It's Not a Stage, But an Emotional Need
Contrary to a common misconception, the desire to 'go home' is not a fixed milestone in the progression of dementia. It is a behavior that can emerge at any stage of the disease, from mild cognitive impairment to advanced dementia. Experts emphasize that the request is rarely about a literal return to a physical building. Instead, it is an expression of deeper emotional needs related to feeling lost, confused, and insecure. As cognitive abilities decline, the person's world shrinks, and they feel a profound loss of control and safety. The word 'home' is a symbol for that lost sense of comfort and familiarity.
The Deeper Meaning Behind 'Going Home'
For someone with dementia, the concept of 'home' is far more complex than just a house. Their brain is processing a different reality, often rooted in a time when life felt more manageable and predictable. This phenomenon, sometimes called time-shifting, can cause them to genuinely believe they are living in an earlier period of their life, such as their childhood or early married years. The physical surroundings they are in, whether their own lifelong home or a care facility, feel foreign and disorienting. This can trigger a deep-seated anxiety and a longing to return to a place that exists only in their memory. Caregivers must respond to the emotion, not the stated request, by providing reassurance and addressing the underlying need for security.
Common Triggers for the 'Going Home' Phenomenon
- Sundowning: This refers to increased confusion and restlessness that occurs in the late afternoon or early evening. As daylight fades, shadows can create visual distortions and deepen confusion, triggering a patient's desire to leave for a place they feel is truly 'home'.
- Overstimulation: A noisy, busy, or cluttered environment can overwhelm a person with dementia, causing anxiety and a need to retreat to a safe, familiar space.
- Fatigue: As the day wears on, mental and physical energy decline. This can increase a sense of vulnerability and trigger the search for comfort.
- Unmet Needs: The request might be a proxy for other unmet needs. They could be hungry, thirsty, in pain, or need to use the restroom but cannot articulate these specific needs.
- Change in Routine: Dementia thrives on routine. Any disruption, no matter how small, can cause significant distress and a feeling of being 'out of place'.
Responding with Empathy and Validation
When a person with dementia asks to go home, the worst thing a caregiver can do is argue or provide a logical explanation. This will only increase their agitation and reinforce their belief that you are deliberately keeping them from their destination. Instead, an empathetic and reassuring approach is required. The goal is to connect with their emotional state and provide comfort, not to win an argument or correct their reality.
Here are some compassionate ways to respond:
- Acknowledge and Validate: Gently say something like, “I know you want to go home, and I understand that feeling. Tell me more about your home.” This shows you are listening and respecting their feelings.
- Redirect with a Distraction: Engage them in a pleasant activity. Try looking at old family photo albums, listening to familiar music, or offering a favorite snack or drink. The redirection shifts their focus away from the anxiety.
- Use a Therapeutic Lie (if necessary): For immediate reassurance, a simple white lie can be kind. Phrases like, “We’ll go soon, but let’s have a cup of tea first,” or “The road is blocked right now, but we’ll check again later,” can calm them without causing distress.
- Go for a Walk or Drive: If it is safe to do so, a short walk or drive can sometimes satisfy their need to 'go' somewhere. The motion can be soothing and the change of scenery can act as a distraction. The drive can end back at their residence without them realizing.
- Look for Patterns: Keep a journal of when these requests occur. Do they happen at a certain time of day (sundowning)? Are they triggered by specific people or events? Identifying patterns can help you anticipate and prevent future episodes.
The Role of 'Home' in Different Stages
| Concept of 'Home' | Typically Observed in | Underlying Emotional Need | Effective Response |
|---|---|---|---|
| Confusion about current residence | Early to Mid-Stage | Familiarity, routine, clarity | Create visual cues, maintain consistent routines. |
| Nostalgia for a childhood home | Mid- to Late-Stage | Security, deep-rooted comfort | Encourage reminiscing with old photos, music. |
| Metaphorical feeling of security | Any Stage | Emotional safety, control, peace | Provide reassurance, gentle touch, calming environment. |
| Feeling of 'time-shifting' | Mid- to Late-Stage | A simpler, more predictable life | Engage in conversations about the past, avoid correcting their reality. |
Creating a Calming and Familiar Environment
To reduce the feelings of unease that prompt the desire to 'go home,' you can modify their current environment to feel more secure and less confusing.
- Reduce Clutter and Noise: Simplify the living space to minimize overwhelming sensory input. A quiet, uncluttered room is far less confusing.
- Increase Natural Light: Good lighting helps reduce confusion and minimize sundowning effects. Keep curtains open during the day and use nightlights to guide paths after dark.
- Familiar Items: Surround them with familiar and comforting objects, such as a favorite blanket, old photographs, or cherished trinkets. This can evoke a sense of belonging.
- Establish Strong Routines: Predictable schedules for meals, bathing, and activities can provide a strong sense of structure and safety, reducing anxiety caused by uncertainty.
Conclusion: The Compassionate Approach
Understanding at what stage do dementia patients want to go home requires shifting our perspective from a literal interpretation to an empathetic one. The request is a profound communication of distress, rooted in fear, confusion, and a longing for security. By validating their feelings, distracting them with positive activities, and creating a supportive environment, caregivers can provide the emotional comfort that the patient is truly seeking. This compassionate approach is not only more effective but also preserves the dignity of the person living with dementia. To learn more about navigating these challenging behaviors, visit the Alzheimer's Society blog.
