The brain of a person struggling with dementia can begin to link facts and details in unusual ways. As the brain starts to change, a false-memory phenomenon can begin to occur. This causes the individual to perceive reality differently than those around him or her, and can lead to hurtful behavior toward caregivers.
One common scenario experienced by caregivers of those with dementia is being falsely accused of things they didn’t do, such as theft, mistreatment, poisoning, or keeping the individual prisoner. Since those with dementia are typically no longer in control of their money, they may feel that a caregiver has stolen their cash. Since they can easily misplace things (like glasses or a TV remote control), they may think caregivers are stealing their belongings. When they are no longer the ones preparing their meals, they may suspiciously think their food or drink is poisoned. Since they are now more housebound than they used to be, it is easy to begin to feel they are being held hostage.
By understanding where these false accusations are coming from, caregivers will be less likely to take the words personally, and will be more apt to respond appropriately rather than defensively. Those of us with healthy brains are able to access very recent memories, allowing us to retrace our steps when we lose something and to understand the truth about our relationships. However, those with dementia have difficulty forming new memories, which often leads them to start filling in memory gaps with older memories, resulting in inaccuracies and a false sense of reality.
Caregivers must remember that to those with dementia, these memories are 100% accurate. While their brains are in fact fabricating a story, the individuals themselves are not aware of this. As a result, when things go missing or caregivers challenge their perception of reality, it is easy to begin mistrusting and questioning others. If you, in your right mind, remembered the details of a recent event with certainty, and someone else told you that wasn’t what actually happened, you would tend to mistrust that person’s judgment. It’s the same for those with dementia. By responding to incorrect assertions or faulty accusations with defensiveness or by trying to prove them wrong, you run the risk of reinforcing that you can’t be trusted and might ruin the relationship.
Instead of using logic and reasoning to try to help them “get it,” or showing evidence that proves they’re wrong, try to meet them right where they’re at through empathy. Respond to difficult scenarios effectively by letting them know that you understand how they feel and that you want to help resolve the situation. Validate what they’re saying and then redirect them to another activity. For example, if someone accuses you of stealing their money, you could respond that that sounds serious, and suggest that you can both go to the bank to look into their account balance tomorrow when the bank is open. In the meantime, you could distract him or her with a pleasant or interesting activity. You could also return more control to the individual by letting him or her keep a wallet of a few dollar bills, or let him or her write “fake” checks to pay old bills (and then shred them).
If you’re accused of poisoning someone’s food, it’s best to simply take a bite of the food to show that it’s safe, or invite the individual into the kitchen to help you prepare the meal next time. If the person accuses you of keeping them prisoner against their will, don’t remind him or her that it is no longer safe to leave the house alone due to the risk of getting lost or injured. Instead, ask where s/he wants to go and offer to go along for a visit…after you eat lunch together. S/he may have forgotten all about the trip once lunch is done; if not, you can take a little field trip together for a refreshing change of scenery.
Always be sure to empathize with the person’s distress. This diffuses the “you vs. me” scenario and puts you both back on the same page. You may need to first take a few moments to breathe deeply and process the situation for a moment before responding. Once you reply, it can be helpful to repeat the person’s concern to make it clear that you heard the concern and are listening closely.
Lastly, try not to be a lone ranger when caring for a person with dementia. If tensions get high between you and the individual, it can be helpful to take a little break by having another family member or another professional caregiver come in for a while, or at least to help to calm things down between the two of you.