Time-shifting and dementia
Time-shifting is when a person’s experience is that they are living at an earlier time in their life.
Changes in perception
A person who is time-shifted may seem to be experiencing a different reality to you. Try to remember that what they perceive is as real to them as your reality is to you.
The person may not understand what more recent technology is or does. They may not recognise friends and family as they look now, expecting them to be much younger. They may think that people who have died are still alive. They may also not recognise themselves in a mirror, as they are expecting to see a much younger version of themselves.
What causes time-shifting?
Memory is important in understanding the world. To understand what is happening now, the brain uses information from the senses, and memories.
A person with dementia often has damage to their short-term memory. This means they may rely more on older memories to make sense of things now. A person with dementia may not recognise an object, or how to use it, even though they can see it clearly.
For example, the person you care for may put their electric kettle onto the stove to boil water. If the parts of the brain that store and find more recent memories are damaged, they cannot remember using an electric kettle.
They may, however, be able to recall earlier memories from their life, perhaps one which they put on a gas hob or the stove. They have shifted to a time in their life before they used electric kettles. The person may feel like they are living in the past, because they’re using older memories to fill in the gaps to make sense of the present.
Who gets time-shifted?
Time-shifting may be more common in Alzheimer’s disease than other types of dementia. However, people with all types of dementia are more likely to experience it as their condition progresses.
A person may not always be time-shifted, but they may move in and out of being time-shifted and living in the present, perhaps over the course of a day.
How does a person experience time-shifting?
A person with dementia may experience time-shifting by:
- Asking if they can collect the children from school, or when they can speak to their mother. They are recalling memories from much earlier in life, and possibly showing an unmet need.
- Not recognising themselves in the mirror, as they believe they are much younger, and the reflection is of someone much older. They can’t access recent memories of themselves.
- Not recognising their adult children or family, believing their children to be much younger. Their memory of them is from a much earlier time.
- Struggling to identify newer technology and what it is for.
- Interpreting people around them in a role they were familiar with in the past. For example, if the person used to run a bed and breakfast, they may think other care home residents are guests. They could help to set out tables for lunch, which is a meaningful occupation for them.
Supporting a person who is experiencing time-shifting
As with delusions, pointing out mistakes to a person with dementia who is time-shifted can be very upsetting. Often you won’t often be able to convince them to recognise their current situation or surroundings, or that time- shifting is not logical.
This is because time-shifting is due to damage to the brain and is not a choice for the person with dementia. It is real to them. If the person with dementia is happy and content, think about whether correcting them is in their best interests.
Tips for carers supporting a person experiencing time-shifting
- Announcing their name when entering the room by saying 'Hi, it’s (name)' or similar. Other family members friends and professionals should do the same. This may help prevent the person from becoming confused and mistaking them for someone in their past.
- Attend carefully to what the person is saying and doing, to understand their reality. Acknowledge their worry, and explain you will try to help. They are more likely to be gently distracted, once they feel heard.
- Not contradicting their experience. They shouldn’t be told what is or is not true in a confrontational manner. They may become frightened or upset.
- Remembering that emotional memories are often easier to retrieve. Staying open, calm and friendly can help the person with dementia to associate a carer with positive emotions, even if they struggle to understand who you are in the present.
- Remaining calm. If a carer becomes frustrated that the person is struggling with the present, they should take themselves out of the situation until they feel calmer. Perhaps making a drink for them both, to take some time out of the room.
- Remembering the positive difference they make to the person with dementia. The person with dementia does not need to fully understand your reality for them to feel happy, so continue to try and do what makes them feel content.
Preventing or reducing time-shifting
These tips may prevent or reduce time-shifting:
- Remove or replace mirrors and shiny surfaces at eye height. Some people may not recognise themselves in the reflection, if they have time-shifted to when they were much younger. They may believe their reflection to be a stranger in their home, and this can cause distress and alarm.
- Unless there is a problem with any appliances they have, such as their TV, avoid changing them for newer technology. They may not be able to use newer and unfamiliar items. It is better that they continue to use their appliances without help, than to introduce newer technology that they need assistance with.
- Talk to them about simple solutions. For example, if using the radio causes confusion, try replacing it with a model that they used when they were younger.
- Try and find out about their life history. This can include former job roles, daily routines, interests and important relationships. Understanding their past may help to understand how they are interpreting their present. It may also help understand questions and actions that seem odd to others (for example, someone getting up very early ‘to clock on for work’). Giving someone meaningful occupation often helps.
This is me
If a person with dementia is living in a care setting or staying in hospital, any problems they have communicating can affect the care and support they receive. Alzheimer’s Society produces a simple form called ‘This is me’ to help record personal information about a person.
This includes how the person likes to communicate, any difficulties they have, and how care and support staff can tailor their care for the person as an individual. ‘Dyma Fi’ is also available in Welsh.
Time-shifting and difficult questions
A person may ask you questions as a result of time-shifting, such as ‘When am I going to go home?’ when they are at home, or ‘When is my mum coming to see me?’, when their mum hasn’t been alive for a long time.
It can be difficult to know what to say to the person you care for. Telling the truth can cause the person with dementia to have an emotional response and, in some cases, may make things worse.
Not telling the truth can also make the person with dementia more suspicious, if they realise that those around them aren’t being truthful. It may also make you feel uncomfortable to lie to them.
There is no right or wrong way to respond to these difficult questions. Try to decide what is in the person’s best interests and be consistent in whatever you decide.
Certain times of the day might be worse than others. There may be triggers. For example, if the question happens near meal times, a snack might help. You may notice that they ask when the environment is noisier than usual, or perhaps later in the day. If you see a pattern, you can take steps to lessen or avoid some of the triggers.
An ideal solution is one that you feel comfortable with, and which considers the best interests of the person you care for. This includes not causing them distress. However, it is often not easy to manage these questions on a regular basis and it is important you have as much support around you as you need. It can be helpful to hear from other carers about approaches they have tried, and what worked for them.
Difficult questions a person with dementia might ask
Asking for a partner, friend or relative who has died
If they are asking for a partner, relative or friend who has died, telling the person the truth may shock and upset them, as it will feel like the first time they have heard the news.
As they may well have short-term memory problems, they could experience the shock of grief repeatedly if they continue to be told every time they ask. Some carers choose to tell the person initially, but do not repeat if it becomes a recurring question.
You may feel that reducing the person’s distress is more important than telling them the truth. If you choose to tell the truth in this scenario, try to give them the news in a sensitive and compassionate way, offering warmth and support.
Think about whether it is in their best interests to continue to be told this news every time they ask. Try not to give details of how and when it happened if it was long ago, as this can add to the confusion caused by their time-shifting.
Try not to ignore the question. The person may continue to feel distressed if their concern for their loved one is being dismissed. You may need to acknowledge their question first, perhaps by saying ‘I don’t know the answer to that at the moment. Is there a reason that you need them?’ Or, instead of answering the question directly, you could say ‘Do you miss your Mum?’ and encourage them to talk about their mother, possibly using photos to reminisce.
They may be asking about a particular person as they have an unmet need, which this person may have provided earlier in their life. This could be a sense of security a partner gave them, or the love their mother gave them. Try and explore this and allow them to talk about the person they miss.
You might use phrases to show you understand how they are feeling, such as ‘It sounds like you’re missing your mum at the moment?’, or ‘You must be lonely without your husband?’. Try to meet the need, for example for security or affection, as best you can.
Asking to go home
If someone asks to go home, describing a place they have lived in the past:
- Try not to argue about whether where they are is ‘home’. If they don’t recognise it as ‘home’ at that moment, then for that moment it isn’t home.
- Ask if there is anything you can do to make them happier where they are now. Often when a person with dementia asks to go home it refers to the sense of home rather than home itself. Find out where ‘home’ is for them – and what they like about it.
- Reassure the person that they are safe and cared for. Check that they are comfortable, not too hot or cold, hungry or thirsty, or needing to use the toilet.
- Keep a photograph album to hand, to gently distract them. Sometimes looking at pictures from their past and being given the chance to reminisce will ease feelings of anxiety. It might be best to avoid asking questions about the picture or the past, instead trying to make comments: ‘That looks like Uncle Vijay. Granny told me about the time he....’
- Distracting them with food or other activities, such as a walk. Ask them as many details as possible about their home and consider completing a ‘Herbert Protocol’ with previous addresses in case they try and return there. A Herbert Protocol is designed to help the police if a vulnerable person goes missing. Visit the website for your local police for more information.
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