How do I help my mother, with developing dementia, ease her geographic location anxiety?


One of the first things my (95-year old) mother lost when she started developing dementia (probably several types, maybe started as vascular) was knowledge/memory of where she was geographically - what town, what street, where the building was in relation to other buildings, how to get around in unfamiliar buildings, how to get from Place A to Place B. Last year, I moved her from New England, where she'd spent almost her whole life, to Southern California, where I live - from one memory care ALF to another. (Managing care from 2500 miles away wasn't working.) Much of the time she doesn't immediately believe that she's in SoCal, so I walk her outside and show her hibiscus flowers and palm trees. Today she couldn't get through her head that she's on the West Coast ... says she's an East Coast girl and feels out of place here. Nothing I can do about that feeling ... I'm very familiar with it, having taken years to adjust to having the ocean to the west and the landmass to the east, and somewhat to the subtle change of seasons. So I assure her she isn't nuts to feel that way. The problem is that not knowing where she is really disturbs her -- and she has enough insight to know what disturbs her. She recognizes her room, much of the time, but can't remember the name of the ALF, or the town, or what state she's in, or if California is east or west (and gets so upset that she wonders if we're still in the US). She wonders how far away I live and what route I take to drive. It's the not-knowing that drives her nuts and I think is one of the reasons she wants to "go home" - which, when I ask her, is the city she grew up in, rather than the town she lived in for 60 years. She lies on her bed and figuratively gnaws on herself trying to figure it all out. And she still is at the stage of wanting to know reality (except I don't tell her her mother died 25 years ago). I have quite a few books of strategies for dementia care, but none of them address how to help someone who gets anxious about not knowing her geographic location and relationship to the rest of the town, state, country, etc. I just gave her an outline map of the US. I have a folder labeled "Answers to Ruth's Questions" with Q and A lists in it that she and I developed together, which she does read and finds helpful; one page in it is "Where am I?" I try to distract her and get her out of her room or doing some activity ... but that doesn't help when I'm not there. Has anyone dealt with this? Any suggestions?

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My mother is on sertraline and Namenda, which together have evened out her moods relatively well. I'll think about the obsession idea ... however, there are plenty of times when she doesn't focus on trying to figure out where she is. I'd rather not raise the sertraline dose as she is still ambulatory with a walker.
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I wonder if her preoccupation with her location is akin to an obsession. I might discuss it with her doctor. My LO, who has dementia, used to have an obsession with her cat. She couldn't stop worrying about where are cat was. Even if the cat was in the same room with her, she was afraid for it's safety. She constantly worried about the cat's safety and whether it could escape from the house through a small crevice. It caused her great anxiety and she was placed on daily medication for anxiety, which helped tremendously. I'd ask her doctor about that and/or consult with a Geriatric Psychiatrist. My LO sees one and she is normally content and pleasant in mood. She doesn't worry or obsess about things anymore.

Also, at one stage, I tried to write things down for my LO to read and get information, but, at some point, there is just a disconnect and even though she could read the words, she was not able to process them and they meant nothing to her, so, I stopped writing things down for her.
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Thank you, particularly for the suggestions on how to turn the conversation. Yes, my mother asked the same sort of questions about where she was located back when she was in Massachusetts, but the questions were more easily answered then, and she wasn't so troubled about not knowing because the area actually was familiar and presumably "felt" familiar. Maybe this is a particular problem for people with an innate sense of direction.
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Many people with dementia are disoriented as to place. Wanting to "go home" even when they are in the home they've been in for 50 years is common. It is possible that in her current stage your mother would be asking these same questions even if she were still in her home in New England. The world seems to look strange to them, and they want to go where things look normal and things make sense. They want to "go home." This generally subsides on its own as they experience other changes in their brains.

My husband went through this very early in his Lewy Body Dementia. I had not yet collected my dementia books or joined a support group. In my ignorance I tried to convince him that he was home. I pointed out various pieces of furniture and told how we acquired them. I showed him the shelf of photo albums and opened one. "See, these are pictures of us. They belong to us. This is our home." He'd nod and agree with everything I said. And after the tour of familiar objects he'd say, "Yes. But I want to go home." It was a relief to discover this is common early dementia behavior and it wasn't necessary to convince him of where he was.

I think your Answers to Ruth's Questions book is brilliant -- especially that she helped you develop it! And the map outline is good. You are doing splendidly.

Possibly you could redirect the conversation by focusing on different parts of it. "Hometown is really nice, isn't it? What were your favorite things to do when you were a girl there?" "I think you got married in the Hometown church, is that right? Tell me about your wedding. Did you carry flowers?" "I understand wanting to go home. Sometimes I miss the East Coast, too. But I am so happy that you are near me and I can visit you so often. I would be very, very sad if you moved away from me." She may tell you all about her wedding and then want to go home. Sigh. This is not an easy confusion to solve.
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