Kay Bransford calls her parents the “senior edition of Bonnie and Clyde.” Her 81-year-old mother and 80-year-old father were recently diagnosed with dementia but have been showing signs of forgetfulness for the past few years.
Bransford’s parents, who have both had their driver’s licenses revoked yet continue to drive, often tell her the excuse they plan to provide police if they’re ever pulled over. Whenever this discussion arises, Bransford is certain that her parents know they were told to stop driving and that they are simply nonchalant about breaking the law. But just moments later, the couple will completely forget the conversation and the fact that they ever even had driver’s licenses.
This is just one of the many stories Bransford has about her parents’ increasingly unusual behavior. She admits she sometimes wonders whether her mom and dad are purposely manipulating her and others. Of course, that thought just adds to the guilt that she and other dementia caregivers often experience while grappling with new dementia-related behaviors.
“They’re not the parents I knew,” Bransford laments. “It took me a while to realize that. In frustration, I thought, ‘Is this the woman my mom really is?’ She says so many things the woman I knew would never have said. I know it’s a manifestation of the disease, but in the moment I sometimes take it personally.”
Are Seniors with Dementia Capable of Manipulation?
Amanda Smith, MD, medical director of the Byrd Alzheimer’s Institute at the University of South Florida, estimates that one-quarter of the caregivers she interacts with have concerns similar to Bransford’s. Adult children often ask Dr. Smith whether their cognitively impaired parents are being intentionally deceitful or manipulative.
“Sometimes caregivers assume that their loved ones are being manipulative because they just can’t believe their unusual behavior,” explains Dr. Smith. “But in reality, people with dementia aren’t able to think through the complexities required to manipulate those around them.”
Eileen Poiley, MS, director of education at the Byrd Institute, notes that short-term memory is the first to go for dementia patients. However, it’s not uncommon for seniors to develop mixed dementia, which can affect several different areas of the brain and cause a unique combination of symptoms.
For example, with Lewy body dementia, a senior’s memory can quickly fluctuate from moment to moment. Their fleeting lucidity may appear as selective memory to outsiders. On the other hand, frontotemporal dementia (also known as FTD and Pick’s disease) affects parts of the brain that control one’s decision-making, behavior and personality. A senior with FTD may do or say things that are socially inappropriate because their ability to gauge right or wrong is impaired. This might explain why a loved one may lash out and make hurtful statements.
Additionally, people in the early stages of dementia usually have some awareness of the fact that they’re losing control of their faculties. As you might imagine, this prospect is very frightening. Like a child, they may act out because they are desperate to exert some kind of control over their life and/or their surroundings.
A senior who is afraid, confused, frustrated and/or unable to communicate effectively can be easily agitated. They may rely on confabulation or “lies” to fill the gaps in their memory, and they may demonstrate childlike behaviors such as emotional outbursts and downright noncompliance with instructions and requests. To caregivers, this behavior may come across as intentionally manipulative, but this is rarely the case. “Dementia patients lose cognitive skills like logic, reasoning, problem-solving and decision-making,” explains Poiley. “So beyond the very beginning stages, a patient really couldn’t be truly manipulative.”
How to Handle Seemingly Manipulative Dementia Behaviors
A loved one’s dementia-related behaviors can be frustrating and even hurtful for family caregivers to deal with. It’s important to keep the following pointers in mind when caring for a senior with Alzheimer’s disease or another type of dementia.
- Don’t take it personally. There is nothing to be gained by thinking your parent is being manipulative. Poiley believes that maintaining this assumption only adds to a caregiver’s stress. Instead, blame the disease rather than the person. Set a goal to maximize and enjoy the time you have with them.
- Practice empathy. Kevin Henning, MD, chief medical director at Amedisys Home Health Care, encourages caregivers to learn as much as they can about their loved one’s condition to better understand what they’re going through. “It’s hard for dementia patients to lose their independence and it’s scary for them,” he acknowledges. It can be very trying when a loved one is being illogical, but it’s important to listen to and be patient with them. No one chooses to have dementia, so reassure your loved one as best you can that you are there to help them through this journey.
- Avoid arguments. “You will not win an argument with a dementia patient,” Dr. Henning asserts. “You can try to reason with them, but you’ll never get anywhere because they’ve lost the ability to think rationally.” Rather than trying to correct a senior with dementia, practice validation and redirection.
- Take a break. If you find you are reaching your breaking point or arguing with your loved one, do yourself a favor and walk away for a few minutes. It’s very possible they won’t remember the point of contention, let alone the argument, after you both take some time to cool down.
It’s also important that all caregivers get regular respite. “Caregiving is a 24/7 job,” notes Dr. Henning. “You have to get away from it sometimes to recharge your batteries.” Look into adult daycare for dementia patients, see if another family member can provide backup care, or hire a professional in-home caregiver for a few hours so you can get a break. Regular respite will help you be more physically and emotionally prepared to handle any difficult situations that arise.
- Look for triggers. Dr. Smith suggests trying to find the underlying cause of your loved one’s behavior. Environmental factors may be to blame, or your loved one may be acting out because they feel confused and isolated. Think critically and creatively about what may be sparking their outbursts or driving their need to argue.
- Seek help. While being a dementia caregiver can seem lonely and thankless at times, help and guidance are available. Find a local support group or online forum where you can share your experiences and meet others who are going through the same trials. Speak to your loved one’s doctors about medications and non-pharmaceutical options for managing symptoms like anxiety, agitation, delusions and hallucinations. Contact your local Area Agency on Aging for information on additional resources in your community that can provide respite and financial assistance.
- Have a plan. Planning for one’s retirement and long-term care is crucial, but not everyone is proactive about their future. Sadly, many seniors do not prepare financially or make their wishes known to family members. Bransford regrets that her parents never discussed these matters with her and her siblings before they became ill. If possible, talk about the pros and cons of assisted living, home health care and other care options with your loved one before their condition deteriorates further.
It’s still difficult for Bransford to reconcile who her parents were just a few years ago with their current condition. She is working towards acceptance and likens it to a mourning process. She says it’s helpful for her to think of her parents as having suffered brain trauma. “I have to remember that they’re not doing things to be mean or cruel—there’s something wrong with their heads. It doesn’t always take away the doubt, but it does make it easier to cope with.”