What is time-shift?
When a person’s short term memory is affected, they are more likely to interpret things in the present, based on memories of the past. This is known as ‘time-shift’ and can result in them living in a different reality to yours. For example as Mum’s illness progressed, she believed she was of working age and would often talk and act as though she was at school. She was a teacher and the layout of care home where she lived resembled that of a school. People with advancing dementia relate to the past because these are the memories that are most vivid. The past becomes their reality.
As the disease progresses further, they are more likely to regress back to their teenage years and early adulthood, as these memories often remain most vivid until the advanced stages of dementia. This is known as the reminiscence bump (possibly due to the fact that a person’s ability to remember new information peaks in our 20s).
As Mum’s illness progressed she seemed to ‘live’ back in the time when her parents were alive and she would often ask after her Dad. Handling questions like “have you seen my Dad?” when he has been dead for 20 years is a difficult one and is one reason why ‘therapeutic lying’ is commonplace in dementia care.
Reminiscence therapy is defined by the American Psychological Association (APA) as “the use of life histories – written, oral, or both – to improve psychological well-being” and is often used with older people. Reminiscence therapy is an effective way to help positively engage with people who have ‘time-shifted’ and can help to manage some of the changes in behaviour that often occur in people living with dementia (see behavioural changes).
How does it work?
Reminiscence therapy can be done with a professional, friend or relative either in groups or on a one to one basis. It can be done with prompts, such as music, objects or photos which can be general, designed to trigger memories such as a piece of music from the 60’s or specific to the person concerned such as a photo of their wedding day.
In essence reminiscence therapy is simply acknowledging that someone has ‘time-shifted’ and is effectively living in the past. Past memories are the only ones that remain. So rather than constantly correcting them or engaging in conversations about things they know nothing about, because they occurred after the brain was damaged, you find things to talk about that they can remember, where they can contribute.
What are the benefits to the person living with dementia?
- Allows them to engage in conversation and recount happy memories.
- Improves mood.
- Increases confidence.
- Reminds them of their identity.
- Greater feeling of self-worth.
Note: Reminiscence therapy is less effective in the more advanced stages of dementia as the part of the brain which deals with longer term memories also becomes affected. I have also read that it is less effective for people living with frontotemporal dementia, possibly because memory loss isn’t the main symptom.
Mum & time-shift
I always tried to join Mum in her reality. I tried to talk about things in the past or kept the conversation very general and if she asked me where her Dad was I always lied and told her he had nipped to the shops.
Having said that I do remember one conversation where I managed to upset Mum as I didn’t acknowledge she had time-shifted.
Mum – “Sorry what’s your name again?”
Me – “Emma, I’m your eldest daughter”
Mum – “How old are you?”
Me – “45”
Mum – “Right, well how old am I?”
Me – “72”
Mum – “72, 72 that can’t be right!”
A moment silence occurred while I tried to think of a suitable reply, when Mum suddenly said with a hint of emotion “Bloody Hell, how did that happen!!”
I quickly changed the subject and avoided talking about age ever again!!!