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Alzheimers changes the capacity of memory, and it can change behavior. Gentle people sometimes become angry screamers. Angry people sometimes become lambs. And many people have unpredictable appearances of behavior that can be distressing--fears, sadnesses, unsettling confusions, hallucinations. A big change in routine can be extremely unsettling and produce some of this behavior. I can't tell you the number of times patients in my dad's nursing home have begged me to get them out of there, that they have to go home, they have work to do, children to take care of, etc etc.

So first--recognize that this behavior, unsettling though it is for you, is normal. It's your SM's confusions and tangled sense of temporal reality, and has nothing to do with any real anger at you. It isn't really a confrontation--it just seems that way to you. Second--recognize that something has distressed your SM, and the most important thing for you is not to become agitated as well. You can help so much by remaining calm and doing your best to be a settling influence. You might gently pat her shoulder (if you know she would like that), and tell her not to worry, you checked the door to make sure it was locked. If she still insists on going, you might tell her sure, after she takes her afternoon nap (or whatever might be appropriate). (You know she won't remember later.) With the people in my dad's unit who become agitated about the need to get out and get home, I tell them to relax, not to worry, that I understand their worries and what they have to do, and I will go and talk with the people in charge and make sure that everything gets taken care of. They thank me, calm down, and forget that it ever happened. (I didn't always handle it so calmly. I found it upsetting when it first happened--but my dad has been there for 3-1/2 years now. I've had plenty of experience. And I've had coping with my dad's agitated hallucinations earlier during any hospitalization.)

It may be an idea to get in touch with the head nurse of her area, or the staff psychologist, or find out if there's a social worker assigned to your SM. Have a small conference and discuss her behavior and how best to handle it. They've dealt with this a great deal, and will have good advice for you. They also know what they've found to be effective when your SM gets confused and possibly hostile. How does her daughter handle such situations?

When your SM is distressed and you're in her presence, just remember that you are a counterbalance to the unfamiliar for her, and do your best to comfort her. And this is also a means for teaching your kids about Alzheimers and helping them to feel less uncomfortable with it.

THE most important thing for an Alzheimers patient--once they're no longer in their home/family environment--is regular, frequent family contact. And I see it all the time at my dad's nursing home. The patients whose loved ones are there regularly are the ones who deteriorate the most gradually, and seem the happiest. The ones who are abandoned plummet. Your SM has very early stage disease, and your contact and caring can help keep her there longer.

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