The Whitworths of Arizona, bringing science to you in everyday language.

Friday, April 28, 2017

Dealing with Shadowing

One of the behaviors that can be very difficult for a care partner to deal with is shadowing, that is, constantly following, often very closely, and getting very anxious if the care partner goes into a different room, outside, or shuts the door to use the bathroom.

Charlie follows me everywhere. I can't even go to the bathroom by myself anymore. I hate it--it actually makes me feel claustrophobic. I tell him to stop, but he just ignores me. Marion

To deal with shadowing effectively, Marion needs to recognize the cause and address it. Like most BPSD, shadowing is driven by negative emotions: anxiety and fear. Charlie is not trying to irritate or control her. Address the fear, not the behavior! All of the suggestions in last week's blog on defusing negative emotions are applicable.

As Charlie's memory and perceptions become faulty, Marion becomes the one safe and known aspect in Charlie's life...his life raft in a sea of uncertainty. Anything she can do to maintain structure and stability will help. Last week's blog names several of these, such as establishing rituals and routines. In addition a care partner can:

Develop some alternative means of orientation such as identifying notes on furniture and doors.

Install white board for daily updates and messages so that the PlwD will be used to using these when calendars and clocks become useless. Using this can help to maintain orientation: "Today is Wednesday, June 1" or "I'll be at golf until 2pm."

Use distractions such as a favorite snack, a meaningful activity or looking at family photos. When the PlwD is past doing these, she can offer him a squeeze ball or a brightly colored scarf to hold, with a "Please hold this for me, honey."

Play recordings of the PlwD's favorite music or of the care partner speaking reassuring words.

Ramp up verbal reassurance and physical touching. Do this all day long, not just when the PlwD is hovering.

Try using an egg timer for short absences. Set the timer in front of the PlwD, and give them something to hold, like a book or a napkin. Say, "I'm going to the bathroom and I'll be back when the bell rings. Your job is to watch the clock." Don't say anything more--that is confusing! Set the timer and go. Make sure to maintain trust by being back on time! Then, reinforce: "See, I'm here even before I said I'd be back!"
If you still leave the PlwD alone, program a simple cell phone with your number on an easy dial button and give it to them before you leave. This will help the PlwD feel less isolated and deserted. (Even so, expect lots of calls...)

Marion also needs to take care of herself so that she doesn't radiate negative emotions that Charlie will mirror with increased shadowing. As care partner you need to:

Watch your attitude, and work to avoid your own negative feelings. "It's the disease, not my loved one" is a good mantra. So is "It's a symptom, not an intentional irritant."

Give yourself a time out if you begin to feel irritable, even if it is just turning your back or closing your eyes. Take a deep breath, repeat your mantra to yourself and then come back and give the PlwD a hug.

Build free time into your schedule, using the friends/family/daycare routines, the timer, white board and phone. Maintain routine and rituals religiously--for your sake, as well as the PlwD's!

Use some of that free time to attend a support group, and use it to vent and ask for help.

* Acronyms:
LBD: Lewy body dementia
PlwD: person living with dementia
PlwLBD: person living with LBD
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

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