My mother has Alzheimer's and thinks that my late father is cheating on her. How do we handle this?
My 86 year old mother was diagnosed with Alzheimer's the first of this year. My father became ill in January, was in the hospital until March, when he died. Mother remembers that he was in the hospital. However, she does not remember that he died nor that she attended the funeral. I have reminded her of these facts hundreds of times, which I found most stressful. The past week I have answered only what she asks..."Have you heard from your dad today?"..."Is he able to get up and around?"....etc. But, now she is convinced that he is chasing after the nurses in the hospital (she has dreams about this at night), found someone else, dumped her and could call and talk to her if he wanted to do so. Daily she is becoming more and more agitated at him. So, neither being truthful nor less than honest with her has worked because she forgets that he died and gets increasingly mad at him. Since neither approach has satisfied (or even soothed) her, what do I do now?
Wow! You have a very difficult issue and unfortunately, it is a very common one. I experienced the same thing with my grandmother too. I wish I could share some good news with you, but patience is going to be your primary friend here.
Patients who have dementia have their own reality and we cannot rationalize that reality or any behavior. It is what it is. I believe answering questions as they come up is the way to go. You can try answering them appropriately ("dad has left us, but he is waiting for us in heaven" or whatever you call the next life). It sounds like you've tried this but it hasn't worked. If you have a photo from the funeral, you may try using that as a prompt for bringing her around.
Sometimes, it's appropriate to allow her to vent and be angry. Losing someone or something makes us all angry. That's part of the grieving process. These are the things to keep in mind: be patient; do not rationalize; don't underestimate the value or redirection (the ability to redirect her attention to something else); and remember to take a deep breath to settle yourself before you react in a way you might regret.
There is no easy answer and I wish you patience and peace.
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This is a very common scenario in dementia and one that really causes anguish for the caregiving spouse. It is a very complicated issue. A couple of suggestions:
- This behavior stems from a few universal issues in dementia. First and most important the bioggest concern of people with dementia, whether AD, Lewy Body dementia, FTD, etc, is an over-riding fear of abandoment; particularly with AD, people know they have it and are terrified it will lead to being "dumped" by the people they love most.
So patients cling to their caregivers --this gets worse over time to the point where you can't go to the bathroom with the door closed.
People with AD lose the ability to recognize people and things over time. So the priest at your church may seem like "just another guy hitting on my wife" to the person with AD dementia.
Emotions are much closer to the surface in AD, so what might have caused a raised eyebrow before the disease, now can cause a catastropic response. The patient has literally no ability to control his feelings. So you are not going to mention the infidelity or deny it because denying it will cause emotions to escalate.
And, we've known for years that people with AD remember negative emotions far more than positive ones.
Our research showed that spouses caring for people with dementia, develop different perceptions about the patient. So whereas a wife might have described her husband in the past with terms like "Husband, lover" in mid-dementia will describe themselves as "mother, nurse, or sister." This invokes the incest taboo (there are certain people in your life to whom you do not make sexual overtures. So the caregiver may not feel as overtly amorous towards someone she now regards as her "son."
I have personally seen redirection work for this and the more it is focused on negatively the longer the person will remember it. So, your goal as caregiver is not to get the person to realize you are true and faithful. The purpose of the caregiver's actions are to diminish focus on the behavior until it goes away.
In my practice I advise caregivers to do the following five step process because it gets you past the issue quickly and in my 34 years of working with families, it works:
A. Acknowledge the patient's distress "You think I was cheating, oh Harold, I am so sorry your feel that way. I will do anything you suggest to correct it!"
B. Apologize again: "I am so so sorry you think that. I love you and have no intention of leaving you. I will try to never upset you again."
C. Agree: "If I thought that you were cheating I would be as upset as you are."
D. Play dumb and promise to fix it....even cry a little. "Oh Harold, I don't know how this happened. I will make sure it never happens again. I'm here with you and have no plans to go anywhere."
E. Why don't we get some ice cream? What flavor would you like?
(Ice cream is the great substitute for mood-controlling medications in my practice!)
Note I never said you should admit infidelity or deny it. Speak instead to that fear of abandonment. You'll find it works a lot better.
Finally, make sure you share this with any supportive family so they can support your anguish.
Geri R Hall, PhD, ARNP, GCNS, FAAN Clinical Nursae Specialist Banner Alzeimer's Institute Geri
Oops! Mia culpa! I just reread your note and saw that the husband passed. I am so sorry for your loss.
I would do two things here. 1) Stop telling her he is dead. It heightens her anxiety and makes her focus on the disturbing thoughts more. and
- Develop a "therapeutic fiblet." Fiblets are what we use to decrease anxiety and prevent it from worsening. Tell her he is on a business trip, at a convention, visiting family or a friend and that he called to say "I love you" while she was in the bathroom. Tell her he will be home "soon" (people with AD lose their sense of time so saying a day means nothing) and that he can't wait to see her.
Then I would change the subject. If she brings of cheating, treat it as a joke,, "Sure Mom, like dad would cheat on you? I've never seen a man who loves his wife more. I know he's on your mond though. What were you thinking about dad?"
You may find from that conversation that he is actually visiting her in her dreams. Very very common with the death of a spouse or significant person.
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