Paranoia is one of the many possible challenges of dementia. It’s a blaming belief or suspiciousness that a person with dementia holds onto, despite explanations or lack of proof of this belief.
Sometimes people with dementia will accuse others in the household of stealing something that they themselves have misplaced. It is very tempting to try to convince the person otherwise when they are convinced that something has been stolen. But arguing doesn’t get us very far when a person has dementia and Alzheimer's. It usually causes stress, frustration and upset for all concerned! It is more productive to “cross to their side of the street” in order to see things compassionately, from the person’s point of view. Sandra Mcgurran, social worker with Fairview Home Care and Hospice Senior Services, recently shared with me the idea that “Compassion = Empathy + Action”. This concept can be applied here.
Here are some DO’S and DON’TS to guide you in giving a compassionate response in these sorts of situations.
DO NOT TAKE OFFENSE on behalf of the accused person.
DO LISTEN to what is bothering the person with dementia, and VALIDATE their feeling, i.e., “That’s not a very nice feeling, to think someone would just take something from you.”
DO RESIST THE URGE to get into an argument with the person.
DO ACKNOWLEDGE the upset. “I can see why you’re upset. I would be too, if that happened to me.”
DO NOT offer a lengthy opinion or a list of reasons why they shouldn’t be upset.
DO OFFER A SIMPLE IDEA. “I wonder if your blouse is in the wash.” Or… “Maybe your wallet was left in a pocket?”
DO BE HELPFUL and action-oriented. “I will go check the laundry room.” “Let’s check your pockets”.
DO ASK QUESTIONS. “Let me get this right. What color was that shirt?
DO BE REASSURING. “Don’t you worry. We will get to the bottom of it.” ‘I’m sure we’ll find it”. “I’m good at finding things.”
DO SHIFT THE FOCUS. “Let’s have a cup of coffee; coffee always helps me think more clearly!” Be sure to offer something you know the person will be interested in!
DO DUPLICATE items that are repeatedly misplaced. For example, if a person often loses their wallet, obtain several of the same kind to keep on hand. Make copies of cards that are in the original, so you can stuff the replacement wallets with those.
But what if YOU are the person being accused directly? This can certainly be tricky.
It’s hard not to feel hurt by such an accusation. What can you do?
DO LET THAT ROLL OFF YOUR BACK in favor of remembering that your family member is functioning with a brain that is doing the absolute best it can possibly do under the circumstances of dementia.
DO TRY IGNORING THE ACCUSATION. Instead, simply validate the person’s feelings, i.e., “Oh no! Your favorite blouse is missing? Of course you’re upset. That’s a beautiful blouse!”
Maybe this will distract the focus from YOUR culpability, or maybe not. Depending on the level of the person’s upset and suspiciousness, you might need to step away and if someone else is available to assist. In that case, try, “I can see you’re upset with me. I’ll go see if Ann will help you look.”
DO THINK AHEAD. For things that are frequently misplaced, it could be helpful to establish and clearly label a home base in the room where a purse can hang or a wallet can sit. You might initiate a routine of checking that spot every night together.
Finally, it can really help in any sort of frustrating situation with a person with dementia to MAINTAIN A SENSE OF HUMOR AND GOOD WILL towards the person. Is there a way you can turn that uncomfortable situation around and actually give the person a compliment? Maybe you can remind them of advice they once gave you! “You know, Mom, I remember you telling me when I lost stuff that I would forget my head if it wasn’t attached. You were so right! You also said that lost things usually turn up if we are teensy bit patient! That was always so helpful!”
For more info on coping with paranoia as well as other challenges that can arise with dementia, see Coping with Behavior Change in Dementia: A Family Caregiver’s Guide, by Beth Spencer and Laurie White.
--Marysue Moses, Ebenezer Dimensions Program Coordinator
Many older adults want to stay in their home as long as possible. There is an assumption that staying in your home means you are independent, but the reality is it can often lead to loneliness and isolation. The health effects of long-term isolation are measurable and include chronic health conditions, depression, anxiety, dementia and even premature death. One study reported the negative health effects of long-term isolation are equal to smoking 15 cigarettes a day.
Those living with dementia can feel an even greater isolation as many of their once familiar surroundings no longer resemble anything of what they remember. Alzheimer's specific communities are shown to provide greater support to conditions that can change very rapidly.
Loneliness too is on the rise overall, but those most affected are those 80 and older according to a 2016 study.
Older adults who are most at risk are often:
The best remedy for loneliness is staying connected. Staying connected, interacting with others, and staying socially engaged with friends and your community can help keep fight loneliness and the health risks that are associated with it.
How can a move to Senior Living help fight loneliness?
When people move into a senior living community, the older adults often tell us, “I wish I would have moved sooner.” And their family members tell us, “We’ve seen our loved one blossom in the last few months!”
We invite you to visit an Ebenezer community. Talk with our residents to hear how their health and their lives have changed for the better after moving to senior living.
For more information about loneliness and isolation, the AARP Foundation offers its online resource Connect2Affect. There you can find a self-assessment to determine your risk factors and tips on how to stay connected. Click here to take your self-assessment. Resources that informed this article include Government’s Role in Fighting Loneliness by Emily Holland, as published in the Wall Street Journal, and the Blue Zones Power 9 ® by Dan Buettner.
There are many different ways that families handle communicating with their loved one about a move to memory care. The most successful plan will be designed to meet your loved one’s needs. Some family members don’t even tell the person they are going to move, knowing this could create undue anxiety. They bring the person to the new space once it is all set up and say, “Surprise! We found you this great new place to live, Mom!” This is usually followed by one of the advantages. “It’s closer to me; I’ll be able to visit more.” Or, if the person is worried about money, “It’s more affordable!” Of course some people are not too fond of surprises, so this approach will not necessarily work for everyone.
Other families are completely honest with their loved one about the need for “more care” and they even have their loved one participate in the move, i.e., carrying a few things to the new space on his or her walker. But telling a loved one about this too far in advance could backfire, making the person feel like they are being “kicked out” of their current home. Once the person moves into the new place, they may keep packing everything up, as they are still fixated on this idea that they have to move.
Do's and Don'ts
However you decide to handle the communication, make sure all family members are on the same page, and keep in mind the following guidelines:
DON’T keep reminding your loved one they are moving if it makes them anxious. You might try telling them once, in a matter of fact manner, to see how they take it. If it stresses them out to talk about a move, don’t keep bringing it up.
DO reassure the person that they will be getting more help. Because of their dementia, they may bring up the same concerns or fears over and over. Let the person voice their concerns, and be understanding in your replies, i.e. “I can see why you’re worried about that. We’ll figure it out.”
DON’T pull your loved one into the details of the planning and packing process. Don’t ask them to decide what to bring and what to leave behind. With memory loss, decision making and any process with multiple steps will present challenges. If you don’t already know which objects or knick-knacks are most important to your loved one, spend time observing what things around their home they use and enjoy on a regular basis.
DO work with a move manager. A great example comes from a family who had one daughter take mom out for a morning of shopping followed by lunch, while the other daughter was assisting the move manager. The move manager set up the new apartment to look almost identical to the room in the old house where mom spent most of her time. This is a very good idea! When they brought mom into her new apartment, she knew something was different, but she felt very much at home right away.
DON’T over-pack. Memory care apartments are small for a reason – large spaces with lots of “stuff” can be overwhelming and anxiety-inducing for people with memory loss. A smaller space with a manageable amount of items in it eases the mind. Again, pay attention to what your loved one actually uses throughout the day and bring just what he or she needs. If your loved one misses something, you can always bring it later.
DO consider leaving the TV at home. As memory loss progresses, TV shows can be hard for people to follow. They can also be upsetting, as they can be confused with reality. Bring music, family photo albums and art or photography books instead – they are more therapeutic. Consider leaving valuables behind too. A person with dementia often picks something up, puts it down, and then forgets where it is. Save yourself the heartache of a missing priceless family heirloom by not bringing it to the new memory care apartment. If your loved one insists on having a wallet or purse, expect that these will be lost and you may need to resupply them in a jiffy! Having some extras ready to go for staff to grab is not a bad idea. Fake IDs and obsolete credit cards can be placed into them. But it might simply be enough to reassure the person that “everything is paid for” or that you’re handling all the bills. You can even write this information down for the person—staff can make multiple copies to give to your loved one when questions arise.
DON’T get started too late in the day. Try to get the move done so that your loved one is settled in their apartment by 2 or 3 p.m. at the latest. As the day progresses we all get tired, but a person with dementia will not cope as well as the rest of us. Enlist more moving help if you need the extra hands to be finished by 2 p.m. – it will make the transition smoother.
DO remember that people usually adjust quite well to their new environment, but that this could take around 2-4 weeks. Be reassured in knowing the staff in the memory care community is there to help your loved one settle into a comfortable routine. Because the new environment (not only the apartment but also the programming and the structure of the day) is designed to fit the needs of a person with dementia, you will start to notice your family member more at ease than they were before the move. When your focus returns to your relationship with your loved one, rather than the details of day to day caregiving, you will also be more content, knowing you have made the right decision.
Finally, remember it is futile to try to argue the person out of whatever feelings they have before, during, or after the moving process. The brain of a person with dementia is going to rebel against your logic and may become extremely frustrated and upset as a result. Be respectful of your loved one’s feelings throughout the process. When the person expresses fear, or sadness, or anger, nod and be understanding. You don’t have to “fix it” for them, but it will be helpful to validate their feelings by saying things like: “I can see you’re upset.” “Of course you’re angry.” “I bet I would feel that way too, if I was in your shoes.” “It sure is stressful to move.” “I’m sorry this is hard for you.” “We’ll get through it together.” “I wish I could help you feel better about this.” “I will do everything I can to help you.” And remember to tell your loved one that you love them!
Aurora Senior Living is managed by Ebenezer, Minnesota’s largest senior living operator. Ebenezer is the senior housing division of Fairview Health Services and has 100 years of experience serving older adults.
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