What is Shadowing in Alzheimer's and Dementia Patients?

Shadowing is a common behavior in Alzheimer's and dementia patients that can quickly become overwhelming for their caregivers. At Visiting Angels, we want to help you understand this habit of following others around, thereby making it easier for you to handle shadowing. Both patients and caregivers benefit when this issue is properly addressed and minimized.

Definition of Shadowing

Shadowing in Alzheimer's and dementia patients is a common activity where the patient follows their caregiver closely and clings to them throughout the day. This can be as extreme as following their caregiver into the bathroom. The patient might mimic the actions and even the mannerisms of the caregiver that they're shadowing. If the caregiver attempts to extricate themself from the situation, the dementia patient can become agitated and nervous. 

Causes of Shadowing

Alzheimer's and dementia patients typically engage in shadowing because they're feeling anxious, lost, and confused. Shadowing can give them a sense of comfort because it keeps a familiar and trusted person in their line of sight at all times. Dementia patients don't always understand that a person who leaves the room for a moment will come back. It's even more alarming for them if that person leaves the house entirely. 

Dementia and Alzheimer's can cause patients to get lost in time, which means that they can't pinpoint current or future dates, and they have no way of understanding when a person will come back once they've left the patient's line of sight. Dementia patients often live in a perpetual state of fear. They're afraid of getting lost, being left with an unfamiliar person, and finding themselves in a place they don't recognize. This is a rational fear for these patients because they often can't recognize their spouse, children, or home. 

Shadowing gives the dementia patient a sense of control. They feel that if they stay in constant contact with their caregiver, they'll maintain a sense of lucidity and safety. It's common for dementia patients to fixate on a single individual, particularly if most or all of their care is provided by one person. This creates a sense of dependence and often leads to shadowing behaviors.

For some patients, shadowing and sundowning are closely linked. Sundowning is a state of anxiety and confusion that Alzheimer's and dementia patients often experience late in the day. As patients become more fatigued, they may find it increasingly difficult to separate dreams from reality or keep track of things, such as places and time. Hallucinations and wandering are commonly associated with sundowning. Patients who suffer from sundowning may increase their shadowing behaviors around this time of the day as well.

Impact on Patients and Caregivers

Shadowing is stressful for both patients and caregivers. Caregivers often describe feeling overwhelmed, irritated, and controlled by the patient's behavior. This caregiver is often a family member who may feel judged or harassed when it's their parent or spouse who is shadowing them. Caring for a dementia patient is time-consuming as well as mentally and emotionally taxing. Caregivers need to make time to care for themselves so they can handle this task. Shadowing often prevents them from taking even small breaks.

Shadowing is taxing for patients as well. Though it may seem as though this activity provides them with security and relief, it comes with many hazards. Alzheimer's and dementia patients often suffer from mobility issues or other physical constraints that make it painful and challenging for them to spend long days on their feet. They can't always keep up with the strenuous pace that their caregivers keep throughout the day. Attempting to shadow diligently hour after hour can become extremely uncomfortable and difficult. Shadowing behaviors must be managed and minimized for the well-being of both individuals involved.

Managing Shadowing Behavior

If you're a caregiver for a loved one with Alzheimer's or dementia, there are many things that you can do to help minimize shadowing behaviors. Most solutions revolve around providing an alternate sense of security and familiarity. If possible, expand your loved one's support group so you're not the only person to whom they feel comfortable attaching themselves. Enlist the help of other caregivers so you can take much-needed personal time while your loved one has someone else to accompany, monitor, and care for them.

When you leave, you can provide them with a video or audio recording of yourself. Even something mundane, such as watching a video of you washing dishes and completing everyday chores in your loved one's home, can provide them with the sense of security they're looking for. You might also record yourself reading well-loved poems or telling a favorite story. You can leave a clock with a timer that will go off when you plan to return. This acts as a reminder that your absence isn't permanent.

If you can't leave the house but need to step out of the room, try giving the person something specific to focus on. Distract them with a task, such as folding towels or sorting socks. This will occupy their mind and help them focus on something other than following you while you go to the bathroom, take a shower, or simply go into another room to take some deep breaths and regroup.

Support and Resources

Don't hesitate to reach out to local resources when you're struggling to care for someone who's engaging in shadowing. You may find an adult day care or dementia care facility in your area where you can leave your loved one to engage in guided, supervised activities while you take a break. You can also hire a home caregiver to provide professional in-home dementia care or Alzheimer's care.

Get the Support You Need for Your Loved One

If you need respite from your caregiving duties, our compassionate caregivers at Visiting Angels can help. We offer in-home dementia care services throughout the Asheville area. Our caregivers are available on a set schedule or on demand as needed. We'll take over and give your loved one the support, care, and supervision they need while allowing them the dignity and familiarity of staying in their own home. Fill out our contact form today or give us a call for a consultation.