Caregiver Corner: Accusations and Paranoia

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“That boy next door keeps putting his trash in my trash cans.” If you are a caregiver, or have a family member with Alzheimer’s disease or a related disorder, you may have heard similar accusations.

Paranoia is a phenomenon that typically appears during the early middle stage of Alzheimer’s. It often starts with small changes in behavior like pulling the drapes, locking doors, or not taking medication due to fear of being poisoned.

A person at this stage of the disease can still assemble multi-layered thoughts like “Why are my trash cans full, and who might be responsible?” But reasoning skills are starting to fade, so a rational discussion can be difficult.

When someone new comes into the home, accusations of theft are common. “That’s the guy who stole my car!” (Often their driving privileges are revoked around this same time.)

But the most painful and frustrating accusations can be those against the closest people: a primary caregiver, spouse, or child. It’s important to remember that the disease is causing these behaviors, and while taking it personally is easy to do, try to keep in mind this is the result of their changing brain. Reach out to others who understand what you’re going through. The accusations feel real to both of you, so it’s important that as care partners you have an outlet for support.

To make the situation easier, be ready with some strategies for dealing with paranoia.

Figure out the triggers and try to avoid them. For example, if the sight of the trash cans on the curb seems to trigger the topic, close the drapes. Or move the trash cans out of sight. You can also say something like “I’ll talk that boy’s mom as soon as she gets home.” Providing reassurance that you understand and believe what is being said can be very helpful.  

Another common problem is when your loved one hides something, for example a wallet, in an effort to secure it from “thieves” – then later accuses someone of stealing it. A wise caregiver will purchase 2-3 wallets that are exactly the same, then replace the missing wallet with a duplicate. When the hidden wallet is found, put it in a “caregiver closet” that you set up, and keep them rotating. Same principle can be applied to other things that can help you during moments of frustration.

Food and nutrition are always areas we get lots of questions about.   If agitated, the person probably won’t sit long enough to eat an entire meal. Think about how you can reduce distractions in the eating area. It’s okay to relax your ideas of proper nutrition. The most important thing is the safety of you and the person you’re caring for.

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