Routine and Having a Familiar Environment
Routine and familiar environment is a huge part of many people’s lives; you can set your watch by their daily habits and activities. For people with Alzheimer’s dementia, keeping routine and being in a familiar environment is crucial to their health and well being.
Unlike people who can make split decisions or consider other options or venture off to places they’ve never been to. People who suffer from Alzheimer’s disease have a difficult time considering options to make a decisions, and they feel out of sorts and lost in places they can’t recognize. Their critical thinking abilities are lessened as the disease affects their brain and brain processes more and more.
Since Alzheimer’s dementia is a disease that impairs memory and judgement, those who are affected fall back on prior learned knowledge and memories to live their everyday lives. Even their established memories and knowledge slowly wither away as this disease slowly degenerates their brain processes. An established routine and familiar environment is extremely important to a person with dementia’s comfort level.
A Connection Between Their Behaviour and an Unfamiliar Environment
Have you experienced outbursts from a loved one who has dementia? Perhaps when you’ve taken them out to a store or after moving the person into a care home? Has your loved one with the disease tried to leave a doctor’s office, or restaurant and asked to “go home”? Have they ever been upset or refused to eat, when you’ve prepared their lunch a few minutes late? You might not have thought that there was any connection between their behaviour and an unusual environment or a broken routine. But you need to know now that it may have had everything to do with triggering it.
It’s very simple if you can think about it from the person with dementia’s point of view. You are hungry at 12 noon, and every day at 12 noon you get lunch. Today, lunch has come at 12:15pm. A person with sound judgement can process the understanding that there has been a delay in the lunch making process. They may think of asking questions to find out what the delay was, and they understand that the delay is not a great issue to get worked up for. A person whose judgement is degenerated will not be able to synthesize that there is a reason behind the delay.
The same goes with putting someone with Alzheimer’s dementia in unfamiliar surroundings, and this has to happen at some point in time. When your loved one is diagnosed with dementia and needs to be put into a care home. When they need to be taken to hospital for testing, or when they miss their favourite show. This routine can be traumatic for them to break even once and they may not be favourable to the change in environment.
Easing to Changing Routines as a Helpful Transition
Someone with sound judgement will understand the reason why going to the new place is necessary, will accept going to a new place, and may even like to go to the new place. For a person with Alzheimer’s dementia, whose judgment is impaired, going to a new place where they have no established memories is uncomfortable. They will feel out of place, may not be able to recognize familiar faces, and may not know what to do and how to behave. The person with dementia can easily become scared, upset and irritable, which can lead to many behavioural outbursts that have to be managed.
Sometimes it is necessary to change a routine, perhaps based on a changed caregiver’s work routine, or to take someone with dementia into unfamiliar surroundings, such as a doctor’s office. As a family caregiver, if you find this very difficult to do, you may need a professional’s help. Please feel free to call me at 778-789-1496 so I can help you ease your loved one into a new routine or offer helpful suggestions on transitioning into to a new and unfamiliar place.
Karen 🙂
Karen Tyrell, CDP, CPCA, CDCP
Personalized Dementia Solutions Inc.
www.DementiaSolutions.ca
12 Responses
Hi, Karen,
I am a caregiver with a woman who at this point still lives in her home of 20 years. Her husband is her constant companion and manages her care 24/7. The woman is considered to be in late-stage Alzheimer’s. She is unable to retain a line of thought when verbally expressing something. I’m unclear what her level of language comprehension is; her husband believes that she comprehends everything he says to her – I don’t believe that’s the case.
Is her living in her present home a benefit to her? If she and her husband move to another state to an area where they have traveled and spent time – and that she remembers, her husband says – will she be negatively affected? I think it would be better if she remained in her home where she and her husband have lived for 20 years, where she has familiar things around her in her home and in her neighboring environment as well.
Would it matter so much to her if they moved to this other state – from Illinois to Florida – other than experiencing a period of confusion and frustration at the lack of the familiar?
Please write back and respond to my questions from your experience of and knowledge base about people with Alzheimer’s as to how they “adapt” to major change situations?
Thank you,
Joan
Hi Joan,
I just noticed your message today in the back end of my website. I am so sorry for this late response.
I am curious to know the outcome of this situation.
In my opinion, it is always ideal to keep someone in their familiar environment for as long as possible.
I don’t know your client so I will not be able to judge what is best for her as everyone is different.
When a person is in late stages – their world becomes much smaller. When the person with dementia can no longer understand their small world, moving them to another comfortable room/home in another State may not make a difference for them. The trip to the other State may be the most unpleasant for them, but when they are in their new place/surrounding, they will likely adjust as long as they feel safe and cared for.
Just curious, can your client walk on her own or is she bed ridden? Does she seem to have some awareness of her surroundings such as can she find her own way to the bathroom? These things will matter and will provide guidance for knowing if she is thriving in a familiar environment.
Hope this helps for now. Again, I am so sad I did not see this comment when it arrived. Hope you will stay in touch!
Warm regards,
Karen 🙂
Can bringing my mom back to her house she spent 60 years help her?
Hi Kenneth, Thanks for you reaching out. Normally I prefer to ask more questions to offer you a better answer as part of my Dementia Consulting…however, I have time for a quick response to you. From the example you shared, I think the move will be disruptive for a few weeks but she will certainly settle in to her new home where family can be close by to visit and to help advocate for her. Should you feel that you would like to arrange a phone or Zoom consultation with me to offer you better personalized solutions and recommendations for your situation, please don’t hesitate to reach out to us and we can arrange this meeting. All the best!
My husband has moderate stage dementia. He is on medication but it seems to be less effective after 5 or 6 years. I find I want to live closer to my daughter about an hour away and want to move. Will this move be detrimental to him or should I just go it alone until such time I can’t take care of him.
Hi Gloria. My name is Maria and I am Karen’s Assistant.
Thank you for sharing about your husband and for your question. We’ve sent you a couple of emails which we hope you have received.
Karen would like to talk with you more in regards what you’ve shared. Would you mind checking to see if you’ve received our emails? If not, please feel free to either send us an email at Info@DementiaSolutions.ca or call us toll-free at 1.888.502.1321.
Thank you again, Gloria for reaching out. Keep well and we look forward to hearing from you.
Just wondering if anyone had a dementia patient that was out of her environment of her normal routine . But she is in unfamiliar area and she became very calm non verbal almost instead of irrational or upset .
Any thought on that behavior
Hi Adele! Thank you for this question! We always appreciate it when people share or asks questions. It gives all of us an opportunity to learn more about dementia and dementia-related behaviours and how we can better support those living with dementia.
In regards to this question, would you be able to provide a little bit more background on your client?
From what you’ve shared so far, if she seems calmer in an unfamiliar environment, “out of her normal routine,” sounds like a good thing. Do you think it may be possible, that she probably enjoyed the break from her “routine?”
I worked in a group home a few years ago, and our residents, though they appreciate and feel secured in their routine; also, seemed to become more relaxed and happier after we’ve taken them out for an excursion outside of the places they are familiar with. I wonder if maybe that’s why. 🙂 Just sharing from personal experience.
Hello again, Adele! Please see Karen’s comments in regards to your question.
From Karen Tyrell:
“What comes to mind first is possible delirium.
Delirium can bring on apathy and quietness. Most people thing delirium can bring on the opposite. It can do both. (Delirium is treatable. Just need to figure out what is causing delirium. (ex. Pain; dehydration; infection; etc.)
I don’t know the person or the routine or the environment, but my second thought is maybe the new environment is much better for this person. (ex. More quiet; less clutter; more calm; warmer; cooler; comfortable; happy; smells are better; lighting better; etc.)
I suggest trying to be a detective to figure out the reason for the changes in her behaviour. Keep us posted. 🙂 – Karen”
I’m not so sure I can fully agree with this, because in my experiences someone with dementia especially in the latter stages is not familiar with their environment no matter what, and honestly wouldn’t know if lunch was at noon or 2 pm. This argument is a little head scratching to me. My mom doesn’t recognize her environment or the people around her even tho she’s been in the same place for two years. And I bet if I took her to her home of 60 years she’d be lost.
Hello and thank you for taking the time to read our post and most importantly, for sharing your experience taking care of your Mom. We welcome everyone’s insights and experiences as they are all helpful to our followers and visitors to our blog. 🙂
My name is Maria and I am part of the team here at Personalized Dementia Solutions Inc. Karen has read your comment and she would like to share her thoughts below.
From Karen Tyrell:
Hello and thank you for your comment.
We appreciate your comment because this puts front and centre the importance of a “personalized,” “person-centric” or “person-centred” approach to caring for someone with dementia. What may work for one client who seemingly has the same symptoms and/or is at the same stage and/or type of dementia, may not work for another.
I agree with you that certainly someone who has more advanced dementia will react very differently than someone with moderate or even moderate-advanced dementia in regards to their environment and routine. Also, every person’s progression will be different and it also depends on other factors including the type of dementia the person is affected by.
Sadly, from your description about your mom, it sounds like she has moved on to a more advanced stage of her dementia. This may be the reason she has minimal awareness of her surroundings, and like you shared, unaware of the time of the day (i.e., “wouldn’t know if it was lunch at noon or at 2pm”). Therefore, it makes sense to me how you would have difficulty relating to the information shared in the blog above.
The article was mainly for those caring for someone who has exhibited changes in their mood and behaviour which, in this case, we’ve discovered, was a result from changes in their routine or environment. With this particular client, providing and following a routine gave her a sense of “safety and security” brought about by the regularity of her schedule and daily activities.
I have witnessed many people who have lived in a moderate-advanced stage of dementia for several years and who still have high awareness and have expressed much difficulty with changes in their routines and with their environment. Everyone will be different. Therefore, caregivers who are caring for someone like this, would benefit from knowing the information shared above so that they can provide the best person-centred care.
Thank you again and sending our warm wishes to you and your mom as you continue on this journey. – Karen 🙂