Q. My father has dementia and he’s delusional. How do I get him to stop accusing the nurses of trying to poison him?

A. Delusions are the result of several parts of the brain conspiring against your father. Human survival depends on our ability to see, hear, and feel threats in order to defend ourselves against them. But dementia destroys a person’s ability to detect and accurately process visual, auditory, and tactile data; and it compromises a person’s ability to make decisions and act in their own defense to ward off threats. Aware of these failures, at least on some level, a person with dementia feels exaggerated vulnerability, which fuels a heightened sense of anxiety. Over time, this anxiety becomes the default mode.

It is natural to feel vulnerable when our power is weakened – we often perceive ourselves as victims when we feel vulnerable. In dementia, this victim syndrome can often escalate into accusations. Whether it’s true or not, your father’s version of the facts is very real to him. Trying to orient him in reality is futile. It’s worse than futile, really, because reality orientation can have very negative consequences.

If you dispute your father’s reality, he may begin to view you as an accomplice to the nurses, and therefore his enemy. Correction can be viewed as betrayal. Instead, join your father’s reality. Acknowledge his set of facts without judgement. Commiserate in some way. “Oh no! If I thought the nurses were trying to poison me, I’d be afraid (angry, sad – whatever emotion they are expressing) too. What are they doing to try to poison you?”

Once you know that it’s the medicine, or the ice cream, or the coffee, or whatever it is that the poison is in, you can determine how to overcome the delusion. For example, if your father thinks that his prescribed meds are the poison, find a way to make them seem like vitamins or supplements. Or, disguise them in food. Or, direct that a different member of the staff administer prescription drugs. If your father believes the poison is in his coffee, instruct kitchen staff to leave coffee off his tray.What’s important to remember is that the facts don’t matter, but emotions do.

Delusions are an expression of underlying emotions surrounding unmet needs. Focus on the emotions that drive your father’s feelings of vulnerability and work to address the causes of those emotions. Anticipate that even after you put your father’s fears to rest, this delusion will repeat. Be careful not to point out that you’ve covered this ground before. That is a form of correction. Instead, treat every delusion as if it’s happening for the first time. The good news is that once you find the right formula to move past the delusion, you can reuse it on the next occurrences of that delusion.

A similar post on delusional narratives may offer additional insights.

More solutions to delusions, and other symptoms of dementia, can be found in The Dementia Field Guide – a practical manual for dementia caregivers.