Packing Away a Delusion

Leila Arnett, 94, moved into a nursing home in Louisville, Ky., last summer. She’s having a hard time — congestive heart failure, aortic stenosis, trouble hearing and seeing, general frailty. She recognizes visiting family members and can make conversation, but her dementia is causing delusions.

Recently Mrs. Arnett reported being kidnapped by a relative’s “ruffian friends,” taken to the dining room and force-fed. As near as her family can figure out, she was referring to volunteers trying to help her eat. The week before, she informed her daughter Elaine, a friend of mine, that a Cuban man had slept with her in the bed.

More recently, her son Dr. John Arnett told me, “She said she’d had a red box and a gray suitcase on her bed, and that while she was in the bathroom, someone had come and stolen them.” This became a recurrent theme over the next few days, as Mrs. Arnett told friends and family about the supposed theft and asked a friend to escort her to the front desk so that she could report it to the police. Reassurance proved futile; the loss had become an obsession.

“I thought, we might as well take this off her mind,” said Dr. Arnett, who is an internist. He knew the red box she meant — it was empty but had once held jewelry, and was in a bureau at her house. When he drove over to retrieve it, he looked around for a darkish suitcase and, in a back closet, located a gray one so old that when he picked it up, the handle fell off. It held table linens and needlework.

Experts are always urging family members to “redirect” people with dementia, rather than point out their errors or argue with them. Their damaged brains can’t retain the facts, and trying to reorient them when they’re confused only causes distress.

When a person with dementia says she is waiting for her husband to come pick her up, it’s not helpful to say, however gently, “He died 10 years ago, remember?” Better to respond with, “I’m sure he’ll be along any minute. Meanwhile, why don’t we walk outside and see the flowers/look at the photos in this book/have some ice cream?”

The idea is to enter into the person’s reality, rather than try to force her into ours. “Sometimes it helps to become a co-conspirator,” explains an article that has made the rounds of various Alzheimer’s Association chapters.

Dr. Arnett brought the two items to his mother’s room while she was at supper. When she came back, “I said, ‘Look, there’s your red box and your suitcase. They’ve been returned.’ ”

His mother was greatly relieved. “There they are, they’re back,” she said, and sorted happily through the table linens for a bit. She acquiesced when her son said he’d take them home for safekeeping, and the matter hasn’t arisen since.

It’s a more elaborate exercise in redirection than most caregivers can muster most of the time. It won’t prevent a future bout of paranoia or delusions. In fact, Dr. Arnett noted, his mother might not remember anything about the red box or the gray suitcase if he mentioned them to her now.

But it gave her a moment of serenity. Sometimes that’s all you can do, and maybe, sometimes, that’s enough.