Week 8 — When Confusion and Delusions Begin to Increase
The Gentle Ethics of Caregiving
Helping families navigate the hardest caregiving moments
Week 8 — When Confusion and Delusions Begin to Increase
Day 1: Understanding the Topic
There are moments in caregiving that can feel especially unsettling.
A loved one says something that doesn’t match reality.
They may insist on something that isn’t happening.
They may become fearful, confused, or certain of something you know is not true.
Caregivers often describe it as:
“They’re not making sense.”
“They’re seeing or believing things that aren’t there.”
“I don’t know how to respond anymore.”
These experiences are often referred to as confusion, delusions, or altered perception.
And while they can feel alarming, they are often part of how the brain changes over time.
What This May Look Like
Confusion and delusions can appear in many different ways.
You may notice:
• believing someone is in the home when no one is there
• thinking they need to go somewhere urgently
• insisting on events that did not happen
• misidentifying people or places
• expressing fear without a clear cause
• becoming upset when corrected
These moments may come and go—or become more frequent over time.
Why This Happens
These experiences are often related to changes in how the brain processes:
• memory
• recognition
• perception
• reality orientation
For individuals with dementia or cognitive decline, the brain may:
• fill in missing information
• misinterpret surroundings
• confuse past and present
• create a version of reality that feels true to them
It is important to understand:
These experiences feel real to the person.
They are not pretending.
They are not trying to be difficult.
They are responding to what their brain is telling them.
A Different Perspective
When a loved one expresses something that isn’t accurate, it can be tempting to correct them.
But from their perspective, they are not mistaken.
They are simply experiencing the world differently.
What feels confusing to you may feel completely real to them.
Shifting perspective from:
“This isn’t true”
to:
“This is real for them”
can change how you respond.
Caregiver Snapshot
Topic: Increased confusion, delusions, or altered perception
Who this affects: Aging adults with dementia or cognitive decline
Primary concern: Emotional distress, fear, and safety
Caregiver focus: Reassurance, communication, and emotional support
Caregiver Insight
Professional caregivers often learn that correcting reality is not always helpful.
In many cases, it can increase distress.
Instead, responding to the emotion behind the experience can provide more comfort.
Warning Signs to Watch For
□ expressing beliefs that do not match reality
□ increased confusion about people or places
□ fear or anxiety without a clear cause
□ agitation when corrected
□ repeating the same concern or belief
□ changes in perception of surroundings
If several of these signs are present, it may be helpful to adjust how communication is approached.
12 Questions to Reflect on This Week
As we move through this topic, consider these questions:
Has your loved one expressed beliefs that seem untrue?
Do they become upset when corrected?
Are they confusing people or places?
Do they express fear or concern without a clear reason?
Are these moments becoming more frequent?
Do they seem distressed during these episodes?
How do you typically respond in these moments?
Do your responses calm or escalate the situation?
Are there patterns to when this occurs (time of day, environment)?
Do they seem reassured by your presence?
Do you feel unsure how to respond?
What concerns you most about these moments?
Try This Today
The next time your loved one expresses something confusing or untrue, pause before responding.
Instead of correcting, try to:
• listen
• observe their emotion
• respond gently
Notice how this changes the interaction.
A Gentle Reminder for Caregivers
These moments can feel overwhelming.
But they are not something you need to “fix.”
They are something you can navigate with calm and understanding.
Your response can turn a moment of confusion into a moment of reassurance.
Questions for Today
• How do you currently respond when your loved one is confused?
• Do these moments feel stressful or manageable?
• What would help you feel more confident in these situations?
Tomorrow we will walk through a real-life caregiving situation and explain what may be happening inside the brain during these moments.
Because sometimes what feels confusing on the outside…
has a very real explanation on the inside. 🤍