Shadowing in Alzheimer's Disease

Shadowing is when people with Alzheimer's disease or another type of dementia constantly follow their caregivers around. They may mimic him, walk wherever he goes, and become very anxious if the caregiver tries to spend any time away from them.

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Why Do People With Dementia Shadow Their Caregivers?

Often, shadowing appears to be driven by the person's anxiety and uncertainty. They may feel like their caregiver is the one safe and known aspect of life, almost like a life preserver. The minute the caregiver walks into a different ​room, goes outside or shuts a door to use the bathroom, the person with Alzheimer's may become afraid, unsure and upset.

Why Is Shadowing Thought of as a Challenging Behavior?

While shadowing isn't one of the more typical challenging behaviors such as aggressiveness or paranoia, it can present a significant challenge. Caregivers dealing with shadowing often report a feeling of claustrophobia, where they're constantly with their loved one and never allowed to do anything alone. Even taking a shower without interruption can be a challenge for a caregiver.

How Can Caregivers Cope With Shadowing?

One way to reduce the frustration of being constantly followed around is to remind yourself that your family member is afraid and anxious. How you interpret their behavior (as a result of fear instead of as purposely trying to irritate you) can make all the difference.

For example, one gentleman I knew felt like his wife was trying to control his every action and interaction because she was continuously following him around and wouldn't even let him work in the garage alone. While this behavior was extremely frustrating, his perception of her acting this way in order to control him made things worse. Recognizing shadowing as a reaction to anxiety and confusion can help provide extra energy to respond to it.

Additionally, it is imperative that you as a caregiver find a way to escape periodically. Even the most dedicated, loving and patient caregiver needs a break. To protect your emotional well-being, allow yourself some private time to take a shower or take some deep breaths. You can set a timer and remind your loved one that you'll be back when the timer sounds.

Maybe a neighbor will take a walk with your loved one, or a respite caregiver can spend a couple of hours with your loved one while you go to a support group. Is there another family member or friend who can regularly visit? You may also want to check on adult daycare centers that have programs for people with dementia. Whatever it is, taking some kind of time off can refill your emotional energy and allow you to continue to care for your loved one well.

How Shadowing Can Be Reduced

  • Meaningful Activities: One way to reduce shadowing is to involve your loved one in engaging and meaningful activities. These don't have to be structured activities with a group of people in a facility setting. Rather, they can be right in your own home and can be part of a reassuring daily routine. The key is for the activities to be meaningful for that person so that they capture her attention, thus reducing her obsession with you. For example, your loved one could fold clothes or towels daily, or work on a jigsaw puzzle.
  • Snacks: The Alzheimer's Association in New York recommends "cereal therapy" or "gum therapy"- where you give the person some food to snack on or gum to chew to occupy them. Of course, make certain the snack you choose is not one that would be likely to cause choking.
  • Music: You can also give the person headphones with a recording of their favorite musical selections to listen to or even make a recording of yourself speaking to your loved one to reassure them. Music benefits many people with Alzheimer's, and the familiarity can be calming and relaxing.
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  • Alzheimer's Association, New York. Sundowning and Shadowing. Accessed October 23, 2012.
  • Alzheimer's Australia Dementia Research Foundation. Anxious Behaviors. Accessed October 23, 2012.
  • Fischer Center for Alzheimer's Research Foundation. Shadowing. Accessed October 23, 2012.
  • The Internet Journal of Neurology. 2011 Volume 13 Number 2. Illumination of Shadowing Behavior in Individuals with Alzheimer’s Disease: Proximity-Seeking? As Life Becomes the “Strange Situation”.

By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.