HOW TO RESPOND TO DEMENTIA DELUSIONS
False accusations can be tough to handle
People with Alzheimer’s disease or dementia might accuse those closest to them of terrible things or believe that other bad things are happening.
There are some cases of true abuse, but many of these false accusations and beliefs are caused by dementia delusions – firmly held beliefs that aren’t real.
Regardless of the cause, it’s difficult to hear your older adult accuse you of terrible things or to watch them be overwhelmed with fear or anxiety.
Do your best to be patient with them and remind yourself that dementia is causing their brain to play tricks on them.
They’re not saying hurtful things on purpose and they’re not being overly dramatic or lying – it’s all very real to them.
We explain why using logic and reason doesn’t work when someone believes in a delusion and share ideas for responding to 4 top dementia delusions: being abused, you’re a stranger, someone’s after me, and there are bugs everywhere.
Avoid using logic, reason, or facts to respond
When your older adult is convinced of a delusion, don’t use reason to explain why it’s not true or try to show proof that they’re wrong.
Their brain is damaged by the dementia and is no longer able to process those logical explanations. Using reason will only upset them further.
Instead, do your best to validate their feelings, let them know that you’re on their side, and help them feel calmer.
Then, redirect them to a pleasant topic or distract them with an activity they enjoy.
We’ve got some suggestions for how to respond to common dementia delusions. But you know your older adult best, so use these ideas as a starting point for answers that are most likely to work for them.
It takes a little practice and experimenting to get used to the validate and redirect technique, but it will get easier over time.
How to respond to 4 top dementia delusions
1. You’re attacking me! You’re hurting me! Get away!
Sometimes when we approach someone with dementia, we can accidentally startle them.
That can trigger a natural “fight or flight” response and cause them to panic and feel attacked.
Even if you’re only offering to help with an essential task, their fright can completely overwhelm them and all they can focus on is feeling like they’re being attacked or abused.
Immediately back away and give them some space
Keep your voice calm and use a soft, soothing tone when speaking
Get to eye level so you can make eye contact (maintaining a comfortable distance so they don’t feel crowded)
Say something like “Oh no, I think I surprised you by accident. I’m so sorry. Are you all right?”
If you were intending to help them with a task, give them a little time to recover and when they’re calm, try the task again using a more gentle approach.
2. Who are you?? I don’t know you and I want to leave!
Someone with dementia may get confused about the identity of the people around them.
This is heartbreaking, but it’s important to remember that the person with dementia isn’t doing it on purpose and can’t “try harder” to remember.
That’s why it doesn’t help to tell them who you are.
In fact, insisting that you’re their spouse, child, or relative can backfire because they’re already feeling confused and possibly scared. That may cause them to dig in their heels and insist that they don’t know you or that you’re not who you claim to be.
Instead, do your best to remain calm and try one of these responses.
You must be very close to [person’s name]. Tell me more about them.
Let me see if I can find [person’s name] for you. I’ll be right back. – sometimes leaving the room for a few minutes can reset the situation and they may have a completely different reaction when you return. And it gives you a chance to recover from the emotional shock yourself.
[Person’s name] just called and wanted me to let you know that they’re at the store / at work / etc. and will be back in a bit. [The person] asked me to keep you company until they get back. Why don’t we get a snack / do their favorite activity / etc.?
Ok, let’s go get your jacket. [Walk them toward the closet and on the way, find something to distract them like a snack or activity.]
Would you like to use the restroom before you go? [Use that as an opportunity to find a distraction.
3. Someone is after me! They’re following me and watching me.
The general disorientation and paranoia of dementia can cause someone to feel anxious and afraid.
This can lead to intense beliefs that people are following them or out to “get” them.
Some of these fears could even be caused by tricks their eyes play on them as dementia changes their perception of vision.
For example, they may think they’re seeing people in the shadows or mistake a lamp or large piece of furniture for a lurking person.
To reduce fears, keep the room well lit to eliminate shadows and remember to draw the curtains before dark so reflections won’t form. Then, try some of these suggestions.
Oh no, that’s terrible! Tell me what’s happening.
I can understand why you’d be afraid. I’m going to stay right here with you to make sure that you’re safe.
That would scare me too. Let me call the police and ask them to send a patrol car to watch over the house. [Just pretend to call]
That’s scary. How about if I double check the locks on the doors and windows and set the alarm system? That way nobody will get in here. [Fib about having an alarm system if that will help.
4. Seeing insects on food or everywhere
Some people with dementia refuse to eat because they claim that bugs are crawling all over their food. Others insist that bugs are on their own body or on surfaces all around them.
If this happens, it’s not helpful to tell your older adult that there are no bugs.
Dementia’s effect on their brain has convinced them of this and there’s nothing you can say that will change their mind.
Instead, validate their belief and find creative ways to solve the “problem.”
Provide them with “bug spray” so they can get rid of any insects they see. It’s safest to use plain water in a small spray bottle so they can spray it on their food or body if they like.
If someone is primarily concerned about bugs on their skin, give them some gentle body lotion and say that it’s a special bug repellent. It’s also possible that their skin is dry and they’re feeling itchy, so the lotion would help with that as well.
Some people may have a solution in mind to get rid of the bugs. Gently ask for their advice and if you can safely do so, pretend to follow it. For example, if they ask for a specific type of bug spray, tape a picture of the brand’s logo to a spray bottle of water. Or, maybe they feel that wiping or vacuuming the area would work.
Ask them how the insects are getting into the house. If they point to a location, make a show of sealing it up so the insects can no longer get in.
Pretend to place a call to an insect spraying service that will arrive in 20 minutes to spray the entire outside of the house and yard to prevent any more insects from ever getting in again.