My husband seems to be declining in certain areas of behaviors that are either unsafe or unhealthy and is also obsessive and gets very agitated about them. His smoking , which was down to 1-2 a day is increasing weekly. He is at a place now where he is very suspicious and accuses us of stealing the cigarettes and other personal items. He hides them in strange places, but thinks I am lying when I confirm that he has already smoked 2 cigarettes or that I do not know where an item is but I will help him look. He is now leaving burn holes in furniture. He has never smoked indoors, but if I leave the room for any length of time, he lights up. Also burn holes on the patio furniture. Should we the Drs. talk with him about nicotine patches. I know he will get very anxious and angry and he, like most with dementia have lost so much already-but this is just unsafe-for him and for everyone around him. The other issue is sneaking into his pill box and either taking pills or insisting that I have not given him his meds. My thought is to buy a lockbox for the pills. He has a beer every afternoon and, again, I worry that although he has done this for years, that it is now not a good thing. I find that I have to hide so many things in order to control his constant needs.
Anyway, my mom smokes MORE and tries to sneak around MORE when I try to restrict her smoking. I don't remember if you answered about whether there is a reason to limit him to 2? Nicotine is very difficult to quit, and someone with dementia has none of the capacity for self-reasoning as regular folks trying to quit. Plus there are physical symptoms of withdrawal that will make someone with dementia even more unreasonable. I control the fire risk and burning damage by controlling mom's access to fire and heat sources (like toasters and stove burners). She hated me for it at first, and fought with me like a nasty teenager. But I repeatedly showed her the existing burn damage and just kept saying I wasn't trying to control her smoking, only trying to keep the people in the building safe - that she had no right to put other people's lives at risk. She has come to accept the rule of smoking in one place, where the fire (lighter) access is. (I secured the lighter with picture wire and duct tape so she can't take it anywhere.) I really do suggest taking the fire away, not the cigarettes.
And as jeannegibbs says, medication is non-negotiable. Lock it up. You will have to stand your ground on this one, no matter how much he rages. If it helps him feel better, have the pharmacist fill the prescriptions in a blister pack system. These are set up like little weekly advent calendars, except pills are pre-sorted into individual, sealed blisters by day of the week, and by time of day. Poke them out of the pack in front of him at medication time - then he can see you are giving him the correct pills at the exact time/day he's supposed to take them. (Edit: don't count on him being able to manage his own meds with a blister pack. My mom still can't get it right on her own, especially as her dementia progresses and she doesn't know what day or time it is half the time, or even whether it's night or day.)
I honestly don't see the issue with having a single beer a day, though, unless he's a recovering alcoholic or there's some specific medical issue. Beer is a pretty low-potency form of alcohol.
I think there's a difference between wanting the best for someone's health and trying to control that person's behaviour. Quality of life is just as important as quantity of life.
For me, part of learning about dementia was to accept that it is a fatal disease. There is no cure, and it progresses at its own rate. My goal was to maintain the best quality of life for my husband -- not to prolong that life, but to enrich it.
Many people with dementia go through a phase of paranoia. My husband thought I was stealing from him. "Gee, honey, I'm not doing anything intentional. But maybe I'm doing something accidentally. Let me get the bank statements for you and see if you can spot something that isn't right." After studying the statements (upside down) for a while he got bored and moved on. Go along with his concerns, but don't "admit" stealing or that other people are stealing from him.
Some people with dementia start to hide things during this paranoid phase. They want to keep those things safe. But, alas, they forget they have hidden them. Keep doing what you are doing by commiserating with his frustration and helping him to look for things. Don't accuse him of hiding them. He doesn't remember it and accusations will just lead to more conflict.
Why limit your husband to 2 cigarettes a day? I think the burn holes in furniture are a very legitimate concern. That is a big safety concern, whether he is smoking 2 ciggs or 2 packs. My mother had this issue. She moved in with my sister and they switched her to e-ciggs. It took a year and a lot of patience, but by the time she went into a nursing home she was no longer smoking. Maybe a patch would be helpful for your husband, if he is willing to try. Show him the burns in furniture and ask if he has any ideas how to prevent them. Ask if he is willing to try to stop smoking. Tell him you will bring him his ciggs in only one place, and then inspect that area after he is done. Preventing furniture damage and fires is a perfectly legitimate goal. It will depend on what cognitive skills he still has, but try to get him on your side.
It is time for you to control his pills. No negotiation. That can have very serious consequences.
Beer in the afternoon? What is the harm in that? If he has done this for years and he is satisfied with one, why deprive him of this pleasure? Soon after my husband's dementia diagnosis I asked his neurologist in front of him whether it was OK for him to continue drinking. The doctor said to limit it to two drinks per day, and to cut back if it gave him mobility problems. He explained this to my husband. I was surprised, but I went along with it. Later his geriatrician said the same thing. Limit it to 2 or 3 drinks a day. Since he never drank more than that anyway, this was very doable. He enjoyed having a beer watching sports on tv. He adored ordering a drink in a restaurant. Often he didn't even finish the drink, but it gave him some measure of independence to be able to order it, like other adults. I am so glad I asked the doctor! It would have been pointless to deprive him of this small pleasure. It was a small thing, but I think it did enhance the quality of his life.
Your husband's dementia is going to progress, whether he smokes, whether he drinks alcohol, whether he eats kale or twinkies. Once you accept that, I think it is easier to focus on true matters of safety.