Dementia can mean dealing with delusions
Creating a calm environment and making sure the person is well-rested can help
My dad has dementia and started saying really weird things lately. He is talking to himself or to someone who isn’t there. He has blamed mom for having an affair (untrue) and throws things around. I am so distressed about this sudden change.
As many as 90 per cent of people with dementia exhibit some type of challenging behaviour related to the deterioration of the brain. This tends to occur in the middle to later stage of the disease but can vary from person to person. Many health professionals now refer to them as “responsive” behaviours.
The brief description you gave makes it sound like your dad may be suffering from hallucinations and delusions. Hallucinations are false perceptions that involve the senses. The individual may smell, feel, see or hear things that are not there. For example, they may feel insects crawling on their body and obviously be very disturbed by the sensation. The person may also hear someone talking to them and engage in a discussion.
Delusions are false, fixed beliefs. The affair that your dad is describing sounds like it may be of this nature. Another common delusion is the false belief that individuals are stealing items from them.
It is imperative to start off with a proper checkup, since hallucinations and delusions do not only stem from dementia. They may originate from another, underlying health issue like dehydration, respiratory or bladder infections, or other undiagnosed medical issues.
Changes in eyesight and hearing can also be contributing factors, and should be checked out regularly. Even if not the cause, they can contribute to more difficulty coping with a changing brain.
It is also important to remember that not all delusions are upsetting to the person with dementia. If it is a comforting thought, even if strange, then it may be better left alone. Their environment can trigger confusion as well as hallucinations or delusions. Some com- mon triggers are mirrors, or shadows of light that can occur in hallways. Specific noises can also cause upset.
Changes to routine can be difficult for some people, as they can no longer respond and accommodate the change. They therefore fill-in their reality with a story that is sensible in their world. A television show may trigger a memory and the individual may incorporate it. Boredom or overactivity can exacerbate this behaviour too.
Non-medicinal approaches are the first line to deal with these problems. Some of these issues can be addressed by gaining an understanding of the unmet needs of the individual, things they themselves cannot now express. Changing the environment to help the person feel safe and secure is a good start. As well, arguing and being confrontational is not a suc- cessful tactic. In fact, it has an opposite effect. Distraction, redirection, calm environment and making sure the person is well-rested are all actions that can help.
Sometimes there is no reprieve and medication needs to be considered. This is a decision that you and the physician should look at carefully.
Knowing the risks and benefits, understanding what behaviour or change you are targeting, and starting slow to monitor the drug’s impact is critical. For some people, medications make life much more pleasant and fulfilling, but it is important to be informed of the risks attached to any pharmacological intervention.
As a caregiver, hallucinations and delusions are difficult to watch and deal with. However, there are specialized resources that can assist caregivers with these and other behaviours. For information check out: behaviouralsupportsontario.ca or speak to the health-care provider who helps with your dementia care needs.
Education about techniques and support are critical to help you and the person with dementia find a way to manage in this difficult time. Nira Rittenberg is an occupational therapist who specializes in geriatrics and dementia care at Baycrest Health Sciences Centre and in private practice. She is co-author of Dementia A Caregiver’s Guide available at baycrest.org/dacg. Email questions to caregivingwithnira@baycrest.org.