Dementia Delusions: How Caregivers Handle False Accusations

A person with dementia may become unable to connect facts with memories correctly and, as a result, can create delusions to fill the gaps. Dementia-related memory problems create behavioral disturbances and personality changes. If the person is also experiencing feelings of paranoia, a common symptom of progressive dementia, delusions may become even more pronounced.

For example, they may forget where they left their checkbook and know that a new caregiver has been visiting the house. To a senior with dementia, the logical answer might be that the caregiver stole their checkbook.

Or, a person with dementia may not be aware that their long-term spouse passed away. When the spouse isn’t there for dinnertime, their mind could jump to infidelity. Similarly, bruising from an unremembered fall or elderly skin condition could look to a loved one with dementia like signs of abuse.

What types of dementia cause delusions?

Multiple types of dementia include delusions as a side effect. And, generally, delusions occur once the disease progresses into its later stages.

• Does Alzheimer’s disease cause delusions? Nearly 34% of people with Alzheimer’s disease experience delusions, according to research published in the journal Archives of Neurology.^[02]
• Can Lewy Body dementia cause delusions? Researchers have found that delusions are even more common among people with Lewy Body dementia, with an estimated rate varying between 13% and 75% of patients, depending on the stage of the disease and the study, according to The American Journal of Psychiatry.^[03]
• Does vascular dementia cause delusions? Vascular dementia delusions are less common, but they can still present as symptoms in the later stages of the disease, according to the journal Age and Ageing.^[04]

Dementia delusions vs. hallucinations

Delusions and hallucinations aren’t the same thing. Both may be symptoms of the types of dementia listed above, but there are key differences:

• Delusions are beliefs that a dementia patient thinks are real, even if they’re unfounded. They may include theft, infidelity, and harm. They do not include visions or sightings and are generally idea-based.

• Hallucinations involve seeing, hearing, or smelling things that aren’t there, according to the National Institute on Aging.^[05] They may include seeing a spouse who’s deceased, hearing music or speech when there isn’t any, or smelling something like coffee or freshly mowed grass.

Let our care assessment guide you

Dementia and delusions vary from person to person, according to the journal Gerontology and Geriatric Medicine.^[06] Some common delusions include the following:

Intentional harm

Someone with dementia may feel like a close friend or family member is trying to harm them. They may believe a long-term partner is being unfaithful, a child is trying to undermine or hurt them, or a neighbor who brings cookies is attempting to poison them. While these delusions can stem from past disagreements or incidents, they can also be entirely unfounded.

Theft

It’s important to remember that people with dementia often don’t realize they’re experiencing memory problems. If they misplace something, they may assume it’s been stolen. Lost pieces of clothing and valuables can make them feel like someone is taking their possessions, leading to anxiety and suspicion.

Disbelief that a home or situation is theirs

Someone experiencing dementia and delusions may not be able to correctly assess where they are, or they may feel a loved one is trying to trick them by keeping them away from a familiar place. They may insist that their house of 40 years isn’t their home, or that a caregiver’s home is a strange, unfamiliar location. This can lead to discomfort and a feeling of being “locked up” or even kidnapped.

A delusion doesn’t feel “made up” to someone with dementia. It isn’t a lie or falsehood, but a belief that reality is different from what it actually is. Most likely, you won’t be able to convince your loved one experiencing delusions that they aren’t real — it would be like someone trying to tell you the sky isn’t blue.

While you can’t generally dispel dementia delusions, there are ways to improve the situation for both your loved one and yourself.

If your loved one accuses you of harm

Recognize your relative is coming from a place of fear. You know you haven’t done anything wrong, but that’s their perception of reality. Instead of trying to convince them you haven’t been attempting harm, try redirecting.

Don’t: Speak reactively, raise your voice, or insist innocence.

Do: Try looking through photos of favorite family memories, engaging in an activity for people with dementia, or even playing a beloved song or movie.

If your loved one thinks someone is stealing from them

Keep in mind that your relative probably doesn’t realize dementia is causing them to misplace items or forget where they’ve put things. Calmly help find the missing item, or, if possible, replace it.

Don’t: Try to convince your loved one they’re being forgetful or insist on a logical explanation. Don’t ask where they put the item last, as it may increase confusion.

Do: Reassure them you’ll help find the missing item, then search calmly and methodically. The Alzheimer’s Association suggests purchasing duplicate versions of items that are frequently misplaced to prevent agitation.

If your loved one spreads falsehoods about you or someone you trust

If your relative thinks someone is trying to cause them harm, they’ll likely tell others. This can lead to uncomfortable social situations. Imagine your grandmother tells everyone from church you’ve been abusing her or that your housekeeper has stolen her valuables.

Don’t: React loudly or insist on logical explanations, as this will likely make your loved one feel even more frightened.

Do: Calmly explain the situation to relatives and friends. If your loved one is experiencing delusions, they’re likely in late-stage dementia and other symptoms are apparent. That said, these accusations can be disturbing and present a moral gray area. If a senior relative is claiming abuse or harm by someone else, look into the situation logically to ensure it isn’t happening before dismissing it as a delusion.

Talk with a Senior Living Advisor

It can be difficult to know how to respond when your loved one is having delusions — especially if they’re about you or another friend or family member. It’s normal to feel distress and frustration. Remember the delusions are the result of a disease and don’t reflect your loved one’s opinions otherwise.

“Some of my auntie’s first delusions didn’t seem too unreasonable,” said Nevaeh, who cares for her great aunt with dementia and often shares her experiences with other caregivers on Reddit forums.^[07]

“She accused a trusted, longtime in-home helper of stealing a pair of earrings. While we were debating on firing her, my sister found the earrings wadded up in paper behind the toilet, stuffed down with some money and a necklace.”

After that, the delusions ramped up: An elderly neighbor was trying to break in each night to assault her, and the church deacon — an old family friend — had attempted to coerce her into a relationship.

“Then she started accusing me of awful things — abuse, neglect — all while I was there being the one who cooked for her, took her to appointments, and cared for her,” said Nevaeh. “I’ve never been more upset about something. It’s not just thankless but also really, really cruel.”

Caregiver statistics show that a caregiver devotes most of their free time and energy to supporting their loved one, even more time when caring for someone with dementia. This can lead to both mental and physical health risks for dementia caregivers. Caregiving can be a rewarding but often thankless job, and delusions can make it far more difficult to manage emotionally.

“We knew she had dementia, and I read about this kind of thing a lot on the forums. But it doesn’t prepare you. You have to let it all slide off your back, but even if you know that in your head, it’s not easy. It really hurts,” said Nevaeh.

Resources to help with dementia and delusions

If you’re caring for an elderly loved one with dementia at home, you may have experienced a similar situation to the one above. Consider these resources to learn more about what to expect and how to cope.

Join a caregiver support group or forum. The AgingCare forum has a discussion section about delusions.

Learn more about dementia. Our guide “Everything You Need to Know About Dementia” can help you learn what to expect throughout the various stages of progressive dementia.

Better understand delusions and hallucinations. Watch the National Institute on Aging’s video series on how to support a loved one with these symptoms.

Learn how to redirect. Redirection is an important skill for any dementia caregiver. Use reminiscence therapy techniques to steer your aging relative away from delusions and into a positive mindset.

Take time for yourself. Prioritizing self-care as a caregiver can help you prevent caregiver burnout over the long-term.

Sometimes, caring for a loved one with dementia at home can be overwhelming — especially if they’re experiencing delusions.

Memory care communities are specifically designed to support the needs of people with dementia. Nurses and care aides are familiar with delusions and their accompanying behaviors, and they’re trained in redirection and calming techniques.

If you feel like your loved one with dementia could benefit from the support memory care communities offer, reach out to one of our free Senior Living Advisors. Discuss your relative’s dementia symptoms so they can help guide you in the search for the best senior living fit in your area.