How to Reframe a DELUSION in Dementia Care


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I got a great question the other day from somebody asking about delusions and what you do when someone living with dementia has a delusion that you can’t really engage with.

Here is an example – She said, “Rachael, my mom is convinced that her dementia care community is her house, which is a good thing. Like great. She’s not talking about going home, but the problem is that she is pretty frustrated because there are all these other people there. So she’s trying to kick out the other residents because she’s like, ‘why are these people at my house?'”

I asked her, how can we reframe the delusion? We’re not going to be able to get rid of somebody’s delusion. We’re not going to be able to fix the delusion that somebody has and say, well, that’s not true.

And here’s the real truth. We’re not going to be able to do that. Right. And we don’t want to, we want to embrace that reality, right? When we’re doing this, we’re embracing somebody’s reality. We want to find where their reality is, take the trip with them there, and be able to make sure that they end up with a positive feeling about whatever the delusion or challenge is that they’re having in this situation. I compared it to a similar situation. I had a resident many years ago who believed it was his house and he was getting mad because he’d come out of his room and there were all these people in the living room. So what I did was I went to him and I said, “Oh, you know, I’m so sorry. I invited all these friends over because I thought that you would want to have people over for the day and I guess I shouldn’t have done that.”

And suddenly his whole demeanor changed and he said, “Oh, oh, well that, yeah, no, I think that’s okay. That’s nice of you. That’s good of you to bring all these people over. We’ll have dinner with them.”

So he went out into the living room and he said, “Hey everybody, welcome to my house. You know, we’re going to be having dinner, come to the dining room.

You see what we did there? We reframed the delusion. And that was exactly the advice that I gave to this woman. I said, you know, you’re not going to be able to convince your mom that this isn’t her house. And frankly, we don’t want to do that anyway. Can we put it in a way to her that we’ve made her feel like it was her idea or rather it was our idea to invite all these people over and that she’s kind enough to have dinner for everybody? We’ll prep the dinner, we’ll do all the work, but thank you so much for having all these people over, you know, thanks so much for being such a wonderful host when someone is having a delusion and we cannot solve the delusion, we can’t fix the delusion.

How can we engage in it enough that we’re able to leave them with a positive feeling and at least for the most part solve it the best that we can?

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Rachael Wonderlin is an internationally-recognized dementia care expert and consultant. She has a Master’s in Gerontology and is the author of three published books with Johns Hopkins University Press. Rachael owns Dementia By Day, a dementia care consulting and education company.

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