Taureef Mohammed
EVERY MORNING, with assistance from her husband, the elderly woman with advanced dementia got dressed – casual business attire – and set out for the office. It was her morning routine. Her husband, a healthy, robust man in his 80s, joined her on her morning commute. The commute was a simple one: a 30- to 40-minute walk around the block, then back home. There was no office. The woman had retired from her bank job decades ago.
“I don’t stop her. I just go with it and we use the walk as exercise. Eventually we always make it back home,” the husband said, nonchalantly, as though this was a totally normal thing to do. A good start to the day, I thought, and, for a person with dementia and her caregiver, a small victory.
On another home visit, I met a father and daughter. The father, who had advanced dementia, lived alone. The daughter, the main caregiver, lived nearby and checked in on her father at regular intervals.
On most mornings, she stopped by on her way to work to prepare a simple breakfast and a cup of coffee, and to give medications. In the nights, she called to ask about his day. His answer was always the same, but she asked anyway. A personal support worker, provided by the government-funded home care agency, checked in as well, although not as regularly as the daughter.
While her father rested in his bedroom, we sat in the dining room and chatted. She started on a positive note, saying her father had recently celebrated his birthday. She got up and pulled a framed document off the wall. It was a list of names, her father’s name one of them. She explained that it was a ship passenger list from the mid 1900s, pointing out the name of the ship and the port of departure and of arrival.
Her father, she said, had recently started to talk more about the past, about Europe, his siblings and parents. He thought his parents were still alive and constantly asked to visit them, she added. Triggered by his living in the past, she had decided to do some research into her ancestry and had purchased the list online. She had framed it and had given it to him on his birthday. And then she’d hung it on the wall.
Did he appreciate the significance of the gift? I don’t know. Did he understand that he had just completed another lap around the sun? Maybe. Was he capable of having meaningful interactions, despite being trapped in the past by an unrelenting disease? Absolutely. And that was the small victory here: finding meaning. And for me, the doctor, looking at the father-daughter relationship from a distance, the irony of a daughter learning about her ancestry through a parent with dementia made the home visit a memorable one.
Living in the past is a phenomenon seen in patients with dementia. It is a frequently reported problem by caregivers and families. Living in the past is usually a sign of moderate to advanced disease and is common in Alzheimer’s dementia. In Alzheimer’s, the short-term memory circuit of the brain is broken first. Nature abhors a vacuum, so long-term memories – parents,
