Lying to those with Dementia

January 31, 2011

I’ve touched on this subject in earlier blogs, but I think it merits its own treatment.  Most of us are brought up to be truthful people.  Lying is just one of those things you avoid like the plague.  However, when a person has dementia, all the rules change.  This thought is completely offensive.  It even offends me as I type it, but perhaps it will make more sense if I give some examples.

Miss Ruth, a lady with dementia in her 90‘s, had a home health nurse come to her house several times a week.  When the nurse arrived, Miss Ruth would say joyfully, “I had breakfast with my mother today.”  The nurse would reply, “Miss Ruth, your mother has been dead for many years.”  Every time the nurse “re-oriented” her, Miss Ruth grieved her mother’s death anew in her mind and heart.

Most of us would agree that the nurse chose legalism over kindness and compassion in Miss Ruth’s case.  If the nurse had said, “Really?  What did you talk about?  What did you have to eat?”  She would not have been lying, just asking Miss Ruth questions about the morning as Miss Ruth remembered it.

“I had breakfast with my mother today,” when you know her mother is dead.  “You need to take me home now,” when he is home.  “I’ve already had my bath,” when you can smell that she hasn’t.  “The people in the next room are having a party,” when you are in the house alone with him.

How do you respond?  The best way to respond is to choose kindness over truthfulness, compassion over being correct, love over being right.

“You need to take me home now.”  Your father is home, but it’s not the home he recognizes.  There is no home he recognizes, so you respond, “Yes, dad, I’ll take you home.  I just need to finish a few things first.  While you’re here, would you help me with….”

“I’ve already had my bath.”  Your mother has not had her bath, but your respond, “You’re right.  Would you mind if I change your shirt, though?  I think there is a spot on it and I want to put it in the wash before it stains.”  Then, do the same with her pants.  Ask her to hold a warm washcloth, lead her to the tub.  Tell her that, since the bath water is already run, she might as well take a bath.  Break everything down into very the smallest steps, since something involving multiple steps like taking a bath may be intimidating and confusing.

“There are people in the next room who are having a party.”  What should your reply be?  “Should we join them?” or “Good heavens!  It sounds really wild!” or “Yes, but I will ask them to keep it down, since you’re ready for bed.”

There are a million different situations when you have a choice:  Be truthful and upset the person with dementia OR be kind and lie / avoid the truth.  Those with dementia cannot re-enter the “real world.”  You cannot convince them that their hallucinations are false or their remembrance of events is incorrect, so trying to “re-orient” them to reality is pointless.  Furthermore, if you constantly correct them, they will grow less and less sure of themselves, risking depression (a very common issue in those with dementia).  Even if they don’t remember the exact words, they will remember how you made them feel.  Choose kindness.  Validate who they are, even in their confused state.  In most cases, being right doesn’t matter anymore anyway.

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3 Responses to “Lying to those with Dementia”

  1. Lindsy says:

    good article, incredible page design and style, carry on the great work

  2. indie ramroop says:

    As a caregiver, I believe in using compassion over telling the truth.. but what would then be a proper approach to someone who is aggressive and at times violent who is lied to by family members that he is not in a home but at a hotel until he gets better?

    • Ellen Potts says:

      We had a family member with Alzheimer’s who became so violent that he had to be committed to a geriatric psychiatry facility as a danger to himself and others. This happens in about 10% of people with Alzheimer’s, so it is a very real problem. If the “hotel” story makes the person angry, then certainly the family should abandon this strategy and try something different. Just about all people with Alzheimer’s constantly want to go home. However, the home they are looking for (with parents, siblings, etc.) is not there any more, even if they live in the same house. What they search for is familiarity, security and love — the “feeling” of home — in a world that increasingly has become unfamiliar to them. Look at old picture albums, sing favorite songs from the person’s teens and twenties, tell old stories, ask the person about an old quilt his grandmother made, etc. With Alzheimer’s disease, caregivers must try a variety of strategies and find what works for their own loved one. It would be nice if there were a “cookbook” approach that always worked with everyone, but sadly, there is not. Find what works for your loved one, use it while it works and try something different if and when it stops working. Prayers for this family in their caregiving journey!

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