Dementia: Flights of Fantasy ~ Let’s Talk About It!
Dementia: Flights of Fantasy
When Clarity and Confusion Collide:
Caring Through the
“In-Between” Stage of Dementia
If you care for someone with dementia, you know this disease doesn’t progress in neat, predictable steps. One morning, your loved one may recall a lifetime of memories, ask about friends from decades ago, and laugh at your jokes. In the next moment, they may declare plans to buy a new car, move across the country, or withdraw their entire savings. They are completely serious, fully determined, and deeply offended that you’re not handing them the car keys.
People at this stage often maintain impressive cognitive abilities in some areas. They might hold thoughtful conversations or recognize faces and places. But when plans or desires clash with their current limitations (such as wanting to drive, live alone, or manage finances), their diminished insight makes these goals seem entirely reasonable to them.
Dementia affects the brain’s frontal lobes, which govern judgment and impulse control. So even though a person might remember past responsibilities, their ability to evaluate whether they can still handle them becomes impaired. This isn’t stubbornness. It’s neurological.
As caregivers, we must remember that our loved ones are not “fighting” us out of defiance. They’re fighting to maintain dignity and control in a world that increasingly undermines both. Below are five Gentle Strategies to Help Caregivers handle difficult situations.
Dementia: Flights of Fantasy
Five Gentle Strategies to Redirect Unrealistic Plans
Below, I share what’s worked for me and what research suggests about supporting someone who’s living in this delicate balance between lucidity and confusion.
Here are five techniques, some of which I use, that are supported by dementia care research. When reality and wishes collide, these tools are designed to steer conversations and behavior gently. I provide some options as examples.
Validate Before Redirecting
Before saying “no,” validate what you hear. Validation therapy, developed by Naomi Feil, encourages us to accept a person’s feelings as real, even when their facts are not.
Example: “You’ve always loved driving. I can see why you miss the freedom.”
Then, redirect: “How about we take a drive together this afternoon?”
Example: “I know you miss the freedom to travel and learn new things. I’d be happy to set you up for some virtual tours on our computer. We can visit museums and flower gardens all over the world. There are tours of the most famous art that you can view from your bed or chair. The bonus is that you can see it all without your legs getting tired and your feet swelling.
This approach acknowledges autonomy while keeping safety boundaries intact. Read more about Validation Therapy.
Use “Yes, And” Statements or the Equivalent
If they are talking about moving to a new home, borrow this technique from improv theater. Instead of blocking them (“You can’t live alone”), blend agreement with gentle redirection.
Example: “Yes, moving sounds exciting, and maybe we can look at some neighborhoods online later to see what fits best. I have a busy schedule this week, so how about starting your search next Tuesday, at 1:00 pm, when I can help you.”
Example: “That’s great! How much are the moving and closing costs? Oh, you’re not sure? We can talk more after you’ve finished your research.”
The person feels heard and respected, thereby reducing agitation and confrontation.
Offer Meaningful Substitutions
If someone insists on withdrawing money or “handling their accounts,” give them a task that satisfies that need for control.
Example: Create a “finance folder” where they can help you “organize statements”.
Example: Have them make a list of the financial topics they would like to discuss with the bank personnel.
The key is to discover and engage the purpose behind the behavior-independence, not the literal request.
Research in occupational therapy shows that meaningful engagement helps preserve emotional well-being and reduces challenging behaviors.
Change the Environment, Not the Argument
There will be those moments when all is calm, and then, your person with dementia mentions something that you thought was handled, and they were adjusting well to the “new normal”. Let’s say the topic of driving comes up (though the neurologist has determined they are no longer safe to drive). Or, they think they are still employed and are getting ready for work.
Instead of challenging their reasoning, shift the environment.
Example: “I know you miss driving your truck. Let’s make a follow-up appointment with the neurologist. In the meantime, would you like to come with me to run a few errands? I could use the company.
Example: If they mention going to work, “Ok, but the office called to say they were closed today. So, how about doing some gardening while the weather is nice?”
Example: “I know you want to go to work, but Nana asked to see you, so we should stop by there first.”
Environmental cues- sights, sounds, routines- often work faster than logical explanations.
Keeping Emotional Bank Accounts Full and Caring for You: The Hidden Grief in Saying “No”
It’s not just about keeping them safe; it’s about your heart. Someone whom you love can no longer drive, work, or live independently. That is its own kind of grief. You’re holding the line for safety while your heart remembers who they used to be. You feel guilty, angry, and exhausted – all at the same time.
You might also doubt yourself: “Am I being too strict? Too soft?” Those feelings are normal. You’re making decisions that they would be responsible for before the dementia diagnosis, so the heaviness of the responsibility lands on you.
Give yourself the same kindness you’re trying to give them:
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Build routines that make redirection easier (same phrases, same “projects,” same soothing activities).
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As applicable, share stories of lucid episodes and tough moments with the medical team so they can adjust their care plans and reassure you.
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Reach out to support groups or counseling where you can say, “I hate being the bad guy,” and hear, “You’re not. You’re the protector.”
Dementia: Flights of Fantasy
Safeguards for Your Person AND Yourself.
Let’s spend a minute on this important issue.
Some caregivers have their person count play money. This won’t work unless the person’s dementia has progressed to the point where they cannot tell the difference. (More about this in a minute, as you safeguard their money,)
The play-money approach works alongside – not instead of – real protections:
- Legal guardianship or power of attorney over finances
- Removal of real credit/debit cards and replacement with a dummy card
- Notification of the person’s bank
- Removal of checkbooks for real accounts
- Online account monitoring by a trusted family member or care manager.
You’re not failing when you divert them from unsafe choices when they suffer from “Dementia: Flights of Fantasy.” You’re succeeding at love in one of its hardest forms.
Every positive interaction builds emotional trust. When the day comes to say, “We can’t do that,” your loved one is more likely to accept it without anger if they feel loved and respected consistently.
Emotional deposits can be small: shared laughter, simple projects, or honoring old rituals like morning coffee together.
Dementia: Flights of Fantasy
Adaptive Care Approaches by Age
Dementia: Flights of Fantasy isn’t confined to older adults. Some people develop symptoms in their forties or fifties, and each age group presents unique emotional and practical challenges.
Identity loss hits hard. Careers, specific skills, parenting, and independence may still be central to life. Emphasize dignity and involvement in family decisions where possible. Create structured daily roles (like helping prepare meals or sorting mail) to provide some purpose.
- People often vacillate between nostalgia and present concerns. Music therapy, reminiscing, or life story projects can be healing.
- Humor helps. Laughter lowers cortisol and helps both of you cope. Try watching old comedy shows or looking through photos together.
- Prioritize comfort, safety, and emotional connection over achievement or correction.
- Gentle touch, soft lighting, and slow pacing can reduce anxiety.
Alzheimer’s Association recommendations by age offer further insights tailored to family caregivers.
Dementia: Flights of Fantasy
Considering Cultural and Faith Backgrounds
Each person’s worldview shapes their comfort and sense of meaning. Culturally sensitive care isn’t about knowing every tradition – it’s about curiosity and respect.
- Religious needs: Include familiar prayers, hymns, or rituals. These often stay intact even in late-stage dementia and can bring peace.
- Language and heritage: Use phrases or foods from their childhood. Memory linked to culture and emotion often persists.
- Gender roles and expectations: In some cultures, elders are the authority. Frame your assistance as “teamwork” or “support.” Do not make them feel as if they must request “permission” every step during the course of a day. This helps to maintain dignity.
When in doubt, ask: “What comforts you most from home or faith tradition?” That question opens the doors to a deeper connection.
Dementia: Flights of Fantasy
The Caregiver’s Balancing Act
As caregivers, we live in emotional crosscurrents between honoring autonomy and ensuring safety, between frustration and compassion. It’s okay to feel tired, even resentful sometimes. The important part is remembering that each confusing conversation is also an opportunity to show profound love.
A favorite quote from Maya Angelou sustains me:
“People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
When I focus on making my loved ones feel safe and valued, even the most difficult days feel meaningful.
Final Thoughts
Dementia – Flights of Fantasy. The in-between stage of dementia (when clarity and confusion coexist) is both bewildering and beautiful. When we learn to validate, rather than correct, to redirect rather than argue, and to replace control with trust, caregiving becomes a form of grace.
As you know, you might not always find the right words, but love speaks fluently in tone, patience, and kindness. Take care of yourself, too. After all, you’re the anchor holding multiple lives steady in an unpredictable current. Click here for my blog, where I share ideas regarding caregiver burnout and tips to help.
Shannon Sapp
Caregiver &
Tablescape/Decor Designer
I hope you have found some value in my blog about Dementia: Flights of Fantasy. If you haven’t already done so, please subscribe to this website. Let’s keep the conversation going! Let me know if there are topics you would like me to cover in future posts. See my contact information on the business card below.
NOTE RE AI: These thoughts represent my own thinking and experiences, but were enhanced in places by using AI to organize the content.
DISCLAIMER: I am not a licensed expert in health fields or nutrition, nor am I certified in any medical capacity. I am simply sharing research I’ve gathered from reliable sources, together with my own experiences, so that we all may learn something along this journey.
Neither I nor this website makes any claims about prevention, diagnosis, treatment, or cure for physical, emotional, mental, or spiritual illnesses or symptoms. This content is for informational and educational purposes and does not provide individual medical advice. Contact your health provider about your situation.
Author: Shannon Sapp: FBC & Signature Designs by SAS
Shannon is a seasoned, Master Caregiver, who had to learn on the job, as she helped her husband through through death-defying moments, hours, days, months, and years. Simulaneously, she cares for two other people with life-threatening issues, and she does this 24/7/365! She's often asked, "How do you DO that?" and has decided to share her ideas to help other patients, caregivers, their families, and supporters. Now, she and her husband are leaders in advocacy for cancer research and in teaching both patients and caregivers healthier ways of living. She also designs interior decor and tablescapes under Signature Designs by SAS.