How to Manage Delusions in Dementia
When caring for a loved one with dementia, you may encounter behaviors that seem confusing or unsettling—like paranoia or delusions.
How do you respond when your loved one truly believes something that isn’t real or becomes fearful without reason?
We discuss the differences between paranoia and delusions and offer faith-filled strategies to help caregivers navigate these challenges with empathy and patience.
Paranoia vs. Delusions: What’s the Difference?
Paranoia and delusions may seem similar, but they’re not the same:
- Paranoia: A heightened sense of suspicion or fear, often linked to feeling unsafe or mistrusting others.
- Delusions: Firmly held false beliefs that your loved one believes are true, despite evidence to the contrary.
For example, a person experiencing paranoia might believe someone is trying to steal from them, even when reassured otherwise.
A delusion, on the other hand, might involve a fully formed belief, such as thinking someone they know has been replaced by an imposter.
Understanding the difference is key to tailoring your response in a way that de-escalates the situation rather than heightening anxiety or frustration.
Why Logic Doesn’t Work—and What Does
One of the biggest challenges for caregivers is resisting the urge to “reason” with their loved one. It’s natural to want to explain why their beliefs aren’t true, but this often leads to more distress.
Instead of reasoning, focus on validating emotions. If your loved one is scared or suspicious, acknowledge their feelings:
- “I can see that you’re really upset.”
- “I understand why you feel this way—it must be hard.”
This approach shows empathy and builds trust, making it easier to redirect their focus or calm their fears.
Practical Steps for Managing Delusions and Paranoia
- Stay Calm and Reassuring
Your response sets the tone. Speak slowly and use a calm, reassuring voice. - Avoid Confrontation
Correcting or arguing can escalate fear or confusion. Instead, shift the conversation gently or redirect their attention. - Provide a Sense of Safety
If paranoia stems from feeling unsafe, check the environment for potential stressors like shadows, noise, or unfamiliar objects. Small changes can make a big difference. - Seek Support Early
Joining a caregiving community provides a safe space to ask questions and get personalized advice. Faith-based communities, in particular, offer both spiritual and practical support.
Faith and Caregiving: Trusting God Through Difficult Moments
As Christian caregivers, we can draw strength from our faith during difficult caregiving moments. When it feels overwhelming, remembering that God sees and understands your struggles can provide peace and reassurance.
Reflecting on Scriptures such as Psalm 28:7—“The Lord is my strength and my shield; in Him my heart trusts”—reminds us that we are never alone in this journey.
If you’ve felt discouraged by your loved one’s paranoia or delusions, remember: it’s not about changing their reality—it’s about meeting them in their emotional space with compassion and grace.
Read more:
Unusual Strategies: What You Need to Know When Your Caregivers Cause Dementia Aggression
Know When Isolation In A Person With Dementia Is Detrimental
Final Reflection
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[0:00] What is the difference between paranoia and delusion? And what does it matter when you are caregiving a spouse or someone living with dementia? Knowing how to address these situations change everything in your caregiving. Hey, Christian Care Companion, welcome to Dementia Caregiver Support for Christians, the podcast where I teach Bible-believing Christians how to make dementia care easier today while helping you focus on tomorrow. If you are a Christian spouse, the adult child, or a family member of a person living with dementia, and you want to find an easier way, this podcast is for you. Here we are looking at kingdom-focused caregiving. We honor the Lord Jesus Christ in our caregiving journey, and we show you practical ways to make your caregiving easier. If you haven’t yet signed up for one of the free monthly workshops, I do a monthly workshop every month that is entirely free for anybody to register for. And in 2025, every single month will be a different topic.
[1:14] This month, we are going to be talking how to quickly regain peace and calm in your caregiving. So I hope you sign up for the free workshop. It runs about an hour to an hour and a half. And I promise you, if you come, you will enjoy it and you will get, it’s an extremely, extremely interactive workshop and you get to ask questions and we get feedback and we have a dialogue. So I really hope that you sign up. If you haven’t signed up for one of these workshops yet, please go ahead and register. There is a replay. You will be able to watch it afterwards. So if you aren’t able to attend it at the time that it is, go ahead and still sign up. Like I said, for the whole year of 2025, we are going to have a different topic every month. And this one is how to quickly regain peace and calm in caregiving. So I hope to see you there. But in the meantime, I would love for you to listen to today’s Dementia Caregiver Support in Action episode.
Understanding Paranoia and Delusion
[2:17] So I’m going to do a little teaching first and then try some strategies. Okay. There are two things, paranoid and delusion, and they’re not the same. Okay. Sometimes people who are delusional look like their parent, but the whole scared thing, it’s very real to him. He’s experiencing a delusion is believing something that isn’t true, right? So he has a pretty fully formed delusion about the male, hallucinations and so on. They all go kind of together. But a delusion is when somebody is truly, truly, they believe that that is that way.
[2:58] And the challenge is a lot, you know, several fold. Number one, this is true for anyone helping any person with dementia. Immediately once we know and we recognize and we have this process going on, we are now helping people who have a problem with the wiring of their brain, okay? Not just, you know, woo-woo or they’re doing it on purpose or whatever. Think about all of the stuff that’s keeping our computer going and the wiring and the internet and all of those wires, right? That’s like our brain. And so his wiring is not working. It’s crossed, it’s broken in pieces, it’s bent, it’s all sorts of jumbled that it didn’t used to be that way. So from the moment that we know somebody has, and this is not easy, and I get that because you guys have been married a while, you have your established patterns of communication, relationship history, all of that, right? But the reality of the matter is immediately from that point on, even if a person’s early on in the journey, trying to reason through things with them is not helpful to them and it’s not helpful to you. All it will create is frustration. So what I teach people to do is you have to consider addressing the emotion that you’re seeing and valid.
[4:24] So for example, you mentioned he’s scared, right? So when he wakes up or he starts to talk about the male, validate what he’s feeling and say, I know it is, don’t say it’s super, you know, it’s not, don’t make it him, but say, yes, this is frustrating. I get it. And then ask, how does that make you feel? Try to get him to talk and see what’s coming out of his mouth. And then, you know, when we try to redirect somebody from, you know, he’s so focused on on that. When we try to redirect them, if we try to redirect them in a U-turn, we’re going to make things worse. Okay. Is that helpful, sweet lady? Yes, that will help. I kind of know what to do going forward. Okay.
Building Community Support
[5:11] People who are really benefiting from the community are the people who joined earlier on before they need it and that have been active and are participating in the community because then they already know what questions to ask and they have a place to come and they’re not constantly wondering, what do I need to do? How do I need to do it? So people listening are interested in tapping into or learning about the community. I’d invite you to just go to the website, thinkdifferentdementia.com. There’s a link for you to schedule a 20-minute call. There’s no pressure. I’ll serve you regardless of whether you join the community or not. But it is a way for you to take this relationship a little deeper, a little bit more hands-on support, because really the research also shows it’s longitudinal support over time. Yeah, for sure. I would highly recommend Lizette. She’s awesome. I appreciate that endorsement. You are well. Thank you, everybody, for listening today. And as I try to remember,
Closing Thoughts and Blessings
[6:12] I try to remember, I don’t always remember. May the Lord bless you and keep you and come back and listen some more. I’m hoping to do more of these coaching style episodes on a Friday. So come back in and check us out. And thank you for being here today.
