By Micha Shalev
Delusional, paranoid, hallucinatory behavior may be a response to internal or external factors. They most often occur as a result of brain changes in the person with Alzheimer’s disease. They may cause the patient great distress or may be little more than mildly stimulating and even comforting. Example: The woman who has an imaginary cat, and enjoys and is comforted by the cat will not be distressed by her delusion.
Problem: Patient believes his food is poisoned and refuses to eat.
Patient misplaces items and accuses others of stealing from him.
Patient can’t hear well and is convinced others are talking about him and/or conspiring against him.
Patient sees, hears or feels persons, bugs, or animals that are not there.
Goal: To help the person feel emotionally secure and safe.
To reduce or eliminate behaviors or conditions in the environment that may appear threatening, or lead to confused thinking.
To reduce physical causes of hallucinatory behavior such as fever, dehydration, impaction or poor nutrition.
Suggested approach: Don’t argue or try to rationalize. This will only upset the person more.
If the patient is agitated or anxious and believes someone is trying to harm him, try to reassure him or distract him. “I will protect you.”
Try to determine what’s causing the behavior. The patient may be misinterpreting a real situation.
Ignore the behavior if it is not causing the patient distress.
If the behavior interferes with caregiving, such as refusing to eat or take medicine because it’s “poisoned,” report the situation to a nurse or physician.
Be sure the patient can see and hear as well as he can. Does the individual need glasses or a hearing aid? Loss of hearing or vision problems are excess disabilities that may contribute to confused thinking and beliefs because the person cannot interpret correctly what he seesor hears. This is compounded by memory loss caused by Alzheimer’s disease. Be sure the area is well-lighted. Reducing noise, stimulation and activity may also help.
Monitor for physical causes: Lack of needed nutrition, insufficient sleep. Dehydration and medications may cause or contribute to confused thinking. Extreme lack of stimulation can lead to disturbance in thinking, too. Some behavior that appears hallucinatory may be an attempt at self-stimulation.
Respond to the feeling tone of the patient’s anxiety. Saying “You sound frightened” acknowledges legitimate feelings. Saying, “I will stay with you” further validates and reassures the person in distress.
Micha Shalev MHA CDP CDCM CADDCT is the owner of Dodge Park Rest Home and The Adult Day Club at Dodge Park located at 101 Randolph Road in Worcester. He is a graduate of the National Council of Certified Dementia Practitioners program and well known speaker covering Alzheimer’s and Dementia training topics. He can be reached at 508-853-8180 or by e-mail at m.shalev@dodgepark.com or view more information online at www.dodgepark.com
