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When a person with dementia insists there’s a stranger in the room

Columnist Carol Bradley Bursack explains what can be done when a person with dementia is afraid that strangers are in their home.

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Dear Carol: Lately, my mom who lives with Alzheimer’s has become terrified of going into my bedroom. She has her own room, but I have a larger closet, so I like to take her to mine to get her dressed. This is puzzling, but I can work with it. A bigger problem is that she also backs away from the bathroom. I use a commode for her in her room along with incontinence pull-ups, but we need the bathroom for showers. I warm up the bathroom and put her in a cozy robe, but when we step through the door she freezes up, saying there’s a stranger in there. I work from home and my time’s limited, so I’m using you as a shortcut. Thoughts? - AM

Dear AM: This is tough, I know, and due to her dementia, there are several possible reasons for her fear. A common reason is mirrors. Why? Likely, your mom’s dementia has progressed to the point where she doesn’t recognize herself as she currently looks. She may recognize herself in a picture taken as a child or even a young adult, but her older face doesn’t register due to her inability to create new memories. Additionally, she’s probably lost her ability to differentiate between a reflected image and a physical person. Now, it’s possible that you knew that, and you are covering the obvious mirrors. However, you may not have thought about a hand mirror on the vanity or any other reflective surface — even stainless steel.

For coverings, there are varying ways to do this including using adhesive vinyl. However, since you’ll want access to the mirror and potentially a medicine cabinet behind it, a curtain rod with curtains seems like a good option. Use curtains that are a cheery color or print since the disease changes vision as well as perception and a dark curtain could look like a hole to her. If you want to continue dressing your mom in your room, you’ll want to cover those mirrors, as well.

The rest of the house may be fine since there are more distractions and she’s not there for such personal reasons. That said, stay tuned in to her responses because any reflective surface such as a toaster could upset her. Even pictures with glass over them. Also, close blinds and curtains early in the evening and any time outside conditions dictate having lights on indoors. That can eliminate image reflection that might contribute to sundowning, a frustrating but common type of late-day confusion, anxiety, and sometimes aggression.

You sound like a dedicated caregiver who is savvy about her mom’s needs. Just the fact that you knew how helpful a commode next to your mom’s bed shows that you’re better informed than you may think.

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For more information about the effect of mirrors, I recommend the Alzheimer’s Association (alz.org) and the Alzheimer’s Foundation (alzfdn.org) . Of course, I’m happy to answer your questions as best I can, as well. Best wishes to you and your mom.

Carol Bradley Bursack is a veteran family caregiver and a nationally-recognized presence in caregiver support. She's the author of “Minding Our Elders: Caregivers Share Their Personal Stories,” a longtime newspaper columnist and host of her blog at mindingoureldersblog.com. Carol's an introverted book nerd, so you won't see her mugging in viral videos, but you can easily reach her using the contact form at mindingourelders.com.
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