7 Things That Can Scare Someone With Dementia

What scares you the most? Loud sounds, spiders, shadows? The thought of intruders, the feeling of being watched, things you can't explain?

Now imagine that you think you see these things all the time. You can't escape from them, and you can't ask anyone to help you with your fears. 

That may be the way someone with dementia feels when they encounter things that are unfamiliar or unrecognizable. 

You may not be able to remove all of these problems from your loved one's life, but understanding what causes fear and paranoia could help you cope with dementia behaviors more efficiently. 

Here are seven common things that can scare, worry, bother, or upset people with dementia: 

Photographs and Paintings

Favorite paintings and family photographs can scare people with dementia. As the disease progresses, those faces that they once knew and loved become strangers. As perception becomes skewed, a person may feel that these are real people watching them, talking to them, robbing them, or threatening them in some way. 


If a loved one talks about "people in their room" or "people talking to them", trying removing photographs and paintings first to see if that helps. 

You can provide small, easy-to-handle photograph albums for family pictures they can browse at their own leisure. Change artwork to landscape works or soothing abstracts. 

This is very difficult, because when we know that our loved ones are slowly losing their memories, our first instinct is to surround them with familiar things and people, hoping to draw out those memories as long as possible. 

It's very important to listen to their cues, rather than our own feelings at times. 

Mirrors can be disturbing and perplexing to someone with dementia

Mirrors and Other Shiny Surfaces

Persons with dementia may not see themselves in a mirror. They see a total stranger. When a house has multiple mirrors, someone with dementia is always glimpsing strangers. 

Perhaps they simply cannot connect that this is their reflection. They may not understand the concept of reflections any more. Or they may simply "be back in time" and think of themselves as looking as they did when they were much younger. In the last instance, the reflection they see of themselves is a total stranger. 


Not only is that disturbing, but mirrors also reflect rooms, objects, and writing backwards. For someone with perception and cognition issues, this can be completely disorienting and scary! Mirrors basically mimic the confusion they are already experiencing. 


You don't necessarily have to sacrifice all of your mirrors though. Smaller  can be hung higher on the wall (above the line of vision). Large mirrors can be moved to places where they will be seen less often, or covered temporarily. (You can use pretty paper or a large piece of art to retain some of the mirror's decorative function.) 

Mostly, it is important to not have mirrors in places such as the end of hallways, insides of doors, and across from your loved one's bed where they can be startling or confusing. 

Dementia Tip: 


Here is a solution we used to cover a built in mirror that couldn't be moved. Use decorative paper and cut a scrolling or openwork design (such as lattice). 


The paper can be taped to the mirror without creating damaging residue. You can still see bits of mirror through the openwork, but its not enough to reveal a whole reflection, making the mirror seem more like a window. 


You can also cover such mirrors with curtains temporarily. (I personally thing the artistic paper is much prettier though.)


Besides mirrors, other shiny objects can cause distorted reflections (think of silver bowls) and glare. Outside glare can also be a problem. One caregiver explained that a set of windchimes hanging outside would turn in the breeze, and flash a light through her father's room. As his dementia progressed, he thought the light was a fire. 

Shadows

Shadows can, at times, be frightening for everyone. Think back to your childhood when the shape of the tree outside projected "monster faces" on your curtains, or how a few common items in your house appeared to be hulking beings when the lights were low. 


With dementia, depending on the stage, the person who is scared may think they see something that isn't there, but they can't explain this fear to anyone else. Imagine being that scared little child, but with no way to understand, investigate, or seek help for the shadow that scares you. 


Some of the things that "shadow shy" adults may see include things like intruders (they may describe them as burglars or murderers), devils, demons, dangerous animals, or people whom they have come to believe might wish to harm them. 

In the latter case, the people named could well be people who have been dead for decades, or whom the elder barely knows. 


Shadowy areas can also create optical illusions. They may seem like deep holes, open doors, burn marks, or steps up and down. These "holes", "voids" or "edges" can cause elders to trip if they try to step over or around them. 

Although you can't banish shadows from your home, you can do a few things to eliminate their appearance in areas where your loved one stays the most: 

• Avoid leaving clothing, blankets and pillows piled up where they can create huge shadows at night. 
• Turn off the lights and examine the bedroom shadows. If trees outside make strange shapes, consider heavier drapes for night time. Do statues make odd projections on the wall? Try moving them where they aren't in front of any light. 
• Get brighter night lights to decrease the shadows on the floor that could cause tripping. Make sure no physical objects are on the floor that a senior might confuse for the shadows. 
• Mark real steps, thresholds and "paths" with reflective tape to help guide your loved one to other rooms. 

Limit loud noises

Loud Noises

What constitutes a loud noise? It may depend on your loved one. For some, it may be occasional sudden sounds, for others it may be the presence of lots of noises creating a loud combination. 

• Gunfire

• Fireworks

• Doors slamming

• Sudden shrieks or yells

• Sirens

• Loud vehicles

• Horns or car alarms

These are examples of sudden noises that can startle. Other noises can include: 

• Rattling pots and pans

• Outdoor machinery or lawn equipment

• Vacuum cleaner

• Dogs barking

• Music or televisions

• Conversations in loud crowds

Sudden loud noises can reasonably startle anyone. It may take much longer for someone with dementia to recover from the fright however. They may be agitated for hours afterwards, even when they can't remember what scared them or why they even feel the way they do. 


Although you can't prevent exposure to loud sounds altogether, you can set some house rules about door slamming, yelling, and horn honking.

Continual noises can be minimized as much as possible in the house, simply by only having one noisy task at a time going on.
 (Don't vacuum with the television blaring, for example.) 


For those with hearing loss, the sound of "voices" from televisions, radios, and multiple people speaking can be overwhelming and confusing. To alleviate agitation, keep volumes turned down, and turn off these appliances when you are speaking directly to your loved one. 


Ask visitors to speak one at a time when conversing with your loved one, and use clear voices, not mumbles. Ask them to turn their phones to silent and to either knock softly or text that they are at your house rather than ringing the doorbell. 

Sudden Changes

I mentioned the stress of suddenly changing decor in my article "Five Christmas Tips for Dementia Caregiver", but a sudden change of scenery can be alarming at any time of the year. 

Here are some things that could be considered sudden changes to a person with dementia: 

• Completely redecorating a room (including paint) all at once. 

• Rearranging furniture 

• Having a person either move into the home (even for a visit) or move out of the home.

• The loss or addition of a new pet

• Drastically altering a daily routine 

• Sudden appearance of a full-time care aide

• Changing caregivers unexpectedly (such as siblings switching care roles, or a spouse quitting work to take over primary caregiving)

• Implementing a new diet or nutrition plan (such as a switch to pureed foods)

• Changing to a new doctor or clinic

• Reorganizing items so they are kept in different places than usual

None of these changes have to be avoided. Indeed, some of them can't be avoided at times. You can soothe transitions by explaining what is happening (even if they don't fully understand), and gradually introducing changes whenever possible. 

In the case of changing the environment of your home, do so slowly, with new routines being added in tiny increments. 

 

Someone with dementia may think busy patterns are moving or crawling

Busy Patterns

I briefly suggested avoiding busy patterns on linens in my post about decorating a nursing home room, as well as in my post on a home a bedroom makeover for the elderly. The reason I mention it more than once is because  busy patterns and prints can actually cause a great deal of agitation in those with dementia, Alzheimer's and other forms of cognitive decline.


Why?  Quite simply, as vision and perception changes, those little flowers or dots can appear to be moving or "crawling". When delirium is present, the person with dementia can become convinced that these are bugs, spiders, or even sets of eyes staring at them. 


It can be even worse if there are actual prints of things such as bugs on the fabric itself (such as butterflies). On the other hand, there are others who may actually prefer graphic prints rather than generic patterns. I suppose this is because a picture of an obvious butterfly is easily recognizable and not as threatening as small, dark flowers that could be mistaken for spiders. 


Other patterns, such as small plaid and gingham, very thin stripes, or paisley prints can also cause agitation. They are intense and energetic, and they give the eyes no place to "rest". 


Aside from busy patterns, there might be a problem with some large designs.  One resident I knew was terrified of her room after being given a beautiful bedspread covered with a large cabbage rose design. 


The reason? The dark pink flowers looked (to her) like large blood splatters. 


The hard part for everyone involved is that someone with dementia may not be able to communicate why something is bothering them. You have the incredibly difficult task of trying to see the world from their point of view, and removing items that might the issue. 

And even their explanations sound strange if they can no longer remember the correct word for something. For example, a certain print of small squiggly flowers may look like spiders to someone with dementia, but perhaps the only word they can think of is "parsley". 

You would be wondering what on earth is so scary about parsley, and might think this is silly, or even an attention-grabbing issue. 

Large Crowds (and Strangers)

You probably had no idea that crowd control would be one of your duties as a caregiver, huh? It may become one of your major roles dementia progresses, as you find yourself: 

• Advising visitors to come one at a time

• Setting a time limit on visits to keep from overwhelming your loved one

• Limiting the times you go out to busy places.

• Keeping holidays and special occasions low-key

• Trimming guest lists to avoid conflict. 

People with dementia often enjoy visits from people. However, many familiar faces will become strangers. 

On the other hand you may have mom or dad claiming that a total stranger is their child/sibling/niece etc. When everyone is a stranger, building a relationship status with people to define their reason for being there can be comforting for the elderly. 

 Correcting it unnecessarily can cause embarrassment or agitation. You have to use your own judgement here. Is it really so bad if mom or dad thinks the home health nurse is their niece, or your son-in-law is the friendly mailman they had 50 years ago? 

Validate the Emotion, Comfort the Person, Remove the Problem

When a fearful situation causes the person with dementia to act out, then you have to step in and calm the situation before it leads to more stress or even physical harm. 

Remain calm, use your body language to express that you are listening to what they say and that you believe them. 

This doesn't mean you have to agree that you too saw the same thing. It means validating their emotion. 

"That must have been very scary for you." or "I know the sound of the sirens must have startled you. " 

Comfort them and distract them by offering to move them to a new location for a short time. Provide a new activity, or conversation. Remain calm and relaxed without arguing with them about what they saw or heard. 

"Why don't we go have a snack and you can tell me how you feel." Often, by the time you have engaged them in a new activity, listened to them, and comforted them, they will have forgotten the event for the time being. 

Dementia Tip: 

An acquaintance offered this advice for an elder who is obsessed with the idea that prowlers are breaking into their room. Buy an electronic doorbell, or other inexpensive "tech-like" gadget and place it on the wall. Reassure your loved one that the new "security system'' will sound if anyone tries to enter their room. 

It might not work for everyone, but it is worth a try if "prowlers" are keeping you and your elderly loved one from getting any sleep at night.