not walk her, her agitation and wandering was quite severe. People like to just medicate them..but these drugs can make them fall. Exercise them instead and make it a daily routine. but that takes a lot of work and I've been doing this for four years..every single day. still the benefits are enormous. now if they are obese or have other physical disability that makes it impossible to simply walk them, you will probably have to keep them doped up...but their lifespan will really shorten due to more inactivity and the more inactive they become the harder it will be to care for them..and you will have to change their diapers (urine and feces) while they are in bed because they become bedbound. Once bedbound they get pneumonia and clots easily and bedsores. Then put them on hospice and they will die from more drugs.

I will address what I think is most important here first...
Your Mom needs to be in a locked or secure unit. It is hard to believe that they would not have told you this themselves. (the facility) They are responsible for her safety while she is in their care. (Different story if you take her to lunch and she wanders off) If the facility does not have a locked unit you need to be looking for one and prepare to transfer her.

Now to your "lost sister"
If your sister is estranged then in a sense she is "lost".
Is there a way that you can get someone to call your Mom and say it is "little sister" Mom can talk to her younger "daughter" and be assured that she is no longer lost. This will only work if your Mom can or still use a phone. My Husband stopped using the phone early on in his journey with dementia. I don't know if he could not remember who he was talking to if he could not see them or if it was because he was never a big talker to begin with.
If she will not or can not talk on the phone if you can get someone that sort of looks like sister to come visit. You do not say how long it has been since Mom saw sister but if it has been a while it might work to calm her down. I do not like deception of this kind but if it helps to keep Mom safe that is the lesser of 2 evils I guess.

Dear Nancynurse, I was one of those guilty of trying to correct my Mom when it finally occurred to me that this part of the disease was my problem! Agree!
There is your answer.
However having said that in your situation, can you not just offer she is at a sleepover with her friends? Was she an athlete, book worm? Adding she is doing what your Mom May remember. Sadly you can never bring back these parts she is losing, but be her friend. Her world has become very scary, you can be her champion, not her teacher anymore? Good luck and God Bless!

I'm going out on a limb here because I never had to deal with this, but I wonder if a baby doll would help? Unlike a real baby, it won't matter if she drops it - but when she goes looking again, you can always find the baby and return it to her.

I wanted to comment on Raylins reply - in case anyone is having the same reaction that I first did when I read a suggestion to substitute a stuffed animal for an actual, live dog.

I admit the first time I read something like that I thought “yeah, right! That has to be the silliest thing I’ve ever heard! As if anyone can be fool by a stuffed animal masquerading as a real one. Even someone with dementia”.

Then I came to be familiar with two women at my mothers nursing home.

One woman held a baby doll and the other - some sort of stuffed animal. I could never tell what animal it was representing as the woman held on to it so tightly. Which is my point.

Both these women were never without their artificial companion. Never. They seem to hold on to these falsies as if their lives depended on them.

Loving on them, talking to them, petting and stroking them as if they were the real deal. Both woman seem content and at ease. I commented as such once to a staff member at the home. Their reply was “they are content and relaxed. Just don’t try to take their “baby” away from them.”

So, anyone who thinks this sounds like a silly idea - "Don’t knock it till you’ve tried it”.

My suggestion is get her a doll that can be wrapped with a blanket. It soothes them and when she doesn’t want the doll place it on her bed she will know where it is.
Best wishes,
Lisa

Take her to the gym every day get her to go ride bike ..cut down on meds some times medacation makes people worse ..just saying A drug is a drug is a drug ..deminsha is a man made disease drug indused ..all about money

Wow. Charlia. Just, wow. You need to keep beliefs like this to yourself. And, it’s “dementia”. Don’t scare people with your off-center opinions. An exercise bike will NOT cure a broken brain.

Cetude, Nothing about dementia is easy. Medication did not dope up my 91 year old Dad at all. It reduced his anger, aggression, but did not make him sleepy. He has vascular dementia from multiple strokes-it shows up on MRI as areas of damage in his brain.
Medication made it possible for him to stay out of a locked geriatric psych unit. It helped him maintain freedom to go into a secure courtyard and stay active.
Nothing about this has been “an easy way out”. We love our father as much as anyone, even though he has been a most difficult and toxic person.

How about saying the daughter has been found and is safe and sleeping now. That might help.

Perhaps an old pic of her might help too? If it doesn't work, and only upsets her, take it back when she's out of the room.
If you say the daughter is grown they don't get it. I'd just say she's found and is just fine.

Good luck~

Nancy - My Mother used to get up in the night (and during the day) and try to get outside - she thought someone was hurting my brother. This went on for days, maybe longer. I kept assuring her that he was at home and he was fine. I would call him and have him talk to her and this would calm her down. It's a waste of time to correct them and it usually makes things worse. I'm sure you know that she "believes" this in her mind. The best you can do is assure her that your sister isn't lost and tell her where she is. I just reread your post and since your sister won't talk to her, maybe another sibling or family member could call and talk with her.

Do you have a young relative that looks like the "missing daughter"? I remember an older cousin with
alzheimers who called me by my mother's name and my daughter by my name. If a young relative could visit for a few minutes that might help; then you offer reasons why she can't return. Or a doll--I had a large rag doll when I was a kid that was about 3-4 feet tall. With "hair" the right color and a simple 50's dress that might be something she would accept.

In a strange sort of way, she is lost. You said your sister has nothing to do with her. In her confused mind - not communicating with or seeing her - she considers the little girl she loved so dearly - is gone, or lost.

Oh my, I need some rest.

Nancynurse;

It is hard to "fib". but it is the best way to deal with issues like your mom's. I'm glad to read that you got her into a locked facility - the consequences of wandering are so dire! It is hard to believe any facility thought the alarm was sufficient - if no one is available to chase after her, how far might she have gotten!?!?!?!

The "little white lies" we have to resort to are not truly lies as they are not done to hurt the person. They are to console and reassure. We have to learn to live in their reality. Bringing your sister in (not likely), having her call, telling mom she's a grown woman or substituting someone else is not going to work. Mom truly believes your sister is 7 and is lost. This IS mom's reality. You cannot reason with dementia, you cannot argue with it. You have to find ways to resolve the issue. Sister is in school (daytime). She's visiting/staying over with another friend or cousin (if you can remember any of her good friends/cousins from childhood, use those names - if mom is "living" in that time, she might recall those names.) Sister can be at after school activities (sports, gynastics, etc.) or afternoon/weekend sporting events. Sister can be coming to visit later, another day, etc. Once you can assure her sister is in a safe place, then redirection might work.

Our mother is now focused on HER mother, wanting to go to her place, wondering what she is doing a major holidays (Thanksgiving, Christmas, etc.) Her mother has been gone about 40 years now. The first time she pulled this on me, she asked if I could drop her off at her mother's on my way home... Umm, looks at watch, gee it's a little late in the day and it is not on my way, but maybe tomorrow. Okay. That was good enough that time. You have to be quick thinking! If she brings it up again, in the summertime we plan to say she's up in Canada visiting relatives, in the winter she'll be in FL. All kinds of excuses can work. She's also forgotten her condo of 23+ years and now is focused on their previous home (and associates that with her mother.)

Don't feel guilty having to fib to your mother. Whatever will work to assuage her anxiety, and yes, there are meds that can do that without doping them up. I had to fight to get that one ordered because doc was concerned it will mask UTI, fall risk, every excuse in the book, but I said when she gets in this state, it is not fair to her, the staff, the other residents and me to have to deal with her ranting, raving and trying to get out for HOURS! She's more likely to hurt herself doing this than any fall risk! It isn't often used, only when she gets truly agitated, and one dose will work! It is generally in the evening and after it calms her down, off to bed she goes! As for falls - she has not had a tumble in about a year, and earlier this year started using the walker, but generally doesn't walk much, so falls are not likely. ALL the falls happened BEFORE we got the Rx!!

As for drugs causing this - not likely. Like others said here about their LO, mom has been on BP meds and until she just stopped taking them, cholesterol meds too. Although the results are not in, having high BP can contribute to developing dementia (vascular), so blaming pharma for causing it, no. Our mother didn't develop obvious signs until she was already over 90 - so many years of BP meds probably helped delay this for her!

For anyone who can barely walk at this point, the gym isn't the answer. However, as a possible preventative, yes, get exercise, stay active, stay socially connected and keep yourself healthy (all of which may limit how many meds you take while younger - I take NOTHING! When suggested cholesterol, changed what I eat and got some aerobic exercise. No meds needed. Potential osteoporosis? No way would I touch those meds they tried to get me to take!) Continue this even when dementia sets it - they do believe these activities can help slow the progression for many.

Nancynurse, I want to respond to your your reply in the thread where you discuss not wanting to lie to your mom. I know how you feel but maybe I can persuade you to look at this from a different slant. When most of us were children, we were essentially ‘lied’ to; Santa Clause, the Easter Bunny, the Tooth Fairy. None of those characters actually exist and yet our parents told us they were real year after year, tooth after tooth. It went on until we were old enough to be informed or figure it out all the while we were raised not to tell lies. Kind of ironic, isn’t it? *giggle
After we became parents ourselves, most of us repeated the same ‘lies’ to our children and created the same grand illusions for them. 
Your mother is, in a sense, a child again. A grown woman with a mind damaged by age. She is searching for the child who is lost to her, with whom she had unresolved issues. She is probably seeking closure, a resolve, mended fences, an understanding and the bottom line is, she is sure that she needs to rescue her. I say, tell her anything and do anything to give her a moment of peace. What else can you do but that. No matter how outlandish or absurd it is, you are doing it for her sense of well being. It may be that you’ll have to have a new trick up your sleeve day after day so just let your imagination go and help her as best you can through this difficult part of the journey. Lies, in the best interest of your mother, at this point, are truly acts of kindness.