Psychology for Everyone

When Dad Became Another Person

After two small strokes, Mr Okafor, seventy-six, was living in Lagos with his daughter, Chidinma. Over the last year he had become confused in the evenings, sometimes shouting and accusing the housemaid of stealing, and …

After two small strokes, Mr Okafor, seventy-six, was living in Lagos with his daughter, Chidinma. Over the last year he had become confused in the evenings, sometimes shouting and accusing the housemaid of stealing, and at other times sitting silent. His neighbours called it 'madness.'

Chidinma was ashamed and frightened. A relative suggested a prayer house where he could be kept 'in a quiet room.' She had almost agreed when her nephew, a nurse, said, 'Wait. A locked room is not care.'

They took him to a doctor. He was diagnosed with vascular dementia. The doctor explained that behaviour changes can be a symptom, that pain, thirst, noise and tiredness can make them worse, and that there are ways to help. Chidinma learned to keep evenings quiet, use the same routine each day, and treat his pain. She sat with him over old photographs and let him help with simple tasks.

The doctor also reviewed his medicines carefully, because older adults are sensitive to side effects. Chidinma stopped feeling that her father was a burden. She said to her sister, 'He is still Dad, only the road is different. He needs respect and dignity, and so do we.'

How to recognise it

  • Evening confusion, suspicion, or agitation in a person with memory loss.

  • Sudden changes in behaviour or personality after strokes or head injury.

  • Behaviour that gets worse with pain, noise, thirst, or tiredness.

  • Family shame, and talk of hiding or confining the person.

  • Risk of falls, wandering or unsafe use of appliances.

What this story explains

This story shows the chapter's points on other causes of dementia such as vascular dementia, on behavioural symptoms needing professional help, and on respect, inclusion and dignity for older adults.

Probable root causes

  • Vascular changes in the brain after strokes.

  • Pain, infection, hunger, thirst or poor sleep adding to confusion.

  • Noisy, unfamiliar or crowded surroundings.

  • Medicine side effects, since older adults are more sensitive.

  • Stigma and lack of information in the family.

What to do

  1. Seek a medical assessment for sudden or worsening behaviour change.

  2. Check for pain, infection, hearing, eyesight and medicine effects.

  3. Keep a calm routine, quiet evenings and familiar objects.

  4. Use meaningful activities that fit his ability.

  5. Make the home safe and plan against falls or wandering.

  6. Never lock or confine him; ask for professional help and carer support.

Whom to consult

  • Family doctor or neurologist for assessment and medical management.

  • Psychiatrist or geriatric specialist for behavioural symptoms.

  • Occupational therapist or physiotherapist for safety and activity.

  • Emergency service or hospital if he is injured, suddenly more confused, or at risk.

Do and don’t

Do Don’t
Do look for causes of distress. Don't lock him in a room.
Do keep to one daily routine. Don't call it madness.
Do keep him included in family life. Don't shout back or argue.
Do review medicines with the doctor. Don't use medicine or sedatives from a pharmacy without the doctor.
Do give carers rest. Don't talk about him as if he is not present.

How to behave and communicate

  • Use a gentle voice: 'Papa, I am here. Everything is safe.'

  • Do not argue about accusations; respond to the feeling: 'You are worried about your things.'

  • Offer simple choices and short sentences.

  • Avoid raised voices, rushing and crowds.

  • Treat him as an adult with a full history.