HAVE you ever been accused of things you know absolutely nothing about? Well, on Monday, March 4, 2024 I woke up to a very disturbing WhatsApp
voice note from an elderly person. The message was riddled with false accusations. My initial response was that the recording of this message was intentional, malicious, and from a rational person so I needed to take the required measures to protect myself. But then the nurse in me kicked in, and perspectives changed.

Having analysed the voice note, I concluded that this behaviour was quite irrational. The accusations included that (1) I created a rift between family members albeit I do not know the person’s relatives; (2) I set up someone to watch a man in public places even though I cannot identify with this scenario; and that (3) I have caused said person great distress inter alia. This was indeed a frightening experience for me.

I am not aware that this individual has been diagnosed with dementia; however, my limited knowledge of the condition suggests that this person may be dementing despite the person sounding quite lucid in the recording.

This experience has prompted me to reflect on coping strategies for dealing with accusations and paranoia in dementia as well as the quality of life of family members and caregivers generally of persons living with dementia.

False accusations and paranoia are among the common indicators of dementia, and I have no doubt that initial responses to these symptoms by family members, caregivers and friends may be consistent with mine. This has the potential to injure relationships and ultimately, negatively affect the quality care offered to dementing individuals.

Dementia in a nutshell

Dementia is a progressive neurodegenerative disorder characterised by cognitive decline, memory loss, and changes in behaviour. Among the behavioural symptoms associated with dementia are accusations and paranoia. These are common symptoms which result from cognitive impairments, sensory misperception, memory loss, and changes in the chemistry of the brain. These individuals may be suspicious and confused while exhibiting symptoms of distrust and baseless accusations towards their family members, caregivers, and strangers. Equally, paranoia can cause feelings of fear, anxiety, and distress, resulting in conflicts and strained relationships.

Managing the symptoms of dementia can be distressing for both dementing individuals and their caregivers. For this reason, coping with accusations and paranoia requires empathy, understanding, patience, and tailored strategies to effectively manage these challenging behaviours.

Some coping strategies for caregivers of people with dementia

Managing dementia generally requires a multifaceted approach, especially to deal with accusations and paranoia. Of note is that empathy, support, patience, understanding, effective communication, and strategic interventions are important to addressing the needs of these individuals. Family members and caregivers should employ effective communication to include empathetic listening, patience and validation techniques to manage accusations and paranoia. Individuals’ feeling should be validated and false beliefs should not be affirmed. This will foster trust and alleviate distress. By and large, conversations should be redirected while reassuring the individual. This will avert arguments and confrontations. Redirect their attention, shift and refocus their mindset and reduce fixation on distressing ideation. Similarly, they may be engaged in activities that they enjoy or engage in conversations on varying topics.

A calm and supportive environment can reduce agitation and paranoia. It is, therefore, crucial to minimise triggers such as excessive noise, clutter, or unfamiliar faces. In addition, feelings of security and well-being can be enhanced by establishing routines, maintaining familiar surroundings, and providing sensory stimulation such as comforting objects or soothing music.

Maintaining a calm and reassuring demeanour when faced with accusations or paranoia is important because dementing individuals may sense emotional cues and become agitated and create a tense environment instead of a composed and calm setting.

Another point to note is that visual cues and reminders can assist the dementing individual to understand their surroundings and recall salient information. In addition, labelling items, utilising memory aids, for example: calendars and visual schedules will enhance the individual sense of control and reduce confusion.

Health-care professionals specialising in dementia care such as geriatric psychiatrists or dementia specialists can offer support and recommend individualised interventions such as medication adjustments or behavioural therapies for accusations and paranoia, and improve the quality of life for dementing persons and their caregivers.

Support groups are also instrumental for caregivers because they provide an environment in which to share experiences and strategies for managing challenging behaviours. Caregivers may also participate in caregivers’ training programmes in order to be equipped with practical techniques for managing accusations and paranoia.

Some effects of dementia on the quality of life of caregivers

You may have already concluded that caring for persons with dementia presents considerable challenges for caregivers and it has the potential to negatively affect their quality of life. While this list of effects is not exhaustive, it is noteworthy.

The caregiver is at risk of developing attendant physical effects such as hypertension, diabetes and cardiovascular disorders, exhaustion, fatigue and compromised immune system. Managing deteriorating cognitive abilities and personality changes, wandering, aggression, and agitation can give rise to stress and emotional strain. Emotional effects may include guilt, feeling of grief, helplessness and frustration.

Social effects may include social isolation and strained relationships with family and friends. The stigma associated with dementia may cause the caregiver embarrassment, feelings of shame, loneliness, and isolation. Another effect is financial strain which includes costs of medication, home modifications, and professional services. Caregivers may have to reduce work hours or leave full-time employment in order to provide care to the dementing individual. This will result in loss of income and financial instability. On the whole, caregiving can easily frustrate and exhaust caregivers resulting in stress, burnout, diminished quality of life and financial instability.

Caregivers may, however, derive resilience and strength from an effective support system such as respite care, support groups or networks and online fora. This support system will provide resources and assistance to enhance the caregiver’s well-being and the delivery of sustainable and compassionate care to the person living with dementia.

Conclusion

In the final analysis it is important that effective coping mechanisms are employed to manage the symptoms of dementia, especially paranoia and accusations. Further, policymakers, health-care technocrats and professionals, and society generally, should prioritise the needs of caregivers and families of people living with dementia through comprehensive policies, programmes and support services. This will ensure that the dignity of individuals living with dementia is maintained and that they receive the quality, compassionate care and services they deserve. This will also ensure acceptable quality of life for caregivers of persons living with dementia.

Adella Campbell, PhD is associate professor and dean in the College of Health Sciences, University of Technology, Jamaica.