Recently, I received a message from a very close friend seeking guidance about an elderly family member whose memory was progressively deteriorating.
My friend described the family member, an elderly woman who is physically relatively well but increasingly forgetful and sometimes disoriented. On one occasion, she is said to have wandered out of the house during the night and was unable to find her way back. On another occasion, after travelling to stay with family in another city, she repeatedly expressed a desire to “go home” despite having only recently arrived and her children yearning to stay with their elderly mother and to relieve the caregiver. The family was understandably worried.
But behind the worry was another equally important question: How do we relate to someone whose memory is changing without losing our patience and without taking away their dignity?
This is a question that many families may quietly be asking and not far from home for many people.
Dementia is more than forgetfulness. Dementia is often casually described as “old age” or simply “forgetfulness”. However, dementia is much more complex.
It is an umbrella term for several diseases and conditions that affect the brain, resulting in difficulties with memory, thinking, communication, behaviour and the ability to carry out everyday activities. Alzheimer’s disease is the most common form, accounting for an estimated 60–70% of dementia cases. Importantly, although dementia becomes more common with advancing age, it is not an inevitable part of growing older.
The scale of the issue is significant.
According to the World Health Organization, 57 million people were living with dementia globally in 2021, and nearly 10 million new cases occur each year. More than 60% of people living with dementia are in low- and middle-income countries.
This means that dementia is not somebody else’s problem. It is increasingly a family, community and public-health concern.
And in Zimbabwe, where families often provide much of the care for older relatives within the home, the psychological impact of dementia can extend far beyond the individual experiencing memory loss.
What is happening psychologically?
From a psychological perspective, one of the most important things for families to understand is that the person with dementia is not deliberately being difficult.
Imagine waking up and being unsure where you are.
Imagine asking the same question several times because you genuinely cannot remember asking it before.
Imagine looking at a familiar person but struggling to place their name.
Imagine feeling that you need to go “home”, but being unable to explain exactly where “home” is.
For someone with dementia, these experiences can be frightening and confusing. The brain is responsible not only for storing memories but also for helping us interpret our surroundings, understand time, recognise familiar people and places, communicate our needs and regulate our emotions. When these functions become impaired, behaviour can change.
A person may become anxious, irritable, suspicious, withdrawn, or restless. They may repeatedly ask the same question or insist that they want to go somewhere. Research in psychology tells us that behaviour is often our communication.
What looks like stubbornness may be fear.
What looks like aggression may be frustration.
What looks like refusal may be confusion.
And what looks like a repeated desire to “go home” may represent a deeper need for safety, familiarity, comfort or reassurance.
This is why simply telling someone with dementia, “I already told you that!” may not solve the problem. They may genuinely be unable to retain the information.
“But I told her yesterday!”
This is one of the most difficult realities for families. A loved one may tell you something today, appear to understand what you have said, and then ask the same question tomorrow, or even a few minutes later.
It can be exhausting.
It can test the patience of even the most loving caregiver.
But here is an important psychological principle: we should not measure the value of an interaction only by whether the person remembers it later.
Suppose you tell your grandmother that a family member has graduated. She smiles, asks questions and shares your happiness. The following day, she may not remember the conversation.
Does that mean yesterday’s conversation was meaningless?
Not necessarily.
The factual memory may disappear, but the emotional experience may still matter.
She may not remember the details, but she may have experienced warmth, connection, affection and belonging.
Therefore, continuing to share family news, photographs, music, stories and moments of connection can still be meaningful, even when the person cannot retain the information in the way they once could.
When someone says, “I want to go home”
The phrase “I want to go home” can be particularly distressing for families.
Sometimes “home” may refer to a previous house, childhood home, a familiar environment or a period in the person’s life when they felt secure. It does not necessarily mean that the physical house they are currently in is objectively unsafe or unsuitable.
People living with dementia can become disoriented in unfamiliar environments, and wandering or getting lost is a recognised safety concern.
From a psychological perspective, therefore, the first response should not always be to argue.
Instead of saying:
“But this is your home. We brought you here yesterday!”, we might respond:
“You would like to go home. You must be missing home.”
Then, gently explore what the person needs.
“What do you miss about home?”
Perhaps the answer is a particular person.
Perhaps it is a familiar routine.
Perhaps it is a favourite chair, garden, neighbour, church, meal or simply the feeling of being somewhere familiar.
Sometimes the emotional need underneath the words is more important than correcting the factual statement.
So, how should families communicate?
The good news is that families can learn ways of communicating that reduce frustration for both the person with dementia and the caregiver.
1. Speak to the person, not about the person
This sounds simple, but it is profoundly important.
Dementia does not remove a person’s humanity.
Avoid speaking about the person as though they are no longer present simply because they have difficulty following the conversation.
Maintain eye contact. Use their name. Speak respectfully and calmly.
The World Health Organization recommends speaking clearly and slowly, using short sentences, giving one piece of information at a time and allowing the person enough time to respond.
2. Do not turn every conversation into a correction
There are situations where correcting someone is necessary, particularly when safety is involved.
But not every mistaken statement requires an argument.
If someone says, “I need to go and see my mother,” and their mother died many years ago, repeatedly insisting, “Your mother is dead!” may cause unnecessary distress.
Instead, acknowledge the feeling.
“You are missing your mother today.”
“Tell me about her.”
The goal is not to deceive the person. The goal is to respond compassionately to the emotional reality behind the statement.
3. Give one instruction at a time
Long explanations can become overwhelming.
Instead of:
“Please go to your room, change your clothes, put the dirty clothes in the basket and then come and eat because everyone is waiting for you.”
break it down.
“Let’s go to your room.”
Then:
“Let’s choose your clothes.”
Then:
“Now let’s go and eat.”
Simple communication reduces cognitive demands and gives the person a greater chance of succeeding.
*4. Use familiar routines
Routine can provide psychological safety.*
Try to maintain reasonably predictable times for waking, meals, bathing, rest, activities and sleep.
Familiar music, photographs, household activities and culturally meaningful routines may also help create a sense of continuity.
For someone whose internal sense of time and place is becoming less reliable, external structure can become an important source of security.
5. Look beyond the behaviour
When behaviour suddenly changes, ask:
“What might this behaviour be communicating?”
Is the person hungry?
In pain?
Tired?
Lonely?
Frightened?
Overstimulated?
Looking for someone?
Confused by a new environment?
Trying to communicate a need but unable to find the words?
This small change in the caregiver’s thinking, from “How do I stop this behaviour?” to “What is this behaviour telling me?” can transform the interaction.
Wandering is not simply “misbehaviour”
A person with dementia who walks out of the house should not simply be labelled as troublesome.
Wandering can occur because the person has become disoriented, is looking for someone or somewhere familiar, is following an old routine, or is experiencing restlessness or anxiety.
But while the behaviour should be understood psychologically, it must also be taken seriously as a safety issue.
Families should consider practical safeguards such as ensuring that the person carries identification (ID card) and emergency contact details, informing trusted neighbours, keeping a recent photograph available, and developing a family plan for what to do in the event that the person goes missing.
Where possible, the home environment should also be made easier to navigate and confusing or dangerous areas should be assessed.
Prevention, however, should not become punishment. The objective is safety while preserving as much independence and dignity as possible.
What about the caregiver?
There is another person who must not be forgotten in the dementia conversation: the caregiver.
Caring for a person with dementia can be emotionally and physically demanding. Family members may experience frustration, sadness, guilt, grief, exhaustion and even resentment.
And then they may feel guilty for feeling resentful.
This creates a dangerous cycle.
The caregiver becomes exhausted.
Exhaustion reduces patience.
Reduced patience leads to harsh responses.
Harsh responses can increase distress in the person with dementia.
The increased distress creates more difficult behaviour.
And the caregiver becomes even more exhausted.
We therefore need to stop viewing caregiving as something that one “strong” family member must simply endure.
Care should be shared where possible.
Families can rotate responsibilities, provide respite for the primary caregiver, share practical tasks and create opportunities for the caregiver to rest.
The caregiver also needs emotional support.
The World Health Organization emphasises that dementia affects not only the person living with the condition but also carers and families, and recommends support, education and opportunities for caregivers to look after their own wellbeing.
When patience runs out, lett us also be honest.
There will be moments when a caregiver loses patience.
There may be days when the repeated questions become overwhelming.
There may be moments when one thinks, “I have explained this so many times!”
This does not automatically make someone a bad caregiver. It makes them human.
What matters is recognising when we are reaching our limits and seeking help before frustration turns into humiliation, neglect or abuse.
The older person’s dignity must remain central.
We should avoid shouting, mocking, infantilising or deliberately frightening someone with dementia. An adult with dementia may need assistance like a child, but they should never be treated as though they are a child.
They have lived a lifetime.
They have relationships, memories, achievements, preferences and a history that deserve respect.
Can dementia be prevented?
Not every case of dementia can be prevented, and age remains the strongest known risk factor. However, current evidence shows that several risk factors are modifiable.
The latest WHO guidance highlights the importance of physical activity, not smoking, avoiding harmful alcohol use, maintaining a healthy diet and weight, staying socially and cognitively active, and managing conditions such as high blood pressure, diabetes and high cholesterol.
This is important because dementia prevention is not only something we think about when someone reaches old age.
Brain health is a life-course issue.
The choices we make about our physical health, social connections and mental stimulation throughout life can contribute to healthier ageing.
When should families seek professional help?
Memory lapses do not automatically mean dementia. However, persistent or progressive memory problems that interfere with everyday functioning should not simply be dismissed as normal ageing. A proper medical assessment is important because dementia has different causes, and some conditions that affect memory or thinking may require treatment.
Families should also seek professional guidance when there are significant changes in behaviour, repeated wandering, problems with eating or sleeping, severe distress, falls, confusion or concerns about the person’s safety.
Psychologists, doctors, nurses, occupational therapists, social workers and other professionals can all have important roles in supporting the person and the family. Dementia care is therefore not simply about medication. Psychological support, social connection, meaningful activity, caregiver education and a safe environment all matter. Let us change the way we see dementia
Perhaps one of the greatest challenges is not dementia itself, but the way society responds to it.
When an elderly person repeats a question, some people laugh.
When they forget someone’s name, others become impatient.
When they behave in a way that seems unusual, they may be called “mad”, “stubborn” or “difficult”. Such labels can be deeply damaging.
From a psychological perspective, the person may be losing some cognitive abilities, but they have not lost their need for love, respect, belonging and human connection.
This is where families and communities can make a profound difference.We may not always be able to restore the memory. We may not be able to stop the progression of dementia.
But we can control how we respond.
We can speak gently.
We can listen patiently.
We can create safer environments.
We can maintain meaningful routines.
We can share the caregiving burden.
We can protect our elders’ dignity.
And we can continue loving the person who is still there, even when dementia has changed the way they communicate with us.
A final thought
Dementia may take away memories, names and familiar pathways, but it does not take away a person’s worth. So, when memory fades, let our patience become stronger, our understanding deeper and our compassion louder. The person may forget what we said, but they may still remember how we made them feel.
Mildred Ngwerume-Sigwadhi is a Lecturer at Reformed Church University and a Counselling Psychologist registered with Allied Health Practitioners’ Council of Zimbabwe.
