Should You Agree With Dementia Patients Delusions
One day, a couple of years into this saga, a psychiatrist caught wind of what I was doing. He chewed me out royally. He was adamant that I was supposed to ground Dad and bring him back to reality. My purpose was to correct and redirect him. In this doctor’s eyes, I had no business playing along with a dementia patients delusions.
Hogwash, I thought. I knew my father was no longer capable of meeting me in my version of reality, and I refused to torture him by trying to force the impossible. If I argued that he was delusional, he would feel degraded and disrespected. This doctors reasoning made no sense to me. I still had my brain, so why couldn’t I put Dads anxiety to rest by joining him in his reality?
The funny thing is, a few years later, a different psychiatrist came into Dad’s room and was admiring his wall of achievements.
I didn’t know he was a doctor, he remarked to one of the nurses.
He’s not, the nurse said with a grin. She explained my secretarial duties, which caused the psychiatrist to burst out laughing.
Later, he approached me and asked where I had learned my technique for coping with dementia-related delusions.
I’m his daughter, I replied. That’s all I needed to cope.
Help With Incontinence And Using The Toilet
People with dementia may often experience problems with going to the toilet.
Problems can be caused by:
- urinary tract infections
- constipation, which can cause added pressure on the bladder
- some medicines
Sometimes the person with dementia may simply forget they need the toilet or where the toilet is.
If You’re Struggling To Cope
Carers often find it difficult to talk about the stress involved with caring. If you feel like you’re not managing, don’t feel guilty. There’s help and support available.
You may benefit from counselling or another talking therapy, which may be available online.
Talk to your GP or if you prefer, you can refer yourself directly to a psychological therapies service.
Who Should Tell The Patient
Pratt and Wilkinson found that the impact of being given the diagnosis was more important than concern about who had disclosed it and in what circumstances. In fact, many patients could not remember who had given them the diagnosis, but they were able to remember how they had felt when they were told.
The Alzheimers Disease Society identified the importance of the role of the GP in diagnosis. Since most people present to their GP with early symptoms and are likely to have a relationship with their doctor, GPs could fulfil the role of giving the diagnosis to the patient. However, Downes identifies that lack of knowledge may reduce the likelihood of the GP diagnosing dementia.
Hallucinations Delusions And Paranoia Symptoms In Dementia
Hallucinations are when a senior or any person has an inaccurate perception of events or objects. This phenomenon is sensory in nature and can occur at any time, for various lengths of time. A senior suffering from dementia or Alzheimers disease will often hallucinate. During these episodes, they will smell, hear, feel, taste, and even see things or events that are not actually there. These episodes can be minor such as seeing bugs or animals or as dramatic as seeing and interacting with a person who is not present.
Seniors with dementia who experience delusions are those who hold firm to a false belief or idea. Most often, this is due to misinterpreting what has been said or a situation. Delusions can be both positive experiences and negative experiences for the senior. For example, one experiencing a positive delusion may have an idea that they are being called upon to assist with something important where the actual activity doesnt exist.
Paranoia is a form of delusion that is always negative. Many seniors with dementia that suffer from paranoia imagine that those around them are stealing, harming them, or plotting their demise. It is important to remember that suspicious paranoia is a common side effect of the dementia disorder, but there may be times where their feelings are based on actual experiences.
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Why Not Try This
Challenging dementia behaviors can be super-stressful. This basic approach can help stretch your patience and move you both toward a more peaceful quality of life.
Best of all, you can start using the Why-This, Try-This approach right away, even if youve been responding differently before.
To make these steps simple to refer to, Ive compiled a free downloadable PDF, 7 Steps to Managing Difficult Dementia Behaviors Without Medication, A Surviving Alzheimers Cheatsheet.
Get Your Free Managing Dementia Behaviors Cheatsheet.
Questions, suggestions, or try tips that work well for you? Please post them below!
Paula Spencer Scott is the author of Surviving Alzheimers: Practical Tips and Soul-Saving Wisdom for Caregivers . You can learn more at survivingalz.com.
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Do Offer Assurance Often
Many times, people with dementia may experience feelings of isolation, fear, loneliness or confusion. They may not be able to express this in the right way and thus may wander off or keep saying that they want to go back home, especially if they are in a senior living facility. This is not the time to shut them out. Its a good idea to assure them that they are safe and in a good place.
If you are close enough, provide a comforting hug every once in a while and remind them that they are in a place that has their best interest at heart. Where possible, engage in exercise or take a walk as even light physical activity may help to reduce agitation, restlessness and anxiety.
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Paranoia Delusion And Hallucinations
Distortions of reality, such as paranoia, delusions, and hallucinations, can be another result of the disease process in dementia. Not everyone with dementia develops these symptoms, but they can make dementia much more difficult to handle.
Lewy body dementia, in particular, increases the likelihood of delusions and hallucinations, although they can occur in all types of dementia.
Patient Who Does Not Want To Know
Nine participants did not want to know what was wrong with them or to receive any information about their illness. Although we did not asked them why, some of them spontaneously tried to explain their choice. Their motives seem to display a wide spectrum from probably full insight through more or less conscious decisions not to know the truth to complete denial of their illness .
I could not find any clinical or demographic characteristics indicating those who would prefer to be told from those who would not.
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Do Not Shy Away From Asking For Help
No one may have all the answers especially when it comes to taking care of a person with dementia. Try doing research on how their behavior changes and what needs to be done to help them live their lives without too many complications. Hire help when it becomes too much as it also ensures that you do not become too frustrated or drained. When you have multiple family members who can help, ask everyone to pitch in and look after the patient so that you can get some personal space to breathe and re-energize when it is your time to look after the patient. When you feel like you can no longer look after your loved one at your own home, it may be time to consider assisted living. In such case, look into dementia care homes that can provide specially trained professionals.
Environment Modification & Medical Intervention
Changing the environment is another effective way to reduce or even abort an episode of delusion or hallucination. If a person imagines they see people in the window, you can open or close the curtains to modify the environment. Maintaining a well-lit space is another way to reduce fear by eliminating shadows. Some seniors may have trouble identifying themselves during an episode and will claim that a stranger is looking at them through the mirror. Covering the mirror or moving them away from it will help reduce the intensity of their episode. Many seniors who suffer from dementia will feel that people are stealing from them. In actuality, most often items have simply been lost, misplaced, or put away in a new location. Keeping duplicates of commonly lost items on hand can also help arrest an episode.
Most holistic and interactive interventions work well for seniors suffering from dementia, but there are times when medications may be the only option. A medical professional can evaluate the senior to ascertain if medication to reduce delusions and hallucinations is the best option. Seniors who suffer from separate mental illnesses like schizophrenia may be suffering from delusions and hallucinations due to that condition and not dementia.
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‘your Brother Died 10 Years Ago’
A person living with dementia may forget about a past bereavement or ask for somebody who has passed away. But reminding them of a loved one’s death can be painful, even causing them to relive the grief they’ve already experienced. How carers should respond to this may vary for different circumstances, but it’s always good to show sensitivity.
Try this instead:
It may be better to come up with another reason for somebody’s absence, while at other times a gentle reminder is appropriate. In the later stages of dementia, trying to remind them that the person has died is unlikely to work and may be best avoided.
Encouraging Someone With Dementia To Communicate
Try to start conversations with the person you’re looking after, especially if you notice that they’re starting fewer conversations themselves. It can help to:
- speak clearly and slowly, using short sentences
- make eye contact with the person when they’re talking or asking questions
- give them time to respond, because they may feel pressured if you try to speed up their answers
- encourage them to join in conversations with others, where possible
- let them speak for themselves during discussions about their welfare or health issues
- try not to patronise them, or ridicule what they say
- acknowledge what they have said, even if they do not answer your question, or what they say seems out of context show that you’ve heard them and encourage them to say more about their answer
- give them simple choices avoid creating complicated choices or options for them
- use other ways to communicate such as rephrasing questions because they cannot answer in the way they used to
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Dont Counter Aggressive Behavior
People with dementia and/or Alzheimer’s may become aggressive in response to the environment. Bath time is often when the aggressive behavior is displayed. The caregivers and/or family member’s approach may also play a part. Rushing, speaking harshly, or forcing a person may result in an aggressive response. When someone with memory loss displays aggressive behavior, it is a form of communication. It may be the only way a person has left to say, Pay attention to me! I don’t want to take a bath! When someone is communicating vigorously, it is the caregivers and/or family member’s job to respect that communication. Hitting, kicking, or biting are ways of saying, stop. The appropriate response is to stop. That doesnt mean not to try again in five minutes or a half an hour.
Do Not Try To Stop A Person Who Wants To Leave A Room
Staying in one place for long periods may result in behavior problems in the dementia patient. It is essential to have a safe environment where they can enjoy the outdoors without any problem. When someone tries to leave a room, do not force them to stop. Doing this may result in an extreme reaction such as severe distress or injuries.
Instead, it is best to accompany the patient so that they are safe. You can even suggest going for a drive around the block so that they can experience a new environment for a short period. If they do not want company, just let them go but stay close by to make sure that the patient is safe at all times.
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What Have You Been Told About Your Illness
Of the 30 participants, 20 reported that nobody had ever talked with them about their illness. Only 5 had had an opportunity to discuss it with their physicians. Sometimes the information was provided by nurses and friends but never by the family members. Only 1 participant said that she had been told her diagnosis. In 2 cases, the professionals attempted to reassure the patients and advised them to take prescribed medication. Three participants reported clearly untrue explanations allegedly given by their physicians: hearing impairment, angina pectoris, and bereavement had been suggested as responsible for their present conditions. Two participants declared that the content of the information they were given was insulting . Two participants either did not remember or could not understand what the informers had been trying to tell them.
Do Keep Eye Contact When Speaking
Communicating with a dementia patient requires a lot of patience, especially during later stages of dementia. It is vital to ensure that you talk in a place that has good lighting, a place that is quiet and without too many distractions. Do not try and stand over the person you are talking to, but rather try to be at their level and keep eye contact at all times. Take care to make sure that body language is relaxed and open. Prepare to spend quality time with the person so that they do not feel rushed or like they are a bother.
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S For Communicating With Someone With Dementia
- Keep yourself in the persons eyeline, and try not to suddenly appear from the side or from behind
- Speak clearly and in short sentences
- If the person is struggling to recognise you, introduce yourself and tell them about the connection between you, for instance: Hello mum, its Julie and I have little Danny, your grandson with me.
- Be reassuring look the person in the eye and smile
- If a person with dementia is getting agitated, take yourself to another room for a few minutes before coming back in, calmly, and saying something like: Hello, Im back now, how lovely to see you.
- Try not to correct the person if they get your name wrong or say something that isnt true this can lead to distress and frustration on all sides. Try to imagine how the person with dementia is feeling
Remember, not being recognised does not mean you are totally forgotten.
Major Signs You May Have Dementia According To Experts
Dementia is a disorder that affects more than 55 million people worldwide according to the World Health Organization. “It is unclear why dementia affects so many people. Unfortunately dementia is a degenerative process and patients can develop dementia with advancing age,” says Dr. Parham Yashar, MD FACS FAANS Board Certified Neurosurgeon at Dignity Health Northridge Hospital. It’s caused when brain cells are damaged, which prevents the brain cells from communicating with each other. As a result, memory, thinking and behavior can be affected. There’s several signs that indicate someone has dementia and Eat This, Not That! Health spoke with Dr. Yashar and the Alzheimer’s Association who explained the symptoms to watch out for. Read onand to ensure your health and the health of others, don’t miss theseSure Signs You’ve Already Had COVID.
According to Dr. Yashar,“The biggest complaint that patients do experience with dementia is forgetfulness.”
The Alzheimer’s Association adds, “Some memory changes can be a normal part of the aging process, but when changes start to interfere with daily living or stray drastically from the person’s normal behavior, it is best to get it checked. Some forms of cognitive decline are treatable, but even if it’s something more serious, getting a proper diagnosis will allow you to manage the condition optimally.”
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What Do You Think Is Wrong With You
I assumed that the participants had adequate insight if they were able to give the correct diagnosis or, at least, to describe adequately their main symptoms. Of the 30 participants, 14 fulfilled these criteria. Most complained of problems with memory. No participant used the word dementia, but a few were able to accurately describe their conditions. Examples are shown in the first box.
The rest of the participants either denied any problems or gave implausible explanations for their predicaments, such as: loneliness,old age,stomach upset, and the like. Four patients simply said don’t know without further elaboration.
Arguments For Limited Truth
Arguments for limited disclosure and deception quoted by Beauchamp and Childress include the following.
Honesty should not be confused with cruel openness, and if disclosure of the information seems to be harmful to the patient, the physician may be justified in withholding the information or even in using benevolent deception. The therapeutic privilege has a long tradition in medical practice, although more recently it has been criticized as an example of unacceptable paternalism. Misleading the patient contributes to the cult of expertise surrounding the medical profession and to a view of physicians not as providing a service, but as guardians of a special wisdom that they may determine when, and to whom, to divulge. However, paternalism frequently appears to be unavoidable in dementia care, and some professionals still defend telling lies to cognitively impaired patients. After all, anxiety, depression, and catastrophic and psychotic reactions do occur as the result of disclosure, and even suicides committed by patients unable to live with the burden have been reported.
Patients are not able to understand the information
Some patients do not want to know the truth about their condition