By JUDD MATSUNAGA, Esq.

Have you ever forgotten where you parked your car? As you walk up and down the aisles searching for your vehicle, do you think – even for a second – that your car has been stolen? If so, you just had a fleeting moment of paranoia. For most of us, the paranoia passes quickly as our memory kicks into gear, and we find our car exactly where we left it.

Now, just for a moment, let’s put ourselves in the shoes of an older adult with dementia. You can see how these same feelings, plus memory loss and confusion, can easily lead to paranoia. We tend to label seniors with dementia as “paranoid,” as if we have never experienced paranoid feelings. Oddly, we can’t even begin to understand such odd behavior, e.g., “Are you crazy???”

Seniors with dementia or Alzheimer’s have brains that are failing, and the delusions and paranoia are symptoms of the disease. Their minds are trying to make sense of the world while their cognitive abilities are declining. Their brains can’t make sense of what’s happening and have created an alternate version of reality to compensate. Although not grounded, the situation is very real to the person with dementia.

For example, when they can’t find something they’ve misplaced, their brain leads them to believe that someone stole from them. Or, when you prevent them from wandering and getting lost, they think they’re being kept prisoner. That’s why many seniors with dementia feel like people are stealing from them or mistreating them. They often feel anxiety, frustration, and a sense of loss.

Sadly, it’s the people closest to them that they often accuse of theft, mistreatment, or other terrible things, e.g., “You stole my wallet and all my money!,” “You’re keeping me prisoner in my house!,” “You’re trying to poison me!” Their accusations may sound crazy, but the situation is very real to your older adult.
    
For family members who struggle with daily care, such accusations are painful and difficult to understand. So it’s extremely important to remember that they’re not personal attacks against you. It’s also important to remember that your older adult isn’t creating these delusions to hurt you and to try not to take offense.

I know, “Easier said than done.” So after reading several articles from board-certified geriatricians and other experts, here are eight ways to deal with false dementia accusations (Sources: https://betterhealthwhileaging.net/,  www.helpforalzheimersfamilies.com; https://dailycaring.com and  https://www.alz.org/help-support/caregiving):

1. Don’t take it personally

Don’t take offense. Remember that your older adult is only making these accusations because of their declining cognitive abilities. They’re trying to make sense of their reality as best they can.  Listen to what is troubling the person and try to understand that reality.

Allow the individual to express ideas. Acknowledge his or her opinions. Then be reassuring, and let the person know you care. Do your best to stay calm and not to take these accusations personally. Focus on reassuring them and showing that you care about how they’re feeling.
    
2. Don’t argue or use logic to convince

The natural response for anyone who has been wrongly accused of stealing or failing to provide food is to argue and defend one’s honor. However, for the person with dementia, such a response will only result in less trust, increased paranoia, and a lot of unnecessary conflict.

It’s important not to argue or use logic to convince someone with dementia that they’re wrong. You simply can’t win an argument with someone whose brain no longer processes logic properly. Don’t argue or try to convince; arguing will only make them upset and more insistent. Don’t overwhelm the person with lengthy explanations or reasons.

Instead, let them express their ideas, feelings, and opinions. It will be easier to calm and distract them if they feel heard and validated. If you are accused of something, even if you didn’t do it, calmly apologize and take blame. If someone else is accused, stay calm and look for an opportunity to change the subject. Offer a simple answer.

3. Use a calm, soothing tone and positive body language

When responding to someone who is worked up over something they strongly believe, it’s essential to stay calm. Bring the adrenaline level of the situation down by speaking in a gentle, calm tone of voice. Simply letting him or her vent for a moment, taking the blame and changing the subject may be enough to get your loved one to calm down.

Share your thoughts with the individual, but keep it simple. You may also want to try reassuring them in non-verbal ways like a gentle touch or hug.
    
4. Create a calm environment

Creating a calm environment is another way to reduce the tension in the situation. Reduce noise and commotion by turning off the TV, asking other people to leave the room, or playing slow songs or classical music at a low volume. Aroma therapy is another way to create a soothing environment.

5. Stick to simple answers

When you respond to their accusations, keep your responses short and simple. Long explanations or reasoning may be overwhelming and cause more agitation and confusion.

If you are accused of stealing, try not to use the words “lost” or “stolen.” Resist the urge to mention how many times the item has been lost in the past. Validate your loved one’s feelings by saying, “That must be difficult for you to be without your special pin,” or “I can imagine how hard it is not to have your wallet.”  

If you are accused of withholding food, validate feelings by saying, “Let’s see if we can find something for you to eat.” Then, provide a healthy snack. Don’t discuss the recent meal that has been forgotten. Such a discussion will only cause anger and a loss of trust in you.

6. Distract with a pleasant activity

The best way to stop them from obsessing about their accusation is to validate, then distract. Switch the focus to another activity. Switch to a fun, engaging, or satisfying activity as soon as possible after sympathizing with how they feel.

Engage the individual in an activity, or ask for help with a chore. Maybe it’s a good time to offer a favorite snack or drink. Or you could ask for help with a no-fail task they enjoy, like folding “laundry” (a.k.a. lots of hand towels).

7. Keep duplicates of frequently misplaced items

If you notice a pattern where your older adult frequently hides and then loses a certain item, consider buying multiples of that item. For example, if they’re constantly misplacing their wallet, buy another of the same style so you can offer to help them “find” it.

Duplicate any lost items. If the person is often searching for a specific item, have several available. For example, if the individual is always looking for his or her wallet, purchase two of the same kind.

8. Seek support and advice from people who understand

Being accused of stealing, abuse, or other terrible things can be devastating. Even if you can hide your true feelings to avoid further upsetting your older adult, it still hurts inside. To help you cope, join a caregiver support group – either in person or online. It truly helps to know you’re not the only one it’s happening to. You’ll be surprised and relieved to learn that many other people have been accused of similar untrue things.

In conclusion, if your loved one is having severe delusions and there is a fear of self-harm or caregiver harm, or if the delusion or hallucination is extremely troubling to the person, it’s important to have a medical evaluation to determine if medication is needed. Ask your loved one’s physician about ways to help them feel secure and safe.

The first line of treatment for the behavioral symptoms of Alzheimer’s is non-drug approaches, but if these strategies fail and symptoms are severe, medication may be appropriate. Be careful; while antipsychotic medications can be effective in some situations, they are also associated with an increased risk of stroke and death in older adults with dementia.

See the doctor to learn both the risks and benefits of medication before making a decision. You may consider hiring a professional caregiver to help with activities or enroll your loved one in an adult day care center. Or consider hiring good in-home care. Make sure caregivers understand that suspicions and false accusations are caused by the disease and are not a reflection of them.

If you can afford it, a geriatric care manager can be a huge help. They can assess your loved one and his or her situation. As a neutral third party and an expert at human relations, care managers can act as a buffer between your loved one and you and your family. Finally, be sure legal papers are in order in case the police are called.

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Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.

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