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How do I deal with delusions?

It can be one of the most upsetting things about being a family caregiver. You're always at your mom’s beck and call. You spend hours helping her, take over household chores, drive her to medical appointments, struggle with her personal care. Yet instead of thanks, you get accusations: “You’ve taken my purse! You’re stealing my money.” Then, as usual, after a few minutes’ search, the purse turns up under the pillow, where Mom hid and forgot it.

Delusions—fixed, false ideas—are quite common with Alzheimer’s disease and the other dementias. Often they can simply be caused by the very nature of the forgetfulness of these diseases: Like many seniors, Mother hid her purse “to keep it safe.” However, she forgets that she put in under the pillow so now it’s missing. You are the only person who has visited; therefore, you must be the guilty party.

Likewise, mistaken identity, another common delusion, can be caused by forgetfulness. As painful as it may be, your father may not remember what his wife, daughter, or son look like, so he no longer recognizes them. Or, forgetful and confused, he may think he is 40 years old, not 80, and so may mistake his grandson for his son.

Sometimes delusions are more mysterious. A person with dementia may decide that the neighbors have moved the fence in six feet during the night or that someone is constantly breaking into the house.

In any case, delusions can be frightening and painful for both the senior and the family. If you are caring for someone who is experiencing delusions, consider these tips:

  • Try not to overreact or get upset, even if, like the false accusation, the delusion is upsetting. Remember, a real disease or disorder is attacking the brain. It’s the disease at work, not the person.

  • In cases of mistaken identity, try offering some gentle cues. “Gosh, honey, it’s me, Mary, your wife!” You can help maintain another’s dignity by saying, “You’ve got such a sense of humor” or “I know I look young enough to be your daughter.”

  • Let the person know you have heard his or her concern. “Mom, I’m so sorry your purse is missing. That is upsetting. Let’s look around just in case it accidentally got misplaced.” You can then celebrate with a big smile and hug when you “find” the purse.

  • “Tell me about that purse. Is it the red one or blue one?” Asking additional questions can allow the person to tell you more about worries and concerns.

  • Don’t argue. You can almost never talk the person out of a belief or concern or convince him that he or she is wrong. If your family member thinks the fence has been moved, say that you will work on getting to the bottom of the situation or call the county to investigate.

  • Take advantage of the passage of time. Sometimes your best efforts will fail and the person will continue to express the delusion. If you provide ongoing reassurance and take a low-key approach, these delusions will go away on their own.

Delusions can be one of the most challenging symptoms of Alzheimer’s disease and other dementias. If they become overwhelming, consider consulting a professional. Reach out to the person’s doctor, a geriatric care manager, or a professional caregiver who has received training in handling challenging behaviors like dementia.

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Thoughts and stories from others

  1. October 23, 2016 at 01:32 pm
    Posted by Adaeze Nwogo

    My brother has Alzheimer's disease. He hides his money and wallet and says that someone has taken them. He says that people are using his toilet and messing it up so he pulls out the toilet seat and brushes the toilet. He says that the walls of the house are moving and the house will collapse any minute. I think he has hallucinations and delusions. Can one have the two at the same time.? It is very upsetting when I watch him in this state and I feel helpless. No idea how to help my brother live normally again and I feel very sad and emotionally drained.
  2. June 19, 2016 at 10:28 pm
    Posted by Lindy

    Thanks for sharing this story. My mother-in-law came to live with our family two+ years ago - her Alzeihmers hasn't got much worse in those two years but I feel like I've aged at least ten years. Almost every day she accuses me of stealing her purse - usually it turns up. Other times I 'find' another purse - fortunately she has about a dozen old purses. She also constantly swears and calls me hurtful names - I feel fragile - like my home is no longer my own. Just seeing that someone else gets accused of stealing when they haven't stolen is great comfort. Thanks
  3. June 15, 2016 at 10:56 pm
    Posted by Mary Donna Fan

    My mother has undiagnosed mental illness because she refuses to acknowledge it. Our family has history although I know environment can be the source of her breakdown as well. It effectively managed to systematically destroy her life and relationships to other people as well. She was married to a patient and loving husband who she then left after 27 years because she suddenly realized that she is inlove with her ex boyfriend. She became fixated with him after receiving a return call and became obsessed that she just left her husband and came back home to chase after the ex.

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