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The Role of Rummaging in Middle Stage Alzheimer’s

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Rummaging and hoarding are common behaviors associated with Alzheimer’s disease.  Although these actions may seem random and meaningless to the frustrated caregiver, rummaging actually serves a purpose in the middle stages of dementia.

Rummaging behaviors usually begin in the early stages of dementia, where a person with memory loss may misplace an object and turn the house upside-down in search of it.  Coupled with a touch of paranoia and suspicion, it can be very difficult to convince the early stage person that rummaging is unnecessary.  It’s sometimes simply not enough to find the object; discovering and accounting for personal possessions are a strong motivation for rummaging.  Discouraging it may lead to agitation, increased paranoia, and more rummaging.

In the middle stages, rummaging is largely a coping mechanism for language deficits and the need to be repetitive.  Once speech and comprehension skills decline, a person in the middle stages has to find another way to interact with the environment.  Using her hands to explore the world is simply a function of survival- if she can’t tell you that she is hungry, then she will just start searching for food herself.  Repetitive actions, such as pacing and saying the same word or phrase over and over again, is usually a behavior used by the person to relieve anxiety and search for reassurance.  Attempting to limit or restrict these activities can lead to an increase in agitation and fuel the need to continue to do it.

The manipulation of objects is actually a valuable skill, in light of the issues that arise in the later stages of Alzheimer’s.  The ability to effectively use the hands for purposeful actions, both with and without objects, is a problematic challenge in late to end stage Alzheimer’s.  Once the person loses the ability to release objects, the onset of the “death grip” becomes apparent. This is seen when the person cannot let go of the walker or grab bar, or set down a utensil while eating.  Once the hand begins to posture in a fisted position, because opening the hand is too difficult, contractures and skin issues begin to emerge.

For this reason, grasping and releasing objects is a good thing.  Demonstrating the appropriate grasp on objects is a better thing.  Maybe a person cannot tell you that the object he’s holding is a comb because language skills are gone.  But if he’s holding the comb like a comb and can briefly demonstrate that he knows how to use it, he still has the ability to recognize objects.  Providing the opportunity to hold and manipulate various objects is a great way to preserve this skill, and has the two-fold benefit of alleviating agitation and repetitive behaviors as well.

In managing the challenges of rummaging behaviors, it is best to control the environment versus controlling the behavior.  Provide a safe place to rummage- a box or a drawer- that is filled with both personal meaningful objects and highly familiar everyday objects.  Start with observing the person as they hold an object.  Does he hold it correctly? Does he hold a pencil in pencil grasp, or a flashlight in a sturdy grip with the thumb on the switch?  If it is being held correctly, encourage the person to try to demonstrate the use of object and even find the name of the object.  Usually you’ll see some recognition or positive indication that the name or use of object is recognized.  That momentary “connection” with the person is the one thing that person has been searching for all along.  Providing that “ah-ha” moment gives the gift of clarity, dignity, and reassurance to a person who is otherwise unable to find those moments.  Connectedness to our environment and the people in it is what we all want, and sometimes rummaging is the only way to find it.

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10 comments

  1. Thanks for another informative article. When I mentioned rummaging at last week’s support group, I could tell the caregivers were not familiar with the concept. I can see the value and will continue to share this along with deconstruction. One gentleman was commenting how he has wife is bedridden and gets bored. He has to do his her hair and make up for her. I mentioned that he might create a box of make up and hair supplies and see if she likes to rummage. I’ll be interested to see if he gave it a shot.

  2. One of the very earliest outward signs of dementia in my mom, predating other symptoms by a year at least, was her habit of “rummaging” in her purse. She would sit in the house, at the airport, at a restaurant, seemingly searching for something in her purse. This behavior progressed into emptying the purse, examining each object in the purse, and doing it all over again as her disease progressed. As we look back, this “rummaging” was one of the first signs of decline–had we only known what it meant at the time! We were so quick to dismiss the rummaging as an irritating habit she had developed…

    • Wow Will thank you for sharing! I’m sure your story will resonate with someone else who may be noticing a quirky habit like that.

  3. Yesterday someone mentioned during a webinar that they are a explorer – not a wanderer. I didn’t realize there was a difference but now I see the difference. I suspect an explorer will probably get lost eventually at which time they will be called a wanderer. I wonder if this behavior might be an indicator as well – hmm.

    • Sometimes semantics can be burdensome, and sometimes it helps with perspective. I prefer the term “explore” also due to the association of the word “wander” to “aimless”, which implies that the behavior is not purposeful. But all the gross motor movement and use of hands in the middle stages is purposeful. It’s how they organize information.

  4. What a great site. I facilitate a support group in Coos Bay Oregon for Alzheimer’s . So much info to pass on.

  5. THANK YOU so much for this post. My mother (in mid- to late-stage AD) spends the majority of her waking hours digging through drawers, closets, her purse, etc., and then hiding or at least “re-homing” most of the things she finds. It was driving me crazy until I did some research and found that it is typical AD behavior, and as long as she isn’t hurting herself, I can let her rummage. Now if I can just FIND everything she has squirreled away…. 🙂

    • So happy to help. Before we knew what we know now, we all used to try to get people to stop rummaging by preventing the behavior. Turns out that only makes things worse. Exploration via touch and vision, and attempting to organize information, is at the root of rummaging. Good luck with your treasure hunt!

  6. What purpose does hoarding service? we find stacks of outdated schedules, old bills. Styrofoam food cartons, empty pill bottles etc stuffed into drawers and cabinets. Then the clutter becomes overwhelming and important things get lost in the mess and disorganization. What is best way to handle/ for truly uneesaary stuff/ will eave behind a few (2-3) of each item but get rid of the rest. She does not like this. Suggestion?

    • True hoarding is psychiatric disorder that falls into the OCD family of behaviors. It is nearly impossible to manage with tips and strategies. The less severe symptoms we see with dementia are an executive function problem- she can’t generate a plan for disposing of things, and she can’t rate the importance or significance of the items. The best way to declutter is to do it with her and guide her to the decision to save or trash with gentle suggestions. Her preference will be to save, but she might get the hang of your logic if you’re easy going about it. You can help her sort things into save, trash, or maybe… and work to get things at least into maybe. It is easy to get frustrated in these situations and tempting to take a bulldozer approach, but this frequently backfires. You can secretly throw out the trash that she won’t miss, but I wouldn’t expect her to be able to manage this issue without some help. I’m sorry… it’s a tough one.

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