“My husband follows me around the house and won’t let me out of his sight.”
“My mom won’t leave me alone; she even tries to follow me into the bathroom!”
If you’ve been frustrated by similarly clingy behavior in a senior with Alzheimer’s disease (AD) or another form of dementia, it’s likely that this person is “shadowing.” Complaints like these are very common among dementia caregivers in the Caregiver Forum. Fortunately, there are ways of preventing these exhausting behaviors from taking a toll on you, your loved one and the quality of care you provide.
What Is Dementia Shadowing?
In Alzheimer’s disease and other forms of dementia, clinging and following behavior is often referred to as shadowing. Most people are familiar with the term shadowing to describe a form of on-the-job training in which a new hire closely follows and observes (shadows) an experienced employee to learn about their responsibilities, procedures and other important information. Similarly, dementia-related shadowing occurs when a senior closely follows their primary caregiver around, sometimes while mimicking their actions or repeating the same questions and comments.
Each dementia patient’s symptoms and their onset vary, but shadowing usually occurs in the middle stages of Alzheimer’s before mobility is seriously limited. Older adults who are prone to shadowing may follow their caregivers around constantly, which can be distressing for both parties.
What Causes Shadowing in Dementia Patients?
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Anxiety and Confusion
Dementia-related behaviors are very complex and influenced by countless factors, but shadowing is thought to be rooted in anxiety and confusion. James Huysman, Psy.D., LCSW, agrees with this theory. He believes that what most dementia patients are saying with shadowing behavior is, “I am alone, scared and have no social support systems other than you.”
Memory loss associated with AD and other dementias leaves elders feeling disoriented and fearful. They may then cling to familiar people that bring them comfort, guidance and reassurance. Some dementia patients become very anxious or even agitated if the person they are fixated on leaves their sight. It is important to note that they might end up wandering outside and away from home in search of the person they shadow, which can be very dangerous. -
Sundowning
Shadowing can be constant, or this behavior may ramp up at certain times of day. For example, behavioral and psychological symptoms may emerge in the late afternoons and evenings for some dementia patients. This pattern of restlessness is referred to as “sundowning” and typically occurs at the end of the day when patients are physically and mentally tired, natural light declines and confusion increases. Pacing, shadowing, hallucinations and wandering are common behaviors that increase during sundowning episodes. -
Seeking a Sense of Purpose
Seniors with mild to moderate dementia often crave familiarity and a sense of purpose. Even if your loved one can no longer do many household tasks independently, unprompted and unsupervised, they may still follow you around and attempt to mimic your actions as you cook dinner, wash dishes, do the laundry or pay bills. When a family caregiver generously steps in to take over these daily tasks, feelings of aimlessness and boredom could set in.
Shadowing may be an attempt to replicate old routines and contribute to the household. Unfortunately, the disease also results in impaired logic, judgement and social skills, so dementia patients commonly fail to realize that their behavior is not only unusual but also a source of deep frustration for their caregivers. Huysman notes that your loved one will probably continue following you until they find (or are presented with) an alternative that they feel is more meaningful.
Effects of Shadowing on Dementia Patients and Caregivers
Constant following and mimicking may seem harmless, but it can have serious repercussions for patients and caregivers alike. While it is beneficial for seniors with dementia to remain as active, mobile and engaged as possible, excessive shadowing is exhausting. Daytime activities can help regulate a patient’s sleep/wake cycle, improve sleep quality and minimize sundowning, but fatigue and anxiety sometimes combine to worsen dementia-related behavioral symptoms. The risk of falling also increases for elders who feel compelled to shadow their caregivers—especially those who forget that their stamina and level of mobility has decreased.
Dementia care is physically and emotionally taxing, and shadowing complicates a family caregiver’s job even further. The consequences are particularly dire for caregivers who live with their care recipients. Shadowing behavior not only interferes with the ability to efficiently manage a loved one’s household and care, but it also prevents you from seeing to your own basic needs.
When your care recipient is constantly following you around, it’s impossible to get a private moment to use the restroom, take a shower, sleep soundly, have a conversation on the phone or nurture your other relationships. Being under constant observation means that even quiet moments and short breaks from care tasks throughout the day are lost. Longer respite terms might be totally out of the question for dementia caregivers whose loved ones exhibit severe separation anxiety and/or agitation. Inability to step back from caregiving will wreak havoc on one’s mental fortitude and almost certainly lead to burnout.
Read: How to Cope With Alzheimer’s Caregiver Burnout
How to Handle Shadowing Behaviors
Addressing underlying issues is an important first step in managing shadowing. It’s not always possible to pinpoint exact causes of dementia-related behaviors, but looking for patterns in a loved one’s moods and actions is often very informative. Start by contemplating a few core questions when shadowing occurs:
- Is my loved one anxious or agitated? Does being near me or keeping me in their line of sight relieve this anxiety?
- Is shadowing a constant behavior or occurring after a consistent trigger? Does the timing coincide with previous instances of shadowing? What about other personal and environmental factors?
- Does my loved one follow me and mimic my behavior to help me? Do they seem to enjoy receiving attention or praise for their “contributions”?
- Am I my loved one’s main source of social interaction, activity and/or entertainment? Could they be bored or lonely?
The answers to any or all of these questions may help you understand and recognize how to interpret clingy behaviors. Developing solutions to reduce their fear and anxiety should allow you to regain some private time in your day-to-day life.
Instances where shadowing appears to be cyclical may benefit from techniques similar to those for minimizing sundowners syndrome. If a senior thrives on being included in a task or chore while shadowing you, redirecting by delegating a few simple “jobs” for them to handle more independently, such as cutting coupons or setting the dinner table may give you a reprieve and build their confidence. Elders who crave togetherness, conversation or more interesting ways of passing the time could benefit from attending an adult day center for people with dementia, hiring companion care services, arranging weekly phone calls with family or making other social enhancements to their care plan.
Unfortunately, there is no magic bullet for “fixing” dementia-related behaviors. Once you identify possible motivating factors behind shadowing behavior, use trial and error to test out solutions that work for you. Creating a daily routine for dementia patients and then incorporating the techniques that you find successful will go a long way in helping your loved one feel calmer, less disoriented and more comfortable at home.
If troubleshooting your loved one’s behaviors and tweaking their care plan doesn’t seem to have an effect on their shadowing, it may be time to consider other options. For example, anxiety and depression are common in dementia patients and very detrimental to their overall quality of life. Consider talking to your loved one’s doctor about medication that may improve outcomes for both of you.
Don’t forget to make your needs and comfort a priority, too. Caregiver burnout is detrimental to your physical and mental health and the care you provide. You need time away from caregiving to properly recharge your batteries. Adult day care, in-home care and other types of elder care services can be stimulating for your loved one and give you a much-needed break. If constant shadowing and other dementia symptoms aren’t improving and have you feeling overwhelmed, it may be time to consider placement in a specialized memory care community or nursing home.
Sources: Shadowing (https://www.alzinfo.org/pym/feature/shadowing-2/); Sleep Issues and Sundowning (https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning); Anxiety and Agitation (https://www.alz.org/help-support/caregiving/stages-behaviors/anxiety-agitation); Wandering (https://www.alz.org/help-support/caregiving/stages-behaviors/wandering)