“Someone is trying to break into my wardrobe. The lock doesn’t work anymore,” M. Maimunah (not her real name), 60, complains to Jo, her youngest son who is visiting her. She lives with her eldest son Din and his family.
Jo nods his head and promises to buy her a new lock when he next visits her.
Maimunah frequently accuses family members of breaking into her cupboard and stealing her personal belongings.
“Who would want your clothes and underwear?” asks Jo in exasperation.
“I have seen Ros (Maimunah’s daughter-in-law) wearing my clothes,” Maimunah insists. “When I stared at her, she quickly changed into another outfit.”
Maimunah complains that whenever she goes out and returns home, a few items of clothing would go missing.
“Someone has cut a piece of my cloth. It is shorter now,” Maimunah accuses, referring to a few pieces of textiles in her collection.
By now, the family knows she is delusional.
She refuses to leave the house, saying that she needs to keep an eye on her personal belongings in case someone tries to break into her room.
They know she has dementia, and she makes up stories. But for Maimunah, the missing items are very real. “I am not making up stories. Neither am I senile,” she tells her family.
On one occasion, Maimunah could not find her medical appointment card and claimed that someone had stolen it. Jo went into her room and searched for the card, and found it in the cupboard. But Maimunah insisted that whoever stole her card had returned to place it there.
Din complains that his mother is paranoid. “She puts her jewellery in a little pouch and keeps it close to her body,” he relates.
When he was helping his mother to look for missing items, he was shocked to find many locks among her personal belongings. “She keeps precious items in a woven bag, and puts the bag in another cloth bag. The two would go into another bag which she secures with a lock.”
“If I don’t lock up my things, someone will steal them,” Maimunah laments.
She even suspects her daughter-in-law of stealing her personal belongings, and screams at the younger woman, demanding that her belongings be returned. And if she still cannot get over it the next day, she would bang on the younger woman’s bedroom door first thing in the morning, to demand for the return of her things.
In one incident, she tried to hit her daughter-in-law with a stick when the latter opened her room door. She threatened to kill her daughter-in-law and then commit suicide. After this threat, Din hid all sharp objects in the house.
Maimunah is on medication for dementia, but sometimes she overdoses. Din keeps on eye on her, and when she becomes groggy following an overdose, he would remind her to stick to half a pill as prescribed by the doctor.
While medication has helped Din and his family to handle his mother’s dementia, Mary Ong is having a hard time dealing with her husband’s behaviour changes.
Her husband, TK, is prone to mood swings. The 60-year-old would pound on the wall and kick the wall for no apparent reason. No one knows what he is angry about.
“He is like a tyrant gone berserk during these episodes. We don’t want him to get angry,” says his daughter, Emily.
When he has a violent outburst in the middle of the night, no one gets any sleep as he will turn the house upside down. When family members try to ignore his temper tantrums, he will get angrier and kick the bed.
Mary has found that one way to appease him is to cook his favourite dishes and coax him to eat a hearty meal.
On several occasions, Ong was taken to see the doctor for his explosive behaviour but when he saw a queue at the clinic, he became very impatient and bolted.
People with dementia may sometimes experience paranoia and delusions, and behave aggressively. This can be very distressing for family members.
“Whenever they are distressed, reassure them that you will help them,” advises consultant pyschiatrist Prof Dr Philip George. “Reassurance rather than confrontation is a better approach. Do not challenge the elderly who have dementia. Provide them with some comfort. When they are more settled, use a diversion. This can be a cup of tea, a snack, a walk, or even assistance with an activity.”
Dr Philip, who is also president of the Malaysian Healthy Ageing Society, cautions caregivers against emotional stress.
“Caregivers can suffer burnout. Hence, it is important for them to evaluate their own mental health. Relationships can be affected while looking after a senior family member with dementia and altered emotions or thoughts.
“Families (and not just the patient alone) need to be counselled together by healthcare professionals. There should be opportunity for respite such as sending the patient to daycare or getting other siblings to take turns to look after them.”
Dr Philip gives a few possible approaches which family members can adopt to avoid the risk of a dementia catastrophic reaction, which is an overreaction to a seemingly normal situation:
> Do not appear rushed, frustrated or irritated.
> Do not argue with or criticise a person who has dementia.
> Always approach the patient from the front, rather than the back or side, as this could alarm them.
> Avoid sudden changes in routine as dementia patients cannot cope well with changes.
> Know the person’s preferences. Some react positively to touch, while others get startled if somebody invades their personal space.
> Discuss simply and calmly what you would like to have the person do prior to attempting to do it. For example, “Dinner’s ready. Let’s walk together to the table.”