Coping with rummaging, hoarding and packing expressions in dementia can be challenging to deal with for caregivers. The behaviors often occur as speech and comprehension skills decline as a way to continue to interact and communicate.
Understanding the behaviors and the motivations behind them can help caregivers develop better strategies for coping with rummaging, hoarding and packing.
“People with dementia can only focus on one thought at a time,” said Hollie Glover, director of education and family support services at the James L. West Center for Dementia Care. Glover leads free education sessions for family caregivers on coping with challenging expressions.
“That’s why we become masters of distraction,” Glover said. The top four distractions, that work with many challenging expressions, are food, music, animals and children.
Understanding rummaging, hoarding and packing
Managing these challenging behaviors can be exhausting for caregivers without strong coping strategies. Understanding the motivation behind these behaviors can help avoid triggers and prepare to manage the expressions safely and effectively.
These expressions occur when the person’s needs aren’t being met. Start with the most basic needs – food, water, sleep, restroom use. Then look at whether the person’s needs for safety and security are being met. What about their need to engage with others and have purpose? Addressing these needs with simple activities, participation in a senior day program, or helping out with simple tasks around the house can all be part of a comprehensive strategy for coping with rummaging, hoarding and packing.
As with all the stages of dementia, the behaviors and symptoms will change as time goes by.
Coping with Rummaging
Rummaging, sometimes referred to as seeking or shopping, is a coping mechanism for the person with dementia.
If the person is rummaging through drawers or cupboards, they could be hungry. The person may be looking for something but unable to articulate what that thing is. The item may be lost, or it may be something that hasn’t been around for years.
While the person may say they aren’t hungry if asked, they may accept a sandwich, cookie, drink or other favorite treat. Ask them about the lost item. What did it look like? What was it used for?
People accustomed to being busy are looking for something to do. Redirect that energy into something helpful or positive. Create a safe space for the person to rummage. Create rummage boxes with familiar items from their past, such as sewing supplies or safe tools. Have the person sort items that are mixed up. At the end of the day, you can mix things back up for them to do all over again the next day.
Coping with Hoarding
Hoarding, collecting or saving, is another common expression. The person may collect food, paper products, tissue paper, or objects such as small stones, flowers or plants. They may carry the objects around all day without eating or using them.
You’ll find objects hidden in clothing or pockets or placed in drawers or closets. Sweet’n’low packets and facial tissues are commonly collected items.
“Most of the time, we can collect those things after they go to bed and put them away,” Glover said.
It’s best not to tell the person they can’t have the item unless it is an issue of safety.
Hide away items that are dangerous to protect the person from injury. If the person is hoarding food, be sure to check their favorite hiding place and clean it out every day to ensure they do not accidentally eat something that should have been refrigerated.
Coping with Packing
Packing belongings or packing bags is also common. The person will say they are packing up to go home, even if they are home. This expression is tied to the theory of retrogenesis, where the person is going back, back, back in time. The home they are going to may be the place they lived long ago.
The person isn’t really trying to go home. They are looking for a feeling of being at home. Talk to the person about home. Ask them to tell you more about home. Who lived there, too? What did it look like?
Remove triggers that suggest it’s time to go home – purses, shoes, and coats by the door and luggage. Look out the windows and see what they see. If the car is visible, move it out of sight.
If they cannot be dissuaded, go “home” with them. Get in the car and go for a drive or go for a walk around the block to get home.
Interventions for all expressions
As the caregiver, how you respond is important. Watch your body language, tone of voice, emotions and facial expressions. Offer reassurance to the person, and do not argue with them. Validate their emotions and meet them in their world. If they’re upset with you, say OK. You aren’t saying they are right, but you are making them feel heard.
Offer favorite snacks or drinks and other distractions. Change the environment as needed to reduce stimulation.
Use food, music, animals and children to distract. YouTube is a great resource if you don’t have pets or children handy. Be sure to show the videos on a larger screen because the person will have difficulty seeing the video on a cell phone screen due to vision narrowing as the disease progresses.
Above all, take care of yourself. To be a good caregiver, you have to take care of you first.
The James L. West Center for Dementia Care offers free education for family caregivers, including many sessions on managing challenging expressions. Explore the available sessions or find upcoming live sessions on the Education Calendar.
