How do you cope with time confusion in dementia patients?
H ow do you cope with time confusion? my husband thinks it's hours and it's only been 10-15 mins. therefore we can't go any where that takes more than 15 mins or he becomes agitated. Please help.
Alzheimer patients often become disoriented to time. Despite being able to read the clock, they may ask repeatedly what time it is and, as you said, misperceive the 'passing' of time. When they leave the house, they may immediately want to return or when waiting just a few minutes at a doctor's appointment, they may complain they have been waiting for hours. These behaviors indicate misperception of reality and may be amenable to treatment. Firstly, caregivers need to expect this type of reaction and identify what type of response works. This behavior indicates anxiety so you can speak to that by asking him if he is worried about being out and then reassure him. Sometimes reality orientation works (i.e. telling your husband that it has just been 15 minutes) but you will be asked again. Sometimes, writing what time you went out on a card he is carrying (we left at 11am) might help if he can then compare to his watch time. If reassurance and distraction are ineffective, your flexibility when his anxiety escalates is crucial; thus, you need to be ready to leave the restaurant, the theater or a friend's home. Other caregiver adaptations include scheduling appointments and events at times when the patient is less anxious. Of course, you could consult with your physician for an anti-anxiety drug (or a low dose of an anti-psychotic) that might take the edge off of the agitation. The goal is to identify what works best to ease his discomfort and enable you to maintain a daily schedule of activity with him.
I would suggest asking the person what it feels like when they have a time misperception--for example if they say "we've been waiting for hours" validate that it feels like hours to them, and say that sometimes it does feel that way when you're anxious, and doesn't 15 minutes go by so slowly sometimes....etc. It is a way of saving face for some patients, and re-orients them. A nurse asked my 90 year old father when his wife died, and he said "last week." It has been 9 months. When I asked him about it, and re-oriented him with the actual dates, he said "well I guess it will always feel like last week."
Loss of time sense is a classic symptom of Alzheimer's disease. It is apparent quite early in the disease when people begin to ask repetetive questions about something in the future such as a family visit, wedding, or appointment. If someone answers the question giving a date or time -- or even showing the patient a clock or calendar it makes the situatiuon worse as the patient has no idea of when the date is. Time is a complex abstract idea and the patient loses it early.
My husband's uncle would call us hourly starting at 2 am to ask: "SO! What time is it at your house?" Other family would direct him to read the clock on his stove, but the poor guy couldn't read it so he would say the clock had stopped.
Another indication is the fear of missing appointments where the patient repeatedly contacts the doctor's staff confirming the time, and shows up several hours early for the appointment, nerveous about missing it.
The patient is aware of the loss and is often quite frightened by it. As the disease progresses the patient lives only for the moment. There is no yesterday or tomorrow; there is just this moment.
Some ways to cope:
Avoid announcing things in advance. You may be excited abiut a wedding in two months, or a doctor's appointment next week, but it can produce real anxiety in the patient.
If the patient asks a question about the time of an upcoming event always ask "Why are you asking?" instead of giving the patient the time. Many times patients will express a concern about being there at the right date and time. Simply saying "I will make sure you get there." is often enough to ease anxiety.
With the husband who wants out of the car, I would A. Tell him you are simply going for a ride. If it ends iup at the doctor's or mall, sobeit. B. Bring things for distraction such as a favorite CD, magazine or catalogue, or something to keep his hands busy. I know it sounds corny but Sing Along with Mitch CDs can be a lifesaver. C. Consider if he knows he is going to the Mall, that he is indirectly telling you he can't tolerate the stiumlus at the mall so either plan for a very brief visit at quiet times, such as 10 am on Monday or Tuesday, or avoid taking him to places that produce agitation.
D. You might consider that it is a good time for Adult Day Programming or respite care so you can go to the mall alone and actually get something done. I am sure your tension works to increase his tension. E. Finally with all due respect to my colleague, I would not try reorientation especially using a clock or calendar as it only serves to point out the deficit to the patient increasing anxiety. Instead, validate. Acknowledge his discomfort and apologize that the trip is so long. Reassure with statements like "We'll be there soon."
You are at a point in his illness when his reticence and confusion indicate two things: fear/panic and fatigue. So if you need to take him somewhere, let him think you are taking a ride and just happen to stop at the MD office. Plan outings to be brief.
Hope this helps a little
Geri R Hall, PhD, ARNP, GCNS, FAAN Banner Alzheimer's Institute