How to Respond to Dementia Delusions

Dementia or Alzheimer’s disease can cause many delusions, leading to false accusations and beliefs. While there are indeed some cases of real senior abuse, most cases of accusation are simply not true. That doesn’t make them any less painful, however. It can be very difficult to hear your older adult accuse you of doing horrible things, or watch them be overwhelmed with anxiety.

It’s important to remind yourself that dementia is simply causing their brain to play tricks on them. Be patient and understand that they’re not saying hurtful things on purpose, nor are they trying to lie or be dramatic. The statements they’re making are very real to them. It’s not helpful to try using logic, reason, or facts to convince them they they’re wrong when they’re convinced of a delusion. The brain damage caused by the dementia means they are no longer able to process logical explanations. It’s far more effective to validate their feelings, tell them you’re on their side, and then either redirect them to a pleasant topic or distract them with an enjoyable activity.

Here are the top four dementia delusions, as well as suggested ways to respond to them:

1. “You’re attacking me! You’re hurting me! Go away!” It is easy to accidentally startle someone with Alzheimer’s when you approach them. This can trigger a “fight or flight” response, causing them to panic and feel attacked or abused, even if all you’re trying to do is help them with a task. Your best bet is to immediately back away and give them some space. If you need to help them with an essential task, give them time to recover and then try approaching using a gentler approach. For example, keep your voice calm, using a soft and soothing tone when speaking, and get to eye level for ease of making reassuring eye contact.
2. “Who are you? I don’t know you. I want to leave!” It can be especially heartbreaking when those with dementia begin to get confused about the identity of loved ones. Just remember that they aren’t doing it on purpose, and they can’t try harder to remember; their brains simply don’t work correctly anymore. Any attempts to remind them that you’re their spouse, child, or other relative can actually backfire, making them even more confused, scared, or agitated. Instead, if they ask for someone by another name, pretend to try to locate that person. If they demand to leave, suggest they first stop by the restroom or put on a coat, and then distract and redirect them on the way. You could also try leaving the room for a minute to see if it resets the situation; they could have a completely different reaction when you get back. This would also give you a chance to recover from the emotional shock.
3. “Someone is after me! They’re following me and watching me.” Dementia causes general disorientation and paranoia, so it’s no wonder that those who suffer from it can become anxious or afraid. Some fears could be escalated by their eyes playing tricks on them, since dementia changes vision perception. They may think, for example, that a shadow or a large piece of furniture is actually a person waiting to jump out at them. Be sure to keep the room well lit and to draw the curtains at night to eliminate shadows and reflections. Appropriate responses might be reassuring the person that you’ll stay with them to be sure they remain safe, pretending to call the police to send a patrol car over, or acting as if you’re locking the doors and setting the alarm system.
4. “I see insects on my food or everywhere!” Dementia’s effect on the brain has convinced them (or their eyes) that they are seeing crawling insects everywhere. Sometimes people see them on their food and refuse to eat as a result. Others see them crawling all over their body or on nearby surfaces. Since there’s nothing you can do to change their mind, you should simply validate their beliefs and find creative ways to help them solve their “problem.” Give them water in a small spray bottle and tell them to use this special “bug spray” on their food or body. You could also give them body lotion (which can help with dry, itchy skin that may be exacerbating the situation) and tell them it’s special bug repellent. You could pretend to call an insect spraying service that will spray the exterior of the house and the yard so bugs can never get in again, or you can pretend to seal up the area of the house where they think the bugs are getting in.

These ideas are a good starting point for answers that are most likely to work. You know your older adult best, however, so feel free to customize them to the individual. Don’t forget that it can take a little practice and experimentation to master the validate/distract/redirect technique, but that it does get easier with time!