Specific delusion help

secondcor521 · September 26

Hi all,

My 88yo Dad has mid- to late- stage mixed Alz/vascular dementia and lives in memory care.

I did read some other threads here on delusions and got the basics down.

For about a week now he has a delusion: he is in a hotel in Houston (Texas), a medical conference has just finished, and he needs to get back to Wichita Falls (Texas) but someone has stolen his new car.

Truth: He's in a memory care facility in Idaho. He did live in Houston just after he finished medical school, and he grew up in Wichita Falls. The car that someone has stolen is a car he gave to me about ten years ago which is now 31 years old.

Right now I'm "helping" him look for the car and suggesting he stay at the hotel until we can find it, and that it will probably turn up soon. That seemed to reassure him but he's also going to keep working the problem from his end.

While delusions are a new symptom for him, I had read about them as a symptom of dementia so I'm not exactly surprised. He doesn't seem agitated but he does seem frustrated that he can't get to where he wants to go because the transportation is missing.

Do I show him the car?

Do I offer to drive him to Wichita Falls?

Do I just keep deferring until it goes away?

SusanB-dil · September 26

Sorry you are dealing with that. I would not show him the car nor remind him of it. Not a good idea to drive him, either. I would go with deferring and distracting until that fixation diminishes. Sorry I can't think of any fourth option, either.

terei · September 26

At this point, I keep deflecting….NOT show him the car. Do not offer any transportation. If he keeps it up, I would consider telling him that the car was found by police + was burned or stripped out or something like that.

I would not start with that, because he then might want to buy a new car. At some point, you may have to pivot when he wants to leave the ‘hotel’ but you’ll have to deal with that if it comes up

fesk · September 27

If you haven't already, rule out a UTI or other medical issue.

If the delusion isn't upsetting him greatly, I would continue to try to distract him. Why not tell him it wasn't stolen and he lent it to a relative (or someone to use) for a week or so and to enjoy staying in the hotel in the meantime. Maybe if he knows the car is in good hands, he'll learn to relax a little about it. Having a car stolen can be distressing. Lending it to someone to use is a nice thing to do and not so distressing. Maybe then change the subject and distract with an activity, etc.

secondcor521 · September 27

Thanks everyone for the ideas and suggestions.

He has had multiple UTIs and they're in the process of checking for one now.

I wasn't actually going to drive him to Texas. I was more wondering about how delusions work - if he would snap out of it somehow when presented with new information.

I am wondering a bit now if he has some sort of unresolved angst about giving the car away. It was a nice car, a bit of a status symbol and my Dad has always been a bit of a status person ("Oh, you drive a X!"). It was also his last car; the one he gave up when he gave up driving. And although he gave it to me, he misremembers that and often claimed that he sold it to me for $1. He might have been more regretful or sad than he has let on in the past.

I guess I'm also wondering if I should ask about why he wants to go back to Wichita Falls. Maybe that's where he thinks "home" is within the delusion. It probably was home when he was actually working in Houston.

SDianeL · September 27

I would not show him the car or drive him anywhere. I would not bring up Wichita Falls. He may think that’s home. “home” to someone with dementia may not mean a place but a feeling. They are lost and want to go home but don’t know where home really is anymore. If he brings it up again, keep fibbing. My DH was worried about the new car we bought before he went to memory care. I told him our son-in-law had it and was taking good care of it. He eventually stopped asking. When he said he wanted to go home, I said when the doctor says you can. He accepted that.

secondcor521 · September 27

Right. I think we need to figure out what (if not just a UTI) is driving this notion of wanting to go home. Maybe there's some emotional need or some change at the facility that we can address somehow.

Historically my Dad has been pretty easily distractible and forgetful, so "Dad, we'll look for the car tomorrow" would usually work because he would forget or let it go. But this has been multiple phone calls to multiple family members over multiple days and he's very focused - almost fixated - on this story line.

harshedbuzz · September 27

@secondcor521

It sounds as if you're handling this development thoughtfully in terms of what's most comfortable and reassuring for dad to hear. Best practices.

You said: I wasn't actually going to drive him to Texas. I was more wondering about how delusions work - if he would snap out of it somehow when presented with new information.

IME, PWD don't snap out of delusions, it's more that the topic comes up less and less. Quite often, as one delusion fades and different one arises.

I am wondering a bit now if he has some sort of unresolved angst about giving the car away. It was a nice car, a bit of a status symbol and my Dad has always been a bit of a status person ("Oh, you drive a X!"). It was also his last car; the one he gave up when he gave up driving. And although he gave it to me, he misremembers that and often claimed that he sold it to me for $1. He might have been more regretful or sad than he has let on in the past.

You might be overthinking the unresolved angst. There are two common issues with dementia they may account for him being stuck in this delusion. The first is a kind of time travel. PWD in later stages, aren't oriented to time. Dad spent a lot of time, mentally, in the 1970s. He was younger, healthier, working a job he loved and mostly free of responsibilities of young children and older parents. He talked constantly of his old friends and even got angry with my mom for throwing out his favorite clothing from the era. As he progressed even further, he went back in time further.

The other thought is that many PWD can and do recall certain memories but maybe don't recall the details— who, what, where, when— correctly and backfill with misinformation. When dad did this, it always felt like he was re-writing family history in a big to make my sister (she was a difficult kid and an irresponsible adult like his sister) look better than she was and me worse. Pre-diagnosis, I resented this mightily. Now I understand that he can recall the feelings associated, but not who was at fault. The memory of the $1 car might be true. In some places it is more expedient to "sell" a car for a peppercorn price rather than gift it. Dad "gave" my DS a classic MGB. In my state, "gifting" is a lot more paperwork and can have tax consequences whereas "selling" at a specific price can avoid this. Because DS was a minor and could not register the vehicle, I hold the title. To avoid having to file tax documents I "bought" it for some small sum.

I guess I'm also wondering if I should ask about why he wants to go back to Wichita Falls. Maybe that's where he thinks "home" is within the delusion. It probably was home when he was actually working in Houston.

It's very typical of PWD to express a desire to "go home". Often, they mean the home in which they were raised by their presumably long passed parents. Many feel "home" is a feeling of security more than a physical place.

HB

secondcor521 · September 27

Thanks, HB.

Last night I was mostly thinking about this current episode in light of another episode a year and a half ago.

The term I've heard used is "confabulating", which is I think what @harshedbuzz is describing in part of the previous post. I think it starts with my Dad's desire to "go home" - emotionally, to a place where he is young and strong and everything makes sense. Add to that the fact that he knows he's not at home and some sense of understanding that he doesn't have a car and can't actually go home. So he confabulates that he's in Houston to explain why he's not at home now, and he confabulates that someone stole his car to explain why he can't go home. The Houston / Wichita Falls aspect may also be a bit of "time travel".

He did this before when he ended up in the hospital a year and a half ago from a UTI and dehydration. He went via ambulance ride and was pretty out of it at the time. When he recuperated in the hospital he obviously knew he was there but didn't know how he got there, so his mind confabulated that I had given him a ride to the hospital - a plausible but inaccurate story.

I can understand the delusion as a way for his brain functioning at diminished capacity trying to make sense out of the world he's in. I think what fascinates me is how he can be talking to me on the phone about being in Houston when I wasn't even born when he lived there - I know it doesn't have to make logical sense, it's just fascinating that he can sound far more lucid and with it at the same time that his brain can ignore the massive logical disconnect.

So now the question is why the emergence in the last week of this desire to go home? I'm not sure. It could be a UTI - he's had lots of those. It could be a change in his routine or the care staff. It could be his recent physical decline such that he needs more help in terms of ADLs and maybe he feels a loss of control. Of course it could just be ordinary disease progression - delusions are common in PWDs after all. I plan to stop by this afternoon and talk over these possibilities with the nurses there and see what they can tell me (mostly about the UA results and/or any environmental changes). Maybe - and I admit it's a long shot - if we can address the emotional need we can calm the delusion. If not, then we can fiblet our way until the cows come home.

terei · September 27

The idea that you can figure out the ‘why’ of any PWD’s actions or delusions can be a never ending search. The LO has a brain that is being damaged day after day by their disease. Since we really dont have a clear idea of how a NORMAL brain functions, it is not reasonable to think that you will be able to determine accurate ‘ reasons’ for their behavior.

Keeping it simple will serve you well with dementia. Otherwise you can be down a rabbit hole of trying to figure out the the ‘source’ of their actions that can run your own brain in circles for hours.

SDianeL · October 1

https://alzconnected.org/discussion/comment/224037#Comment_224037

sorry but you can’t reason with someone whose reasoner is broken. I doubt you will be able to determine his emotional needs either. Even if you do, you won’t be able to fix them. Agreeing to his reality and-or fibbing are usually the best ways to help him.

Specific delusion help

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