This post was co-authored by Nettie Harper and John Zeisel
You go to the nursing home to visit your mother, who has been living with Alzheimer's for over a decade. She is in the lounge watching TV. She sees you. "Hi Joan, so nice to see you. How are you? How is Mother?" But Joan is her sister and you are her daughter. She doesn't seem to remember that her mother, your grandmother, died long ago. What a terribly painful moment for you -- to be forgotten by your own mother!
What can you do? You could say, "No, Mom, I'm not Joan. I'm not your sister; I'm your daughter. Don't you remember Grandma died many years ago." That sort of jolt of reality might bring some people back from their fantasy. But usually it is just upsetting and doesn't work for longer than a minute or two if it works at all.
What should you say or do? There are no guarantees, but here are some suggestions.
Your Mom is lost in time -- at least at that moment. Her reality is different from yours, but she still needs your affection. A hug and "Hi, it's nice to see you too" would be a good beginning.
But now what?
Your mother does not need to be reminded that her mother is dead. That you want her to know the truth, that you want her not to be lost in time, is absolutely understandable. But having her know the truth is probably more about your wish for your mother to be your mother than about achieving something that is important to her in her current mental state.
There is no harm done accepting the fact that your mother is talking to you as if you and she were sisters. You might say some positive things about your grandmother to get your mother talking about her mother. As she talks, she may remember on her own that her Mom is not alive, which is better than having the knowledge forced on her. She may relive some of the grief, but you can comfort her and help her to move on.
In general, it's important to try to understand that when your mother asks for her mother she is probably expressing a need of some sort. Maybe she's lonely, maybe she's frightened, maybe she's bored, maybe she's angry at someone, maybe she has a tooth ache or needs to go to the bathroom. These are all things she might have turned to her mother about when she was a child and even later.
The key is figuring out what need your mother is experiencing that made her ask for her mother. Sometimes a simple question such as "What were you thinking about Mom?" can provide you with clues. You probably won't get a clear statement such as, "I need her to take me to the dentist because my tooth hurts," or "I want her to take me to the store", or "I need her to help me pick out a dress for my daughter's wedding". But she may say things that enable you to figure out that that is what she means. And you may or may not be able to address her felt need.
Of course the answer could be, "I miss her." There's nothing you can do about that except say, "I do too". But it may be that your mother is lonely. What can you do about that?
In addition to trying to arrange more company for your mother, keeping pictures of people who have been important to her, including her mother, can be very helpful. A felt presence often reduces the pain of an actual absence, whether a person has dementia or not. Pictures and mementos help avoid fear. Familiar things around people with major memory loss creates a sense of stability in an otherwise confusing world.
Another approach is to create a "memory book". Essentially this is a notebook or album in which there are pictures from the past with simple captions, such as "You and Daddy on your wedding day". You can also include important information about the present. Perhaps your child -- her grandchild -- just graduated from college. A picture and a note can substitute for a memory in your mother's mind. In essence, memory books store memories that no longer stick in the mind in an external place to which she can turn repeatedly.
Also, keep in mind that you don't need to talk about your grandmother just because your mother mentioned her. You can also say something like, "Mom's not here now. Let's take a walk."
That simple? It may or may not be. But even if it is, your own emotional reaction is probably really tough. It's hard to feel forgotten by someone you love.
Nettie Harper is Regional Director of Operations and John Zeisel is the President of Hearthstone Alzheimer Care. He is also the author of I'm Still Here, a book about caring for people with Alzheimer's.
Follow Michael Friedman, L.M.S.W. on Twitter: www.twitter.com/mbfriedman395