When a person develops any form of dementia, it is difficult for family and friends to witness their diminishing capacity and the unbearable frustration it brings. One of the worst things we dementia caregivers must cope with is the fact that a loved one’s brain is broken and may cause them to tell terrible “lies” about us. Neurological damage can cause patients to make up hurtful stories and level false accusations toward their caregivers. No matter how far-fetched the untruths and accusations may be, a dementia patient believes these things are true. As much as these untruths may hurt, it is important to remember that there is no ill intent; the disease is causing your loved one to fabricate stories.
What is Confabulation?
The neurodegenerative processes that cause dementia have pronounced effects on a senior’s behavior, emotions and ability to think rationally. However, even as the brain incurs damage, it still struggles to make sense of the information and stimuli it receives and to work around lapses in memory and cognitive ability.
Many dementia patients rely on confabulation to fill gaps in their memories, especially when compensating for memory loss in the early stages of the disease. According to a review article published in the International Journal of Neurology and Neurotherapy, “confabulation is the creation of false memories in the absence of intentions of deception.” Although a dementia patient’s distorted recollections of memories (and even events that never happened) may seem like blatant lies to a family caregiver, the truth is that “individuals who confabulate have no recognition that the information being relayed to others is fabricated.”
Delusions are another type of false beliefs that can present in elders with Alzheimer’s disease and other forms of dementia. Unlike confabulations, which are related to memory recall, delusions tend to affect multiple aspects of a dementia patient’s behavior across a variety of situations. Paranoia or suspicious delusions are particularly distressing for both patients and family caregivers to deal with. These pervasive false beliefs typically cause seniors living with dementia to believe they are being followed, imprisoned, stolen from, neglected, wronged or victimized—often by those closest to them.
Do Dementia Patients Lie?
Emotions like anger, anxiety and confusion often leave elders feeling vulnerable and taken advantage of, which causes them to become defensive and accusatory as they try to make sense of what they cannot understand or remember. Misplacing and “hiding” personal items is a hallmark of dementia, which can be terribly disorienting and frustrating for patients and caregivers alike. When you add in a bit of paranoia and delusional thinking, a “lost” purse or medication bottle can suddenly spur a senior to falsely accuse their family caregiver of theft.
Unfortunately, there are many instances where people have taken advantage of someone with diminished mental capacity. However, when dealing with the cognitive changes in dementia it is far more likely that helpful and well-meaning gestures are misconstrued as acts of trickery or deceit. For example, a dementia patient may ask a caregiver or family member to launder a piece of clothing, repair their eyeglasses or purchase groceries using cash they provide. When they find their favorite blouse, glasses or money is gone, they fail to recall their own request or misconstrue the information they’ve been provided. Accusations can fly and then the caregiver is left trying to explain themselves to someone who is impossible to reason with.
Dementia, Delusions and False Accusations of Elder Abuse
I was fortunate that none of the elders I cared for ever leveled serious accusations against me, even in their severely demented states. Some caregivers aren’t so lucky, and some fabrications can have very grave consequences. False allegations of elder abuse and neglect aren’t just emotionally devastating; they can have dire legal and financial ramifications for family caregivers as well.
If reported, Adult Protective Services (APS) or the police may investigate allegations of elder abuse. Even if it has been confirmed that a loved one has dementia, making up stories about being mistreated or financially exploited can still trigger a full APS investigation. This is often humiliating for family caregivers and may seem like a waste of time and resources, but elder abuse is a reality for many seniors. The National Center on Elder Abuse (NCEA) estimates that as many as 2 million seniors are abused in the United States. Proper authorities must look into all reports to protect vulnerable adults.
Most false accusations stem from a dementia patient’s inability to connect with reality. For example, assistance with bathing or dressing may be misconstrued as inappropriate touching. Trying to get an elder in the car to go on an outing or to a doctor’s appointment may translate to kidnapping in their broken mind. The way they perceive the world around them has changed and their reaction is often one of fear, suspicion and self-protection. Remember that, when it comes to making up stories, dementia patients are not intentionally causing trouble. Unless an elderly loved one has a history of compulsive lying or malingering, it is likely that their fabricated stories are purely a product of their cognitive decline.
Coping With Dementia and Lying
Each dementia patient experiences different symptoms at different times throughout the course of their condition. Since Alzheimer’s disease and other forms of dementia do not typically progress in a neat and predictable pattern, it is important to understand that new behaviors like confabulation and wandering often come and go without warning. As with many other symptoms, it is best to prepare for the likelihood of dementia behaviors before they arise instead of being caught by surprise.
How to Handle Dementia Accusations
- Seek support. It doesn’t matter if it’s from the Alzheimer’s Association 24/7 Hotline, a spiritual leader, another family member, a social worker at your loved one’s nursing home, fellow caregivers in a support group or a friend. You need to discuss your concerns with someone to vent your frustrations and get sound advice on how to move forward.
- Keep meticulous records if you have anything to do with managing your loved one’s finances. Ensure your documents are well organized and readily accessible. Not only will this help make your caregiving duties easier in the long run, but it will also ensure you are prepared to defend yourself against any false allegations. In some cases, showing concrete proof of sound financial decisions to a dementia patient may help mitigate their fears and put an end to accusations of financial abuse.
- If your loved one prepared legally for aging and potential incompetence, have copies of all pertinent forms on hand. This includes HIPAA forms and power of attorney (POA) documents that give you access to their medical and/or financial information.
- Consult with an elder law attorney if necessary. This is extreme, but sometimes caregivers do wind up needing legal counsel if the accusations against them are serious enough. Something as simple as failing to account for spent or comingled funds can lead to a full investigation.
- If an investigation does transpire, cooperate fully. You may feel some resentment toward APS staff or police officers, but they are only doing their jobs. If you have done nothing wrong, then there is nothing to hide.
- If you have siblings or other family members who believe the accuser and not you, you may want to consider working with a family mediator to resolve the situation.
- In cases where a dementia patient has a history of pathological lying or is causing serious damage to a family caregiver’s life and reputation, it may be wise to consider detaching with love. Choosing to manage a loved one’s care from afar or declining appointment as their agent in accordance with their POA documents can help protect a caregiver from harmful accusations. Unless the senior has listed an alternate agent in their legal documents or is still mentally competent to execute a new POA, then he or she may have to be assigned a private or public guardian to manage their care and finances.
Try Not to Take Dementia Lying Personally
The Caregiver Forum is populated with stressed caregivers who are struggling to cope with dementia patients’ hurtful untruths. Even when they are performing simple household duties like washing clothes or setting up a pill box, they can be faced with accusations of theft or neglect.
I remember the last year of my mother’s life when she frequently told the housekeeper at her nursing home that I was stealing her clothes so I could wear them to work. It was funny in its own way, but Mom’s suspicions and lack of trust were also somewhat painful. I was simply doing the same thing I’d done for years: swapping her out-of-season clothes in her tiny closet with season appropriate items that I stored for her. We had done this little switch-out for years, and it had always been fun rediscovering forgotten items and gifting Mom a few new ones. However, that last year of her life, it was just sad.
While it hurt my feelings that my mother thought I was capable of stealing from her, I tried really hard not to take it personally. We dementia caregivers must remember that the outrageous things our loved ones say are the disease talking, not their old selves. Try your best to keep your sense of humor even during the most trying times. Dad may be livid and screaming about you stealing his dentures, but if you think about it, the concept of stealing someone else’s teeth is mildly comical. There is some truth to laughter being the best medicine. Many caregivers, including myself, often find that if they didn’t laugh, they’d end up crying instead.
Keep in mind that these accusations are often transient and patients eventually forget the incidents they initially reacted to. It is hard for a caregiver to forget that they have been accused of stealing or harming someone they love, but this is a time to remember that the person is sick. A great amount of tolerance and patience is needed in dementia care. Confabulation, paranoia, delusions and other behaviors are brought on by the disease. Unfortunately, there are times we must protect ourselves and document our efforts to care for those we love. If an accusation should turn into more than a fleeting outburst, seek proper help and guidance to ensure you can remain blameless and continue providing quality care for your loved one.