How do you handle confabulation?

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How do you handle confabulation?

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My 94 yr old dad has moderate dementia with Confabulation. He has created “memories” involving each of his 2 friends, and one where my husband told Dad he was taking our money and putting it in a secret acct so he could go out and play with women.

He moved into Assisted Living last month and has created another couple of stories. One was, a guy came in and dad gave him his old medical alert button, quit, and took the button (I had the button and turned it in, which he forgot).

The latest has to do with his stool softener med. since he was having diarrhea (“ever since I’ve been here”). I told him I would see about getting the dose cut down to what we had at home. Today he called me and said someone called him saying that if he didn’t take the medication he would have to leave. I really doubt it happened, but called and left a message for the nurse to double check his dose, since it was less than on the bottle (I believe I indicated the dose for him on his meds list when we moved in). She is supposed to call me back.

His MD started him on Serequel the week before he moved, and we were hoping this would help his anxiety and cut down on his false memories.

Now that he is in Assisted Living, how should this be handled? Should I just placate him and hope he drops whatever issue he has next time? Should I let the Nurse know, if it involves the facility? I think he is in a great place, but it is somewhat new, so what if something really happened and I blew it off?

Thanks

Adie

Alzheimer's & Dementia Assisted Living Delusions Moderate Dementia

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Confabulations and delusions. Both are common symptoms of dementia. Both are similar and even the experts say they're hard to differentiate. But for both, the best solution is to validate their concerns, offer a solution and redirect. It takes creativity to satisfy their belief. Never argue or deny their concerns. "Oh, I didn't know that. I'm going to talk to so & so and get it straightened out. How about some lunch?". Or, "Oh, I forget to tell you dad he gave me the button. I can get it if we need it. Let's take a walk".

In either case, your dad believes what he's saying so respect that and offer a solution.

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You seem to be describing something more like hallucinations, or false memories, rather than confabulation.

Confabulation is when a person with dementia makes up a story in order to "safe face." For example, if a stack of unpaid bills is on the table, when asked why they have not been paying their bills, their might say something like, "because my grandchildren were visiting and I was very busy" - even if there is no truth to the story. (The reality is that they have forgotten how to go about paying their bills - but they cannot admit that to themselves or to others.)

If the "story" involves something or someone at the AL place, it should be reported and documented, lest it come back to haunt you. Sometimes there is a grain of truth to the stories that an elder makes up.

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Imho, you did the right thing with placing the call to the nurse. The faux tales will no doubt continue as your LO has a broken brain. Prayers sent.

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My mother has a hard time with this sometimes as well. My sister and I double- check with each other, and also with Mother's AL facility to verify stories if we are really concerned. We try not to correct her, but just go along or try to re-direct her if she is not upset in any way. We joke that we don't want to "gaslight" Mother by not believing anything (because we have been wrong once or twice!), but we do verify. Sometimes we will warn each other if a particularly dramatic/fabulous story is making the rounds of her mind, just so we are on the same page. Other responders to this question have noted that, if the staff has been working with the aged for any length of time, they have seen this before. I am sorry, it is hard.

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I think he has dementia so nothing is going to work. I would just simply ignore this and I would make my concerns known to the facility. I am sure they have seen it all and can deal with it better than you can. At the same time, listen and check on what he is saying about the help and the place he is in - make sure nothing is happening to him that should not be happening. These people are the "victims" of the workers - fact of life. Some cases are real and others imagined - so check things out as best as you can.

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Any "change" in a resident's ( with dementia) daily routines seems to create a different set of challenges. Until Covid-19 becomes a non-issue and impromptu
visits resume, you will never know. For your sanity, I would support "he's in a great place."

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Donto ever blow off what your Dad is saying.

Nice Facilities can be very nice on the outside.

It wouldn't surprise me one bit that your Dad wax tokd if he didn't take his meds he'd have to leave.

I have a 96 yr old Dad that has 24 7 Care in his own home and I caught the Cargivers saying if he didn't do this or that they would threaten him with him having to go to the Hospital. I put a stop to it quick.

No matter which home your Dad is in, there are always good and bad people working in Senior Care Homes.

If it was my Dad, I would have a Nest Camera installed in his Room, I did that at my Dad's house and so glad I did as I've caught Caregivers doing and saying all kinds of things that I had to talk to them about.
The Nest Cameras are Easy enough to do and then you can check in on your Dad any time day or nigh just by cell phone or computer.

No one ever knows when your checking in.

And the best part is it holds memory up to 30 days so if he said something just go to your Nest Sight and play it back and see and hear for yourself.

Remember, there is usually some truth about what is said and just because a place looks nice and tge people act nice to use had nothing to do with how a person acts toward your Dad.

Have a Camera Installed. You just mount a little thing on the wall and plug it in and set it up on your phone.

It did wonders for my worries and sleepless nights thinking about how my Dad was.

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I think this must be very common with dementia patients. Mom was calling for a while carrying on about her 3 storage units in a nearby city that no one is paying the rent on and they are going to get rid of all her stuff. This woman has never had a storage unit in her life. Next, the nursing facility took her wheelchair to work on and when they brought it back the back wheels were gone and they moved the brake to the back so she can't reach it. We hear these over and over again. We just listen. When I talked to the facility, they said they have been using mom's wheelchair with her all along and it is fine, it's just all in her mind.

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Consider his "stories" about medical care may have an element of truth in them. Check with his nurse in a matter of fact and gentle manner, "Dad is saying that ______ is happening. I know he confabulates, but can you check on this and get back to me by_____?" Staff will be happier to help when you acknowledge his thought process problems and not make accusations.

Consider his confabulated stories to be mash-ups of memories in his brain. He remembers that something happened with people he knows, places he knows, and events... but they are not connected correctly. As long as the stories are not provoking anxiety or fear in him, I wouldn't bother trying to correct "the story." Some may unpleasant to you - like your hubby meeting women secretly - but that usually has more to do with your dad's viewpoints than reality.

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You know your father better than anyone else. It’s easy to dismiss “stories” that are probably untrue. I had a similar situation with my mother, but I found that maybe there was some truth; particularly if the same of similar story was repeated. You need to rely on your sixth sense. Look for evidence if it’s about abuse or harm to him. Make sure you sign off on all medications and/or changes to them.

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The fact that he's in assisted living means that they already know about your father's "stories" because they get a lot of that in such places and know how to handle it. Let them handle it. You did well to get him into a facility and it will take some time for him to adjust to his new living arrangement. I would insist that the nursing staff communicate with you though. Especially if you call and no one gets back to you.

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I experience a lot of this when Mom was in AL. She would hide something then tell me it had been stolen, usually by an employee. I would let the director know, telling her I knew it wasn’t true. Then I would search her room and find where she had hidden the item.

Mom always said "Well I didn’t put it there!" She said someone was coming into her room and hiding things trying to make us think she was crazy. She knew something was wrong but just couldn’t accept her own decline.

The staff is experienced with this kind of behavior, that’s why I always alerted the director and let her know that I did not suspect the staff who were all very lovely people.

Just keep in touch with the staff.

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Still in shock since this has happened to a family member.

I have said that even though we grew up together, each of us recall a different aspect of an event. I listened.

There was no way that her take on what happened was true. Since discovering the confabulation, I am at a loss, still. And needing to protect my own emotions. I prefer not to talk at all to persons under the influence of anything.

I think it is a result of her self treatment with CBD and THC in high doses.

I have no voice or authority when it comes to her treatment.

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Confabulation is unconsciously filling in memories with fabricated, misinterpreted or distorted information. It is not conscious. I would not challenge the memory but I would address the affect that is at the basis of the confabulation. Support and verbal assurance is often helpful. If an individual has dementia, a move can be quite disconcerting until new behavior patterns are established. I would assure your loved one that you take their concerns seriously and will follow up.
Seroquel is an antipsychotic medication that is sometimes used to enhance sleep. If the MD is not a psychiatrist then I would find a geriatric psychiatrist to evaluate the medications and symptoms. Many hospitals have geriatric centers that complete a comprehensive evaluation and forward the recommendations to the attending physician for on going management. Medications can create problems as well as resolve problems. The elderly are particularly susceptible to drug reactions.

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"Confabulation is unconsciously filling in memories with fabricated, misinterpreted or distorted information. It is not conscious."

Thank you for this statement. I need a better understanding of this issue. I find myself often saying to my husband (who denies he has dementia), "That didn't happen."

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How do you actually GET a dementia patient into a memory care facility when they refuse to go? My 86-yo mother remains adamant she will never go to MC or any other care facility. She is physically strong as a horse but her cognitive decline is horrid. She can no longer care for herself at all. She has a history of physically attacking nurses and security in a hospital. She is also very paranoid. I need to get her placed, but HOW is this possible when she becomes aggressive and refuses to cooperate? I am afraid she will hurt another person again.
I need to know HOW to go about just getting her into an mc. Any suggestions?

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Have you discussed a trial of medication with whoever provides her medical care? You will find that it will be somewhat less difficult to place her if you are able to describe what you’ve tried previously to help address aggressive tendencies.

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Mine would (in a very giddy manner) talk about a particular wealthy businessman who was actively pursuing her romantically. It made her so happy and I don't think I actually argued with her about it. Those stories seem to have stopped, but have been replaced by stories of all things financial - including specific transactions from the past which did not happen because I was handling her funds at the time. We've also had some future-oriented stuff as well and her thoughts on managing her money. She no longer remembers how much SS she gets per month, but she sure has BIG plans for it.

That said, we have brought a few stories to the staff's attention so they would know the truth. Periodically, she proclaims that she is "moving" and that would be an example of something I'd want the staff to know is not true.

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My FIL was a real storyteller.

Mostly of his exploits from WW2. We just listened and kind of ignored him, as he needed to paint himself as a hero.

He also worked as a private chauffeur for a private limo company for years. IN the few weeks before his death he told us he had driven Elvis to and from the venue, John Denver and a few rock groups. Here we had been hearing boring war stories for 30 years and before he dies he finally tells us something INTERESTING.

Since he didn't follow pop music, these people meant nothing to him. To my kids, he suddenly became a pop star himself.

The war stories were just self-aggrandizement. The driving stories were simply the truth as there's not much to add to "Yeah, I drove Elvis for the 3 days he was here". Meant nothing to him.

Just listen. FIL would tell the MOST outrageous stuff and we knew he was making a lot of it up, but, heck, nobody was hurt.

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WWII was the biggest event of your FIL 's life, that's why he talked about it so much. If you can, watch the documentary "The War" by Ken Burns. It will help you understand why that period of time was the most significant happening in his life. Young men (boys) experienced horrible sights! Your kids, and you, should be proud that he served! Sure as time goes by, we all become heroes of our own stories!

(Elvis and John Denver cannot compare to WWII)

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I feel for you! My husband is a champion confabulator. If there’s a way to limit that, I’d LOVE to hear it. His tales are sometimes highly entertaining, but are mostly involve his ex-wife taking his money and possessions, taking the kids to TN (they’re 42-53 yrs old, btw), or his middle kid (who looks just like him) not being his biological child. Another favorite is my brother being mad at him over MY taking his charging cord last time we visited. He claims my brother sent him letters and emails threatening him. My DH, not me, was the one who packed up the cord and brought it home and my brother laughed about it when I sent him a pic of the cord and asked if he was missing anything else. My dearly beloved is scared of losing charging cords and will scarf up any in sight and cram them into his infamous grey bag. I’ve found cords in there with plugs that don’t fit anything made in the last 20 yrs! If anything is missing, that bag is the first place I look. Im sorry I’ve got nothing to offer but sympathy.

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Your dad is the third person I've heard of who was on anti-anxiety meds and has diarrhea. Get his doctor to try another medication.

As for the stories, let him take the lead, and go with them. Sometimes they can be quite interesting!

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As long as you have good two way communication with the staff, this is pretty harmless.

By now, you’ve probably learned that he’s past the point of being a reliable communicator, and the staff is probably realizing that too.

If he happens to be conversing lucidly on some particular topic, enjoy those interchanges with him as you would have prior to his illness, but if he seems agitated and is relating something that doesn’t seem logical, check with the caregivers that work with him, to be sure that this is in fact a result of his condition.

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It is the disease talking and honestly there is not much to be DONE about it.

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Hopefully, your dad is in a MEMORY CARE ALF and not just a regular ALF? My mother has moderate dementia and is in a Memory Care ALF after having to transfer over from the regular AL part of the building. Her world is much smaller over there with less things to worry about in general (ie: microwaves, fridge, etc) so life is easier for her to manage. She can't get lost, either, since the MC is much smaller and configured in a square shape so all hallways lead to the activity room.

In any event, if he's 'confabulating' then he's making up stories. If you trust the ALF and the quality of the nursing care he's receiving, then you'll need to let the stories go, otherwise you'll go crazy trying to sort the 'truth' from the 'lies'. If I were to believe everything my mother told me, I'd have lost my own mind long ago! I kind of let it all go in one ear and out the other and only fact-check on her if I feel there is a REAL problem going on, which is rare.

Seroquel may or may not help your dad with his confabulation issues, who knows? The jury is out on the efficacy of ANY and ALL dementia medications at this stage of the game, unfortunately.

Here is a good article on the subject and how to handle it:

https://www.verywellhealth.com/responding-to-confabulation-in-dementia-97969

Wishing you the best of luck!

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