One of the most frequently asked questions about Alzheimer’s disease is some form of “Why does my loved one beg to go home?” Sometimes the person is in his/her own home when the distressing emotion becomes overwhelming.

In our decade-long experience with our mother the most heart wrenching episodes revolved around her compulsive, distressing need to go home. She would give off signals around mid-afternoon. She would suddenly awaken from a nap, or toss aside her lap blanket, or stand up and announce she needed to go home. She would already be in her home where she had lived more than sixty years. The environment was branded with her furniture, pictures of the family, things she had made, and flowers from the garden she had tended. No amount of telling her she was at home was convincing enough to calm her. She paced, begged, cried, and accused us of not loving her. The experience was awash with sorrow for all of us.

These types of episodes are common with Alzheimer’s patients. But what causes them, and how can they be avoided? Most of the answers are conjecture, and avoiding the painful experiences comes through trial and error efforts, if at all. 

We have speculated about mother’s case.  When she was active and managing her household, mid afternoon was a transition time to her late afternoon and evening activities: children coming from school, husband retuning from work, dinner time, etc. Did an alarm sound to drive her toward an expected result? A result lost in time and place.  Her sense of “going home” could have related to her urgency to do the things she ordinarily did during these hours. On a more dynamic level, was she searching for both a time and place where she felt safe, connected to familiar surroundings, and defined by a role she understood? She longed for home, for her safe place. The signal alerted her, but the connections to purpose and meaning were disabled. 

I am reminded of a remarkable essay I read in Time magazine titled “Time Travel in the Brain.”  The authors, Daniel Gilbert and Randy Buckner, contend that we are constantly traveling in time, revisiting the past or constructing the future whenever we wish. The authors suggest that Alzheimer’s disease savagely attacks the brain networks that had made possible the “time travel” with no chronological boundaries. Sadly, the experiences of persons with Alzheimer’s are stalled in the moment, a state the authors call an “endless now.” Life is reduced at both ends – past and future. The alarm goes off, urging a response, but no memories can be accessed to define appropriate actions. The moment fades only to be replaced by another dead spot in time. 

What can be done to break the cycle of repetitive, sorrowful Sundowner events? No sure suggestion is viable.  Experimental efforts are usually necessary.  Of course, interventions are based on the level of anxiety the loved one is experiencing and the attendant behaviors. 

While most caregivers aren’t qualified or don’t have the time to “psychoanalyze” every behavior, they usually know the values, habits, past commitments, fears, and skills of their loved ones.  Thinking about these alongside presenting behaviors may suggest a helpful intervention. 

·         Reassure the person of your love and presence. 

·         Go with him/her on a short walk. 

·         Take the loved one for a ride in the car. 

·         Anticipate the behavior before it happens and engage him/her in a simple activity that may be associated with the time the syndrome usually occurs; e.g., setting the table for dinner, watering flowers, sweeping the patio, etc. 

·         Keep noise and multiple stimuli at a low level. 

·         Remove coats, keys, or any object that might suggest “It’s time to go home.” 

·         Walk through the home with the loved one and point out familiar pictures and cherished possessions. (Rational persuasion usually is not helpful). Place your hand on his/her hand and move it to touch a treasured object. 

·         If he/she is worried about a person (e.g., my daddy, my husband, my sister, etc.), make a “pretend” telephone call to make sure the person is okay and to assure him/her the loved one is well. 

·         If the behavior is mainly pacing, make the environment safe enough for him/her to do so within safe boundaries. 

·         If the loved one tends to wander away from a safety zone, measures must be taken to prevent this; e.g., alarms or locks on the exits. MedicAlert and the Alzheimer’s Association have joined resources to offer a program called MedicAlert+Alzheimer’s Safe Return. This is a 24-hour emergency response service for wandering and/or medical emergencies. Go to WWW.alz.org for details. 

Home is where the heart is.  Finding it is never easy.