Rummaging and hoarding are common behaviors associated with Alzheimer’s disease. Although these actions may seem random and meaningless to the frustrated caregiver, rummaging actually serves a purpose in the middle stages of dementia.
Rummaging behaviors usually begin in the early stages of dementia, where a person with memory loss may misplace an object and turn the house upside-down in search of it. Coupled with a touch of paranoia and suspicion, it can be very difficult to convince the early stage person that rummaging is unnecessary. It’s sometimes simply not enough to find the object, discovering and accounting for personal possessions are a strong motivation for rummaging. Discouraging it may lead to agitation, increased paranoia and more rummaging.
In the middle stages, rummaging is largely a coping mechanism for language deficits and the need to be repetitive. Once speech and comprehension skills decline, a person in the middle stages has to find another way to interact with the environment. Using hands to explore the world is simply a function of survival — if the person can’t tell you that they are hungry, then they will just start searching for food themselves. Repetitive actions, such as pacing and saying the same word or phrase over and over again, is usually a behavior used by the person to relieve anxiety and search for reassurance. Attempting to limit or restrict these activities can lead to an increase in agitation and fuel the need to continue to do it.
The manipulation of objects is actually a valuable skill in light of the issues that arise in the later stages of Alzheimer’s. The ability to effectively use the hands for purposeful actions, both with and without objects, is a problematic challenge in late to end stage Alzheimer’s. Once the person loses the ability to release objects, the onset of the “death grip” becomes apparent. This is seen when the person cannot let go of the walker or grab bar, or set down a utensil while eating. Once the hand begins to posture in a fisted position, because opening the hand is too difficult, contractures and skin issues begin to emerge.
For this reason, grasping and releasing objects is a good thing. Demonstrating the appropriate grasp on objects is a better thing. Maybe a person cannot tell you that the object he’s holding is a comb because language skills are gone. But if they are holding the comb like a comb and can briefly demonstrate that they know how to use it — they still have the ability to recognize objects. Providing the opportunity to hold and manipulate various objects is a great way to preserve this skill, and has the two-fold benefit of alleviating agitation and repetitive behaviors as well.
In managing the challenges of rummaging behaviors, it is best to control the environment versus controlling the behavior. Provide a safe place to rummage — a box or a drawer — that is filled with both personal meaningful objects and highly familiar everyday objects. Start with observing the person as they hold an object. Do they hold it correctly? Do they hold a pencil in pencil grasp, or a flashlight in a sturdy grip with the thumb on the switch? If it is being held correctly, encourage the person to try to demonstrate the use of object and even find the name of the object. Usually you’ll see some recognition or positive indication that the name or use of object is recognized. That momentary “connection” with the person is the one thing that person has been searching for all along. Providing that “ah-ha” moment gives the gift of clarity, dignity and reassurance to a person who is otherwise unable to find those moments. Connectedness to our environment and the people in it is what we all want, and sometimes rummaging is the only way to find it.
Source: Sue McShane Paul OTR/L; Home Care Rehab and Wellness; 866-727-3422; www.homecarerehab.com