False accusations—such as theft, poisoning, mistreatment, or confinement—commonly occur among individuals living with dementia. These behaviors stem from underlying cognitive, medical, environmental, or social factors rather than malicious intent. For nurses, understanding the root causes is essential in preserving trust, delivering compassionate care, and ensuring safety. This article explores these factors and offers practical strategies for responding effectively.
1. Co-existing Medical Conditions
Acute medical conditions—including delirium, infection, dehydration, or metabolic imbalances—can worsen confusion and trigger suspicious beliefs. Dementia-related changes in brain recognition and memory contribute to misperceptions, leading to accusations that may feel real to the person (Dementia UK, 2023).
2. Cognitive Dysfunction, Medication, and Nutritional Factors
- Confabulation: This is the production of false or distorted memories without intent to deceive—common in certain dementias. Patients may confidently present fabricated memories as reality (e.g., claiming someone stole or harmed them) due to impaired source monitoring and reality filtering.
- Delusions and False Beliefs: Dementia frequently involves misidentification (e.g., thinking a caregiver is a stranger and accusing them), theft delusions, or unfounded beliefs of persecution (Jeste et al., 2006; described in Cerejeira et al., 2012).
- Medication and Nutrition: Certain medications (e.g., anticholinergics) can exacerbate confusion or delusional thinking; malnutrition, vitamin deficiencies, or electrolyte imbalances may similarly worsen cognitive clarity. Though direct recent studies specific to false accusations are limited, these are known contributors to cognitive instability.
3. Mental Health Conditions
Psychiatric symptoms like paranoia and delusions often accompany dementia and can cause false accusations. For example, a person may irrationally believe a nurse is poisoning them or a family member is stealing their belongings, driven by misinterpreted sensory inputs or cognitive distortion. MentalHealth.com
4. Environmental Factors
Unfamiliar or chaotic environments can heighten anxiety and suspicion. Visual, auditory, or contextual confusion may cause someone to misinterpret caregivers’ intentions or surroundings, fueling false accusations. Although direct empirical studies are sparse, understanding environmental triggers is critical for prevention.
5. Social Factors
Social isolation, stress, or loss of routine may increase emotional vulnerability and suspicion. Miscommunication or lack of familiarity can deepen mistrust. Platforms like Alzheimer’s Society’s Talking Point describe how family members cope emotionally when falsely accused, advising caregivers to avoid taking accusations personally and, when needed, physically and emotionally remove themselves temporarily for self-care. Alzheimer’s Society
6. Safety Considerations
False accusations can escalate emotional distress and pose safety risks—for both the individual and the caregiver. It’s vital to assess capacity, ensure neither party is harmed, and consider structured support systems when accusations persist or escalate.
7. Other Considerations
False accusations should be carefully evaluated: sometimes they reflect real events (e.g., actual theft). Nurses must balance validation and investigation—ruling out genuine concerns while recognizing cognitive contributions.
8. Strategies for Nurses
Drawing from current sources and best-practice guidance:
- Validate Emotion, Don’t Confront – Acknowledge distress (“That must feel upsetting”) without confronting the content of the accusation. This avoids escalating defensiveness. inspiredhomecare.com
- Use Calming Redirects – De-escalate by gently shifting to meaningful or enjoyable activities, such as a simple chore or sensory distraction. inspiredhomecare.com
- Maintain Calm and Perspective – Remember the accusations are symptoms—not personal attacks. Avoid reacting emotionally. Family Caregivers Online
- Environmental Adjustment – Simplify surroundings and ensure comfort to reduce confusion. Familiar decor, lighting, and routines contribute to stability.
- Medical and Medication Review – Check for acute causes (e.g., infection, dehydration), review for delirium, and assess medications for cognitive side effects.
- Assess Capacity and Safety – Evaluate whether the person can safely remain in place or requires enhanced supervision. Engage interdisciplinary supports when needed.
- Communicate with Family or Team – Educate team members and family about roots of false accusations to foster empathy and consistent responses.
How NCCDP Can Help
NCCDP’s programs provide practical, evidence-informed training:
- Certified Dementia Practitioner (CDP) and CADDCT: Offer strategies in person-centered care, recognizing delusional thinking, and non-confrontational communication.
- Training in confabulation and delusional behavior management equips nurses to respond with empathy and maintain therapeutic relationships.
- NCCDP standards promote environmental design principles, safety planning, and interprofessional coordination to prevent escalation of false accusations.
Conclusion
False accusations in dementia are distressing but are rooted in cognitive changes and emotional vulnerability—not malice. By understanding factors like confabulation, delusions, medication effects, and environmental triggers, nurses can respond with compassion, protect dignity, and rebuild trust. Structured training—such as that offered by NCCDP—supports nurses in implementing evidence-informed, patient-centered responses that preserve safety and connection.
References
Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 73.
Dementia UK. (2023, January; review 2026). False beliefs and delusions in dementia. Retrieved from Dementia UK website. Dementia UK
Jeste, D. V., et al. (2006). [As cited in Cerejeira et al., 2012.]
Naomi Carr & Morgan Blair. (2023, May 16). Paranoia and delusions in dementia patients. MentalHealth.com Library.MentalHealth.com
Talking Point members. (2022, June 1). Dealing with false accusations made by a person with dementia. Alzheimer’s Society Talking Point. Alzheimer’s Society
AccessJCA. (2024, February 16). 8 ways to deal with false dementia accusations. DailyCaring / AccessJCA.
FamilyCaregiversOnline.net. (2024, February 6). 8 strategies for managing false dementia accusations. Family caregivers online.
