How do we deal with Dad's dementia delusions?

21 answers | Last updated: Nov 06, 2016
Daughterann asked...

How do we deal with Dad's dementia delusions? My dad has severe dementia and has been getting more and more suspicious and agitated. When my mom leaves the house to run errands, he's often convinced she's having an affair. He believes she and I are taking money from him and will leave him destitute. When I try to reassure him that there's no truth to any of this by showing him the checkbook or telling him specifically where my mom is going, he only gets angrier. What can I do?


Expert Answers

Kenneth Robbins, M.D., is a senior medical editor of Caring.com. He is board certified in psychiatry and internal medicine, has a master's in public health from the University of Michigan, and is a clinical professor of psychiatry at the University of Wisconsin-Madison. His current clinical practice focuses primarily on geriatrics. He has written and contributed to many articles and is frequently invited to speak on psychiatric topics, such as psychiatry and the law, depression, anxiety, dementia, and suicide risk and prevention.

Your father has developed paranoid delusions, and knowing how to respond to him is partly a matter of understanding what causes them. Delusions -- false, fixed beliefs -- are a common complication of dementia, particularly in the later stages. They're called "fixed" because no matter how good your argument is, no matter what proof you provide to show his belief is false, he can't be budged. You could have a private investigator follow your mother and film her every move to show there's no affair, or you could have the best accountants comb his finances to prove there's no wrongdoing, but it wouldn't help solve your problem.

Often the delusions in dementia are paranoid, as in your dad's case, because the delusion is in part an attempt to find something or someone to blame for why the person with dementia feels he has so little control of his life. Your father doesn't have the insight to recognize that it's his progressive dementia that's the source of his trouble. Instead, he presumes that his problem stems from someone betraying him.

The best strategy is to let your dad say what's on his mind and listen attentively. When he's done, let him know you're very sorry he feels this way, then try to gently change the subject. His belief is fixed, so trying to reason with him won't help. Agreeing with him, obviously, would open up a whole different set of potential problems.

Unfortunately, paranoid delusions can lead to aggression, so if gentle redirection isn't helpful, it's important to get professional help. A physician can evaluate him to be sure there's not a medication or a treatable medical condition triggering the delusions. If not, the doctor may broach the subject of considering an antipsychotic medication to treat the delusions.

Two important things to know about antipsychotics, though:

  1. They often decrease the intensity of delusions associated with dementia, but they aren't likely to eliminate them.
  2. The FDA has issued a severe warning about people with dementia taking antipsychotic medications. This is because there's an increased mortality risk for people with dementia who take them.

Be sure, therefore, to give careful consideration to the potential benefit such medication may provide in comparison to the potential risk.


Community Answers

Cuqui answered...

My father has exhibited some paranoia symptoms. This article is very helpful in preparing everyone else in the family on how to react to my father when he gets those feelings.


Jamccollom answered...

My father is delusional and was recently prescribed antipsychotic meds which seem to have calmed down the agitation/anger but have increased the delusions. The tips on how to handle those situations are very helpful and I plan on passing this on to my mother.


Iamagram answered...

My husband does all of those things. A little humor helps, not to make fun of him, but he always had a good sense of humor, loved to tell jokes and I know what and when is appropriate. This dialog is a wonderful help. Patience and understanding and listening is the best! We have a prescription for antipsychotic meds, but to use only in case of a severe melt down. For example we went away for 4 days and on the way home he panicked and tried to get out of the car and when we got home he accused me of disposing of his wife. It took two of our kids and about 5 hours to calm him down. I didn't have the meds then. Needless to say, no more overnite travel and we have the I.C.E. meds now.


Darlened0324 answered...

These tips are very helpful. I will talk with my husband's doctor regarding the antipsychotic medicine. His delusions are even worse late at night. Previously I would give him Ambien but it no longer seems to work.


Sz 7 answered...

As my father's oldest daughter, I was the first person in the family to recognize the symptoms that my father had shown for quite a while. At first, my sisters were thinking he was not doing too good because of my being deaf and that I COULD do a better job of taking care of him. I knew from the bottom of my heart that it was not true what they said to me. Because of my love for my father, I started to seek help for him and it was when I discovered the website, CARING.COM. I found it to be helpful. I'd recommend it to anyone who needs support.


Antoinette tong answered...

I am so grateful,as alone on caring 24x7 with Dementia. so helpful, and informative. Antoinette big hug xxxv


Sheila55 answered...

I am able to tell my mother that she and I are the only ones in the house. sometimes she believes me and sometimes she is sure I am not telling her the truth. as long as we don't go on and on about it. if she continues to insist someone else is in the house, I just say "oh". I am interested in trying antipsychotics but her other caregiver isn't. I take them myself and they work here. her agitation and restlessness are not too bad yet, so I guess we will wait. she only takes aricept now.


Redneck angel answered...

Sometimes, when all of the above doesn't relieve ths problem, just saying "Stop!", will. Last summer on an outing, my Mom decided that when we left a restruant, I left my brother in the men's room (my brother is in his late 50ies & lives in another state), stranded & without a way home. On the way home Mom pleaded for me to turn around & get him. She even started to open the door of our moving car & junp out to go back! This came up on every subsiquent trip into town for the next two months. Finally, on the way to the haridressers, I got exasperated & told her firmly, "Mom, if you don''t stop talking about this I will not be able to bring you to town ever again." She commented that it wasn't very nice of me to leave him alone in a strange town like that--she had the last word--but then dropped it. It is now 4 months & quite a few town trips later; so far, she's never mentioned it again!


Hedwig answered...

This is helpful advice in a context in which the delusional person's family members and attorney are all on the same page. But when the delusional person has a family member or two (or an attorney) engaged in actively sparking, creating and promoting the delusions (in order to deflect potential paranoid blame onto innocent family members) it is a much more challenging situation--similar to gaslighting. In such a case, the innocent family members are screwed...


Dwc answered...

My wife was prescribed risperidone (Risperdal) for her delusions about two years ago by a psychiatrist. The side effect for her were worse than the delusions. I find that with patience they will pass. I get her in the car and take her somewhere if that is appropriate to distract her. That often works, especially if I get her a little something to eat along the way. Eight years ago we wrote out a family autobiography. Showing it to her and getting her to read parts of it helps sometimes. Sometimes nothing helps but letting time pass.


Alice baby answered...

So helpful indeed. I wasn't sure what to do when my Mom would fabricate these events known as "delusions", however, my aproach had already been to just say oh, Mom, I'm so sorry that (what ever it was) and just kindly respond with the sweetest voice--She often thinks I am with her in the house and I just say"No Mom, I am here--then I redirect her thoughts to something else--this is so sad, It's so hard to see our precious parents like this-


Alice baby answered...

Oh Yes, very, very helpful. My Mom's delusions are becoming more and more undesirable. I have learned to say just that, "Mom, I am so sorry you feel that way," and I quickly think of something, even if it is made up!!!!! Then, I redirect her into a positive direction. Last night she wandered over to a neighbors' home. She did not want to come back thinking it was "unsafe" with my brother. It took some time. She was convinced and NOTHING or NOBODY was going to change her mind. I just kept saying the same thing over and over, I am sorry You feel that way, Mom. We have a nice dinner ready for you, it is very safe in the house. Finally, she responded, "Really, are you sure"" whew... got through another one..... Sometimes it takes quite a long time---not to "convince", just for them to focus on something else for the moment. This has been the most difficult time in my entire life for me to experience. However, I will give it everything I can to keep my mother comfortable and safe.


Dd0324 answered...

I talked to my husband's doctor who prescribed a mild anit-depressant. I also have found that music helps calm him down. Long trips are no longer doable for him which limits my ability to visit our grandchildren who live in other states. Unfortunately, my husband's no longer recognizes me as his wife or his girlfriend, which who I would be depending upon the time of day. I am now "a friend he has came to visit" and he continuously packs throughout the day and asks me to "take him home to his wife and family." He no longer recognizes our children and grandchildren although our two oldest children live within walking distance of us. It seems placement in assisted living is imminent; he was diagnosed in 2007.


Amcclintock answered...

These inputs have been very helpful as I have felt at a lose when mom goes into this state. There has not been anything I have found that assists her in moving beyond this place. This results in me loosing patience and speaking back to her in a logical way which I know makes no difference other then make the event escalate. I though have discovered that giving her additional meds agitate her dementia and symptoms related to it.


Jprscrprs answered...

This information was quite helpful, particularly re: paranoid dementia. My mother is 96, has had progressive paranoid dementia for many years,none of her physicians have mentioned it. I'm a Nurse Practitioner, my sister is a social worker and we recognized it fairly early, just had a hard time coping with the paranoia part. Mother also has very limited vision and hearing, though she's quite cognizant of her surroundings, local & natl politics, and other issues and conversed quite well, just doesn't recognize the dementia. The visual issues also create something called Charles Bonnet Syndrome in which there are very real hallucinations and there are times when it's difficult to determine the difference between delusions and hallucinations despite the descriptions in medical information. There are several ways to cope with the CBS and it helps her to know she has CBS, makes the delusions less fearful sometimes.


Ca-claire answered...

Luckily for me, Mom's delusions only started once she was in hospice care, and towards the end of that. Since her delusions were benign, most of the time, I just played along with them. Usually, they were about her Mother (who passed away 50 years ago when I was 5). I would just play along and say that Grandma just stepped out to run an errand and would be back. Sometimes she would just look at me when I said that, like she knew that I couldn't have just seen her, since I only saw her a few times in my life. Others, she would just say OK, and go on to the next thing. Dad who was the same age would just keep trying to explain to her that her Mother had died years ago, and then Mom would start crying. Couldn't get Dad to play along - he's the logical engineer.


Recorderist answered...

The VA neurologist prescribed Risperidol for my 84-year-old husband's paranoid delusions. For almost 30 years, he the sweetest, moststrongest, gentlest, most confident man I have ever known. The phenomenon had reared it's head three years ago, at which time it held no anger, & I was able to talk him out of it (in about 3 hr.s) each of the 3 times. Then it stopped until the beginning of the year. Suddenly, despite his being extraordinarily healthy, they hit again but with rage & aggression--directed at ME! I wound up repeatedly locking myself in the bathroom---for 2-3 hours at a time for safety reasons. After a month, the Risperidol was started, but over the next month, it did nothing but cause severe urinary incontinence problems. So I was able to sign up with a "palliative care" hospice--which Medicare pays for, & their dr. switched my husband to Seroquel. I'm a reader. Seroquel worried me. But he requires fairly little--just 1 or 2 tiny syringes worth of ATV cream to the backs of his hands which I say the dermatologist recommended. (On the hospice program, Medicare covers all his presciptions, too. Also, a nurse comes to the house twice a week to arrange for refills, check his vitals, & record notes on his condition.) At night, he gets one Seroquel pill at lowest dose made. This has ALMOST stopped the delusions completely—at leadt for now. And I'm starting to come out of the PTSD with constant wakefulness & nightmares. Problem, even when the paranoia is about someone else, the anger is directed at me. It hits & escalates rapidly. Now, he's even reverted to his affectionate self, so we're BOTH much happier. His troubles might come at any time of day but were worst at night--sometimes late. His body language & intense quietness right before the storm came to alert me.


A fellow caregiver answered...

My father has delusions and is very angry. Two doctor groups refuse to see him anymore and now there is no doctor to take him to.. He blames the doctors and me for his getting his driver's license taken away but he drives anyway. Most people cannot tell that there is anything wrong with him. His long-term memory is excellent and he knows his personal information. He tells us we are ugly, fat, stealing from him, and talking about him. He cancelled all his insurance on the car and house and says we are all out to get his money (he has very little). The bank told Social Security he was dead after he took his money out of his account. My siblings and I are afraid of him and it takes a lot of courage to visit him or call him.


A fellow caregiver answered...

All the finger pointing and people chiming in about how their parents must be delusional is disgusting. Yes, some of them certainly are, but others are using loose metaphors (e.g. feeling unsafe with a brother meaning that emotionally being around that person isn't good for your parent) and their children are misinterpreting it on a literal level that seems reminiscent of a self-unaware person with autism.

If you genuinely feel it's sad and unfortunate that your parent is slipping -- if they genuinely are falling away from reality and not disagreeing with you on quite possibly subjective things -- you should take a different, more human response.

For one specific poster, you would certainly not be talking about how medication that dampens their emotions and simultaneously causes them to suffer from further delusions is somehow "helping" because you no longer have to deal with unwanted negativity.

I just can't say any more than this. I'm riled enough as is. Those of you who are branching delusions into subjective disagreements are sick people and should not be allowed to harm others like you already are.


A fellow caregiver answered...

Whoa, speaking of delusions, where did that come from?