My mother with dementia keeps threatening to kill me, how should I handle this?

A fellow caregiver asked...

My mother has not had a full neurological exam, but has been diagnosed with dementia. She is no longer able to write a check or to know what a bill is. She is very functional and healthy except for the dementia. I brought her to my home 2 weeks ago and she can't remember why she is here. She really thinks I kidnapped her and daily tells me repeatedly that if she could figure out a way to kill me she would. Constantly being told that you are hated and threatened is causing me to wonder if I can care for her. Mom has always been strong willed but not hateful. She even tells strangers that she wants to kill me. This is all new to me and I have never been around anyone that. has this disease. Also how do you get someone to a doctor against their will?

Expert Answer

Helene Bergman, LMSW, is a certified geriatric care manager (C-ASWCM) and owner of Elder Care Alternatives, a professional geriatric care management business in New York City. She consults with nursing homes and daycare programs to develop specialized programs for Alzheimer's patients.

Behavior changes often accompany dementia and unfortunately, family members on the 'frontline' are often the target of verbal and sometimes physical aggressiveness. Your mother appears to be suffering from delusions, a very common symptom of dementia. Persons with memory loss or other cognitive impairments like disorientation will make up explanations that help them to understand what is going on. They are confused and this is their 'functional' behavior. Her perception of reality seems significantly impaired and thus she thinks you have 'kidnapped' her or want to hurt her. Her response of threatening to kill you is her defense; she sees she is not in 'her home' or her comfort zone and cannot remember or understand why.

Education about how to treat delusionary behavior will be helpful. If there is a local Alzheimer Association chapter, perhaps they offer educational sessions about coping with behaviors. It is often recommended that if someones delusion is not dangerous, that you enter into it with the person instead of being adversarial and trying to deny their accusation. Of course, safety and security are priorities. Therefore, if you promise your mother that she will be safe with you and you will return her to her home soon, perhaps she will not threaten you. There are pharmacological ways to treat delusions too and if you cannot get your mom to the doctor perhaps you can access a mobile crisis team to provide crisis intervention. If your area does not offer such homebound supports, then you will need to convince her to go out (perhaps for lunch) and manipulate her to the doctor for help. Think of her delusions as you would physical pain- it requires treatment.