Safety and the Reality of Altered Perception
The Gentle Ethics of Caregiving
Helping families navigate the hardest caregiving moments
Week 8 — When Confusion and Delusions Begin to Increase
Day 3: Safety and the Reality of Altered Perception
Over the past two days, we have explored how confusion and delusions can begin and what may be happening inside the brain during these moments.
Today we focus on an important question caregivers often ask:
Is this just confusion… or could it become unsafe?
In many cases, these experiences are emotional and cognitive.
But at times, they can also create real safety concerns.
Understanding when to be aware—and how to respond—can help caregivers feel more prepared and confident.
When Confusion Is Primarily Emotional
In some situations, confusion or delusions may present as:
• expressing a belief that is not accurate
• recalling events that did not happen
• feeling uncertain about surroundings
If the person remains:
• calm
• seated or resting
• responsive to reassurance
the situation may be more emotional than physical.
In these moments, reassurance and presence are often the most helpful response.
When Confusion May Become a Safety Risk
There are times when altered perception can lead to unsafe situations.
This may occur if the person:
Attempts to Act on the Belief
For example:
• trying to leave the home to “go somewhere”
• searching for someone who is not there
• reacting to something they believe they see
Becomes Fearful or Agitated
Fear can lead to:
• pacing
• sudden movements
• resistance to guidance
• increased risk of falls
Misinterprets the Environment
A person may:
• mistake objects for something else
• become disoriented in familiar spaces
• misjudge distances or surroundings
This can increase the risk of:
• falls
• injury
• unsafe movement
The Role of Environment
The environment plays a significant role in how these experiences unfold.
Certain factors can increase confusion:
• low lighting or shadows
• cluttered spaces
• loud or overstimulating environments
• unfamiliar surroundings
Creating a calm, well-lit, and predictable environment can help reduce distress.
The Risk of Escalation
One of the most important things caregivers should understand is:
How we respond can either calm or escalate the situation.
If a caregiver:
• corrects forcefully
• argues
• dismisses the experience
it may increase fear or agitation.
If a caregiver:
• remains calm
• offers reassurance
• speaks gently
it often helps reduce distress.
Caregiver Insight
Professional caregivers are trained to prioritize safety without challenging the person’s reality directly.
They focus on:
• guiding rather than correcting
• redirecting rather than confronting
• maintaining calm presence
This approach helps protect both emotional and physical safety.
Warning Signs to Watch For
□ attempts to leave the home
□ increased pacing or restlessness
□ visible fear or distress
□ reacting to things not present
□ sudden changes in behavior
□ caregiver feeling unable to manage the situation
If several of these are present, additional support or safety planning may be needed.
Try This Today
Take a look at your environment.
Ask yourself:
• Is the space well lit, especially in the evening?
• Are there areas that could be confusing or cluttered?
• Does the space feel calm and predictable?
Small adjustments can make a significant difference.
Questions for Today’s Reflection
• Have there been moments where confusion led to unsafe behavior?
• Does your loved one become fearful or agitated during these times?
• What changes could make your environment feel calmer and safer?
Understanding the difference between emotional confusion and safety risk allows caregivers to respond with clarity instead of fear.
Tomorrow we will explore one of the most challenging parts of this topic:
how to respond ethically when your loved one believes something that is not true.
Because sometimes caregiving is not about correcting reality—
it is about protecting the person within their reality. 🤍