Deconstructing Home

All right, welcome back.

I'm joined again by Dr. Jason Karlawish.

So Dr. Karlawish, what have you learned in your practice from patients and caregivers about why moving is so emotionally difficult?

A couple reasons, most of which, many of which are in the show that we've just heard.

Beginning, for example, when family's doing the moving, there's a host of emotional entanglements around objects, et cetera, who gets what's worth keeping, et cetera, which even if you're working with a professional is, of course, intense.

Not so much for the professional because they don't really care about your set of decorative teapots, but they have to work with you to decide, do we really need 30 teapots or whatever it might be.

I think it's emotionally difficult in very unique ways for each patient and caregiver.

But I think there are some overarching kind of themes or questions that sort of capture why.

And I hear these played out in my practice.

So a common question I get from patients and caregivers is some variation on how long can I remain in my home.

And that's a question which behind it, of course, is a host of matters related to disability, perception, et cetera.

And I often ask that, well, what are your concerns about remaining

in your

home? But behind that also are some other questions and or statements that often are uttered by patients, sometimes repeated by caregivers that the patients told them.

I want to stay in my home forever.

Or on the caregiver's part, I will keep her, I will keep him in his home forever.

And it's these kind of swearings of, you know, the home that has been created shall always endure for this person.

And of course, as we talked about at the beginning and we've heard amply across this episode, the idea that home as you are living in it now with the mind that you have now will work forever is, I just think, a fiction.

I think the way that diseases that cause dementia distort perceptions, cognition, function, in addition to some of the physical impairments, oftentimes make the home that you are in no longer work for you.

And I've seen this played out across multiple different patients.

And it's sad, and I'll use that very blunt three-letter word, sad, to see how some patients and caregivers almost bind themselves to this mast of, I will never leave this home.

But having said that, there are some examples where you have to be really judicious about how and in what ways you change home.

Tell me more about that.

Yeah, so I'll give you – it's no longer acceptable to say someone has dementia, I think, and then not ask the next question, which is what disease is causing it.

Now, in some cases, we can't figure out the disease that's causing the dementia.