You’ve been helping Dad with his bills and investments for years—and now he’s suddenly convinced you’re trying to steal his money.
Or you’ve shared a happy marriage for decades with your beloved wife, but now, out of the blue, she’s accusing you of having an affair.
These are disturbing and, unfortunately, familiar scenarios for many who care for loved ones with Alzheimer’s or another form of dementia. It’s not uncommon for people with dementia to exhibit paranoid or delusional thinking or, in some cases, to experience hallucinations. Approximately 30–40 percent of people with Alzheimer’s will develop delusions, typically paranoid delusions, at some stage of the disease, and the incidence may be even higher among those with a history of abuse or trauma.
When paranoia, delusions or hallucinations occur, it can be traumatic for caregivers. These behaviors are not only difficult to handle at a practical level, but they can be very hurtful at an emotional level.
Your best weapons? Knowledge—and some coping strategies.
Know the Terms:
Paranoia is an unrealistic concern that others are “out to get” the person or will harm them. The person with dementia, for example, may become convinced that he’s being followed by the police.
Delusions are firmly held beliefs that are not real. Dementia can trigger also paranoid delusions—Mom may believe that someone is poisoning her food, or Dad may think someone is stealing his money. No amount of arguing or reasoning helps.
A hallucination is different from a delusion. Delusions involve false beliefs, but hallucinations involve false perceptions of objects or events. When someone has a hallucination, they may hear, see, smell, taste or even feel something that isn’t really there. Hallucinations are less common but can affect people with some types of dementia.
Paranoia, delusions and occasionally hallucinations tend to occur in mid- to late-stage dementia. Confusion and memory loss can contribute to these problems as the person struggles to make sense of their world. For example, if Mom can’t remember leaving her purse in the closet, she may accuse a family member or caregiver of stealing it. If your husband doesn’t recognize a caregiver or visitor, he may believe there’s a dangerous stranger in the house.
While these accusations can be hurtful, remember that the dementia is causing these behaviors. Try not to take it personally. It’s the disease talking, not your loved one. Keep in mind, too, that for the person with dementia, these situations seem very real, even though they aren’t grounded in reality.
When to Ask the Doctor
In rare cases, paranoia, delusions or hallucinations may have a cause that is reversible or treatable. Consider the possibility that the person may be experiencing delirium—a sudden change in thinking caused by infection, surgery or other illness. Some medications can cause delusions or hallucinations as well. Drug interactions—or too much or too little of certain medications—can also affect a patient’s mental and emotional stability. If your loved one’s paranoia, delusions or hallucinations are new or came up suddenly, discuss these possibilities with your loved one’s doctor.
Ditto if you believe that delusions could lead your loved one to harm themselves or a caregiver. While the first line of treatment is through nondrug approaches, medications may be appropriate in severe cases.
Tips for Coping
First, try not to let your loved one’s suspicions get under your skin. And be sure to explain what’s happening to family, friends and caregivers. Help them understand that suspicions and false accusations are not a reflection of them. Second, try to maintain your loved one’s daily routine as much as possible. A predictable, consistent schedule will reassure the person and may help reduce anxiety.
1. Don’t argue or try to convince. Allow the person to express their ideas, and acknowledge opinions. Offer reassurance and a gentle touch. Remain calm.
2. Turn off the TV. What may seem like innocent “background noise” to you may provoke fear or confusion for your loved one. Remember that the line between reality and fantasy is often blurred in people with dementia.
3. Offer a simple answer. Don’t try to persuade the person with lengthy explanations.
4. Look for patterns. Does the behavior tend to occur at a certain time of day? Keep a log of the person’s activities, and look for ways to avoid situations that may trigger paranoia or delusions.
5. Distract and redirect. Try to switch the person’s focus to another activity. Ask them to help you with a chore, or point out something of interest.
6. Keep extras on hand. If the person tends to repeatedly lose and search for a particular item, consider keeping several available. For example, if Dad loses his wallet and thinks it’s stolen, buy two or more of the same wallet, and offer the extra one should he lose his wallet.
Finally, understand that coping with delusions, paranoia or hallucinations can be quite trying and difficult. Don’t go it alone. Join a support group or find an online forum where you can share and discuss your experiences with others who are going through the same thing.