Join us in this informative episode as we explore the topic of delusions and cognitive challenges in senior care. Harrison engages in a conversation with Joan Carlson, an expert in elderly care, to discuss the various scenarios that arise when seniors experience cognitive decline and develop delusions. They delve into the differences between delusions, paranoia, and hallucinations, shedding light on the impact these challenges have on seniors and their families. Joan shares valuable insights on how families can approach and manage these situations, emphasizing the importance of understanding the unique perspective of individuals with dementia. Discover practical strategies, such as reassurance and distraction, to create a calm and supportive environment for seniors facing these cognitive challenges. Tune in to gain valuable knowledge and guidance in caring for your senior loved ones.
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Episode Transcription
[Harrison] Hey, good morning, Ms. Jones.
[Joan] Good morning, Harrison.
[Harrison]So, I’ve been thinking about this issue of delusions and different, you know, mental challenges that come up in caring for senior loved ones, especially in the, in the case of cognitive decline. And there’s all kinds of different challenges that end up popping up for families and for seniors. But specifically when there’s cognitive decline and the seniors start kind of concocting these different scenarios in their mind, even though they consider them very real, how have you approached this? How, how can families approach this? Maybe also speak to what are some of those typical scenarios? Let’s just kind of talk about this subject because it does come up a lot and sometimes families are caught off guard. What, what are your thoughts?
[Joan] Yes, it comes up a lot and I thought I’d mention a couple things about the differences between like delusions, paranoia, and hallucinations, and also the issue of delirium. All of this affects, elderly people in different ways and the families.
Delusions with Seniors
So delusions are like a false belief or judgment that there’s no factual thing to corroborate that. And about, I think I saw someplace that about 70% of people with Alzheimer’s disease feel or get into some delusional experience and it’s kind of surmised that that’s somewhat because your brain isn’t quite working and you see something and you interpret it, you know, in your own way, and you can’t help it.
That’s just what’s going on or not going on in your brain. One thing we tell people is to make sure you do rule out medical or other causes. For example, a lot of times when people have hard time taking medications, they’re crushed and put in applesauce. So then it might, the applesauce might taste bitter. So the, the resident says, Oh, they’re poisoning me. So that’s kind of a delusion that there are some factual things. So it’s like trying to figure out, is there another way of getting that medication or showing them that you are putting that med in there so that they can see the reality. So you try to sort out and also to sort out, what’s going on in reality. Sometimes a change in venue, they, they move from, say, the hospital and they’re back home, they have different caregivers come in…all of that can be disorienting and can result in them saying, you know, something’s really wrong and they’re, they’re out to get me.
So you have to kind of sort out, is the person really just truly delusional? Is there some illness? Like we keep talking about UTIs, but that is one of the biggest plagues of elderly men and women and can cause a lot of behavior. So sorting out if that’s going on, and again, a new environment. So if they’ve just come home from the hospital or rehab, giving, giving them a few days to see if, if that delusion kind of settles down, and you can kind of then work with them a little bit. Sleep disorders can cause that when people don’t get enough sleep, they can become quite delusional. So making sure they have adequate sleep. Again, making sure they’re not ill. I’ll talk about the general behavior, things to do to manage all of these. Paranoia is when someone has feelings of persecution or jealousy, that’s systematic. It’s always there. It’s not just today. And again, sometimes you have to kind of look at what, what is going on.
Again, different caregivers. Someone moves, a lot of times we’ll see when people move into a, say, a rehab. They’re all, they don’t like me, you know, none of them like me because maybe you come from your home where you have just one or two caregivers and all of a sudden all these people are coming in, in your room every time and, some of them are warm and jolly and some of them are kind of serious.
Dementia & Paranoia with Elderly Loved Ones
Again, with different types of dementia, their ability to reason sometimes breaks down and so they can become then very paranoid because they can’t put all these things together in their mind. So, and it’s also important to dissociate paranoia from forgetfulness. For example, they put their purse in the top drawer of their dresser when they were going out so they would not lose it and then they come back and forget where they put it and so somebody obviously stole their purse.
So helping them sort out the reality from that, and again, when you have different people coming in if, if it’s not a consistent caregiver, it’s very not unusual for an elderly person to assume that this new person is going to steal from them. You know, that can happen. So, building that trust and getting to know each other is important.
Then, of course, there’s hallucinations. And those, that’s really defined as seeing or hearing or tasting things that aren’t, aren’t there. And, that can be very scary for the person going through it, as well as the caregivers.
Dealing with Hallucinations for Seniors
Hallucinations are very common with Lewy body dementia, um, those Lewy bodies affect.
The sight part of the brain and therefore that person can see things that aren’t there. And they can’t help it. I’ve, I’ve had a resident recently in a community that I was working in. He and his wife, he had, has Lewy body and he has hallucinations, but he knows they’re hallucinations.
It still scares him and his wife says, Oh, he’s just hallucinating. They kind of gotten to the place where. They’re accepting, but it’s important always in these situations not to argue with the person. Don’t say it’s not there. What we tell people is if they say there’s a bunch of people in that closet and they’re going to come out and instead of saying, no, that’s not and arguing with them, you just say, don’t worry about it. I’ll take care of it for you. So you kind of go with it without saying, yeah, you’re right. There are people in there. You don’t do that. I’ll take care of it. Don’t worry. Be patient. Never, never argue with any of these. You know, if someone says they’re trying to poison me. Don’t argue. Just say, well, let’s, let’s look at what’s going on. Let’s see about, you know, have you had your meds? And sometimes medications can either cause some of these behaviors, the hallucinations or delirium, or sometimes, the lack of medication. You, if you take someone off it, like people with Parkinson’s have, have to have their medications on time, every time. And if it’s, if there’s a delay, a lot of their ability to function goes away very, very fast. Someone says like turning off a light bulb. That’s how fast they can change. So making sure people are giving them their meds at the same time on time. And it’s, and you have to do that. So some of the ways to deal with it, again, don’t ever argue. See if there’s any things that trigger it. We had a resident one time who was a, a World War II, in the World War II, and if he heard a loud noise, he would, you know, scream and run under his bed or try to run away. So we knew that if there was a loud noise, that was going to trigger a hallucination on his part. So if there’s certain things that trigger that kind of behavior to, to try to avoid that. Making sure that they’re safe. If they are really frightened by a delusion or a paranoia or hallucination, making sure they’re not going to hurt themselves or someone else. If they have always been maybe a physical person, and they think you’re about to hurt them, you know, they’re going to punch you. And so you have to make sure you’re, you’re protected. And you’re safe. But I think the biggest thing I see, people wanting to do, family members, staff, everyone, is to argue with them. Say, no, that’s not true. That is not true.
Delirium & Seniors
And one other thing that I want to mention that’s in this same boat is called delirium. And that’s really an acute illness. That’s not a… Temporary thing. And it has been really studied and shown that a very high percentage of elderly in a hospital experience delusions. And they are, you, you can’t argue with them. They can, they’re just totally not there. And a lot of times, like, it, I heard a presentation from Piedmont Hospital, which has a geriatric specialty, tell family members never let your, your elderly relative go to the hospital by themselves, if you can have somebody with them, because it’s just surmised that the noise, the constant coming and going, the beeping sounds, all of that can play a really havoc with the brain. And delirium shows in that they’re really, they’re totally out of it. They’re acting crazy. And you can’t reason with them and you can’t calm them down. So that’s some of the time where we have to go to meds. So, so I think the overall thing is it can happen, especially if there’s any type of dementia. The, what, how you perceive the world, they, you know, they define dementia as seeing the world differently, experiencing the world differently.
So we don’t know what their brain interprets something as. So it’s not arguing, but kind of working with them, seeing if there’s similarities of when they act a certain way, keeping them calm, keeping them involved, exercise, good sleep; all the things that we all need to do to stay well, but you have to pay a special attention with an elderly person, particularly if that elderly person has some dementia.
[Harrison]
When you’re talking about reassuring them rather than arguing with them, that, that is a counterintuitive point that comes up constantly. I can’t tell you how many times we’ve seen that where the family member is arguing and thinking that they’re being helpful, and trying to help them understand the reality of the situation when we encourage them to just reassure, like you mentioned, that goes so much further for the client. That’s the end goal.
[Joan]
Yeah, but it’s the normal human thing. I mean, if you told me that you’re looking at me right now and there are these little people behind me, you know, you know, somebody else is going to say, Harrison, that’s, that’s not true. You can see Joan. You see the picture. You see this. But, you know, you just have to realize, especially if they have dementia, that it is real for them. And all you want to do is say, Don’t worry. Let’s go take a walk or, you know, just something to distract and, and, but just don’t argue because all you do is raise their anxiety more and more and more.
[Harrison] We just recently had a client who would, was constantly asking about her children. Even when her children were in the room, or it could have, it could have been just children generically, but she would ask, how are the kids? I just want to make the, make sure the kids are okay. And the daughter approached me and she said, you know, I just don’t know who she’s talking about. I don’t know what kids she’s talking about.
And so, you know, we just encouraged her, like you said, to, to just reassure the kids are doing great. They’re doing amazing. And when the family started implementing that, she just reached a level of calm that was really helpful for her.
[Joan] And sometimes people will say I want to go home or I want to go see my husband, and your husband died, you know, 10 years ago. I always tell people, don’t, don’t say your husband’s dead because then they’re going to grieve again. But just saying, what do you miss about your husband? What would you be like, what would you be liking to do with him? So you acknowledge. What she’s feeling without upsetting her.
[Harrison] Well this is incredibly helpful. Thank you so much for taking the time to break down the differences and talk about some potentially helpful tips and tricks. So thank you so much Ms. Jones.