The Emotional Toll of Alzheimer's

When Alzheimer's patients build new bonds in a nursing home, it can have a serious impact on a family.

From the WebMD Archives

The Oscar-nominated movie Away from Her portrays a long-married couple struggling with Alzheimer's disease and the emotional toll it causes when the wife, played by actress Julie Christie, gives her affection to another man whom she meets in a nursing home.

This heart-wrenching and emotional dramatization of Alzheimer's brings home the difficulties families face when a person's ability to recognize and maintain relationships gradually declines -- especially when the relationship is between a husband and wife.

This scenario becomes even more complicated when a person with Alzheimer's is placed in a nursing home, and amidst the confusion and loss of memory, finds new companionship with someone other than his her or spouse.

"One of the challenges of Alzheimer's is that it will cause a person to lose the ability to recognize their loved ones, including their spouse," says Peter Reed, MD, senior director of programs for the Alzheimer Association. "Once that recognition is gone, it can be very difficult for both the patient and the family."

Experts offer WebMD insight into the minds of Alzheimer's patients who build new bonds in a nursing-home setting with a person of the opposite sex, what those connections can mean, how Alzheimer's affects families, including spouses and children, and how they can cope with a disease that takes their loved ones away from them.

Alzheimer's and New Bonds in a Nursing Home

More than 5 million Americans have Alzheimer's disease, according to the Alzheimer's Association. It's a condition that causes problems with memory, thinking, and behavior. Alzheimer's ultimately affects a person's ability to work, engage in normal everyday activities, and maintain relationships.

So how can it happen, that two people with Alzheimer's connect at an emotional level?

Richard Powers, MD, chairman of the medical advisory board of the Alzheimer's Foundation, says that while it's doesn't happen all the time, "it's common enough that we need to be able to deal with it in a thoughtful and compassionate way."

Powers describes it as waking up in a strange location, where you don't know anyone, and you can't understand your surroundings, and maybe, even the language the people around you are speaking. If you meet someone else who speaks the same language, someone who seems to be as lost as you are, wouldn't you form a bond with this person, as two strangers in a foreign land?

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"Alzheimer's patients, even in the nursing-home setting, based on my observation of their behavior, continue to search for companionship and friendship," says Powers, associate professor or pathology and neurology at the University of Alabama.

But is it just companionship and friendship they're looking for, or could it be love?

Powers explains that when two healthy people fall in love, they know who they are, and who the other person is; each individual is able to access all the chronological information in their lives and make a decision about whether he or she is emotionally devoted to the other person.

That may not be the case for people with Alzheimer's, and drawing a distinction between their ability to form a bond and their ability to "fall in love" is important.

"You have to be careful about saying 'falling in love' when you're talking about people with advanced stages of Alzheimer's whose disease requires them to have nursing-home care," says Powers. "Falling in love requires memory, communication, reason, decision making -- and Alzheimer's patients no longer have many of these capabilities."

While two people with Alzheimer's disease in a nursing home may form a new bond, and express it by holding hands and sitting together on a couch, whether or not it's love as society knows it is arguable. Still, Powers explains that the connection probably makes each person feel more comfortable and secure in his or her strange surroundings.

But importantly, what impact does the connection have if one of the patients is married?

How Alzheimer's Affects Families

"When a person with Alzheimer's is placed in a nursing home, the separation anxiety is real for his or her spouse," says Reed.

To compound the matter, when the Alzheimer's patient's ability to recognize his spouse dwindles, and he makes a new connection with someone at the nursing home to fill the void, it can make the anxiety almost unbearable.

"A spouse is going to feel abandoned and replaced," says Donna Schempp, LCSW, program director of the Family Caregiver Alliance. "I think that some of the grief they are feeling will now have a face. You've already lost that person because of the cognitive impairment, but now you've truly lost them because they don't know who you are and they are giving their affection to someone else."

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Still, there's a silver lining, and that is in knowing that your loved one has found some comfort, even if it's with another person.

"As a spouse, you have to remember that it's not that your husband or wife is rejecting you, or that they don't care about you anymore, but they lack the ability to recognize these memories or their feelings," says Powers. "It's the disease; it's not personal."

For the children of Alzheimer's patients, struggling to come to grips with not only their parent's disease, but also their parent's new companion in the nursing home, can be just as devastating.

"Sometimes adult children can have a harder time with it than the spouse," says Schempp. "It's difficult to deal with feeling like your mom or dad has been replaced."

As a spouse or a child, it's important to come to grips with the disease and how it affects a person's brain and body.

"Alzheimer's patients need social connections and bonds just like everyone else," says Reed. "They can still form new connections, but the behavioral and emotional changes they are experiencing mean they respond and react to their new -- and old -- connections in different ways."

Coping With the Emotional Toll of Alzheimer's

Coping with the loss of a loved one's presence -- both physical and mental -- when she's placed in a nursing home is hard. Even more difficult is dealing with a new companion she may have found. Experts offer tips for dealing with Alzheimer's disease, a loved one's newfound bond in a nursing home, and its impact on your family's life:

Remember, it's a disease. "Deal with it as part of a disease process -- it's not a conscious decision to abandon you," says Powers. "It's important to think about the person not being able to make choices at that level."

See the silver lining. "Think about how your spouse is finding comfort in their new companion, and even if it doesn't make you feel good, remember that it is probably a nice feeling for them," says Schempp.

Find support. "The Alzheimer's Association encourages people to reach out for help," says Reed. "We offer community support programs and online resources for families who have been affected by Alzheimer's disease."

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Understand it can happen anywhere. "Whether the person with Alzheimer's is at home or at a facility, their ability to get attached to someone new other than their spouse is still there," says Schempp. "It's not exclusive to the nursing home; it's random depending on how their brains are working."

It's not just wives and husbands, either. "Very often, a person with Alzheimer's doesn't know who their child is anymore and replaces them with a home aide or a friend," says Schempp. "In their brain, by creating an identity with this new person, they are reconfiguring the family dynamic that was comfortable or nurturing to them."

See the world through their eyes. "Every day they struggle with verbal communication, memory loss, and confusion," says Powers. "When you start to have these familiar faces around you in a nursing home, of course you are going to find friends. It makes sense. It doesn't mean they are replacing their spouse or the family they've loved their whole loves, they're just adjusting any way they can."

WebMD Feature Reviewed by Louise Chang, MD on February 14, 2008

Sources

SOURCES:

Peter Reed, MD, senior director of programs, Alzheimer Association, New York City.

Donna Schempp, LCSW, program director, Family Caregiver Alliance, San Francisco.

Richard Powers, chairman of medical advisory board, Alzheimer's Foundation; associate professor, pathology and neurology, University of Alabama, Birmingham.

CDC.

Alzheimer's Association.

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