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Should You Lie To Someone With Dementia?

There is a phrase, “therapeutic fibbing” which refers to the method of being untruthful with someone who has dementia. “Therapeutic fibbing is lying, or bending the truth, in order to avoid increased agitation from a person with dementia.” Not all families approve of this method but in my experience, it is very effective and there is research that agrees with me.

…research has now indicated that this technique can help reduce caregivers’ stress while reducing the stress of those with cognitive impairment as well. – ocagingservicescollaborative.org

It just makes sense, when you think about it. But I do understand that it can be difficult to purposely tell a lie to someone you love and are caring for.

Is It Okay To Lie To Someone With Dementia?

The intention behind the act of lying to someone with dementia is often to avoid upsetting that person with reality which oftentimes causes unnecessary distress.

Instead, focusing on the memories someone with dementia is talking about instead of correcting any untruths can help everyone involved.

When your parent has dementia, intention matters. The purpose of a lie is usually not to create false beliefs. Instead, lying in dementia care is designed to promote wellbeing, distract from upsetting circumstances, or protect a loved one from harm. This small but important distinction makes a difference when determining the best path forward. – aginglifecare.org

Some other instances where you may need to lie for the benefit of the person with dementia are…

  • “The car is in the shop” or “It’s too expensive to fix” – are two fibs that can be told when the person with dementia is demanding to drive their car but it’s not safe for them to do so.
  • “I need to see my doctor, I need your help.” – is something that you can say to get your senior loved one to go to THEIR doctor. If they believe the visit is for you, instead of them it may be easier to get them there.
  • “I’ll let you know when your mother/father arrive – should be about an hour or so.” – is a fib that can be told when your aging loved one with dementia is wanting to know where their parents are and when they are coming to pick him/her up?

Are You Supposed to Correct Someone With Dementia?

Aging adults who suffer with cognitive decline such as dementia or Alzheimer’s have problems with short term memory and sometimes long term as well. There are some who have delusions and many confabulate (I saw this quite often when working with my elderly patients).

According to a review article published in the International Journal of Neurology and Neurotherapy, “confabulation is the creation of false memories in the absence of intentions of deception.” Although a dementia patient’s distorted recollections of memories (and even events that never happened) may seem like blatant lies to a family caregiver, the truth is that “individuals who confabulate have no recognition that the information being relayed to others is fabricated.” – agingcare.com

My experience as an Occupational Therapist has taught me that most of the time it is not beneficial to correct someone who has dementia when they say something that isn’t true.

Instead, what works very well is to respond to their question or statement and then ask them a question about that topic or change the subject to something completely different.

An example would be something like this…

Your elderly mother says “I have to go to the dry cleaners to pick up my dress for the party tonight.

Your response can be “I just called and they said the dress will be ready in an hour – did you go to alot of parties when you were a teenager?” OR
I just called and they said the dress will be ready in an hour – let’s make some cookies for when Sarah gets home from school.

Years ago, during my first year practicing as an Occupational Therapist in geriatrics, my supervisor instructed us to correct any lies/untruths that our patients with dementia would say with the truth.

I can tell you that I don’t recall any incident where I did that where my patient did not become agitated, angry, more confused, etc. It was not a successful way to deal with someone suffering from this terrible disease.

This oftentimes ended up interfering with any other activity we were trying to engage our patients in. (Needless to say – many therapists and myself included did not use this method often.)

Thankfully, in my second year as an Occupational Therapist – the rules changed. It was discovered (no surprise to us practitioners) that by revealing the truth to our patients with dementia, we only aggravated the situation which in turn caused emotional and psychological distress to the patient (and to us as well!).

So, the standard for treatment then became to try to understand what our patient was remembering and why and to engage them in their line of thinking. Basically, instead of trying to get them into “our world” – we needed to go into “their world”.

It worked beautifully.

Here’s a great example that I remember…

I had a beautiful woman in her late 80’s with dementia and I was working with the Physical Therapist to help our patient walk with a walker. We knew it was going to be difficult because learning a new task when you have dementia is extremely difficult.

As we walked with her, she began saying that she needed to get to the porch because her mother was coming to pick her up. Of course, her mother had passed away many years earlier.

Instead of telling her that we were not going to the porch and that her mother was dead, we simply began asking her questions about her mother.

  • What did her mother like to cook?
  • Where was her mother born?
  • Did her mother like to dance?

The point is that our sweet patient was remembering her mother and we wanted to encourage that thought and help reinforce that happy memory for her.

Not only were we able to continue our activity, we did so in a calm and pleasant manner.

Whereas if we had gone with the truth – she may have broken down crying, upset to find out (again) that her mother had died and of course – abandoned the activity and therapeutic intervention.

Yes, it’s true – within an hour or so she would have forgotten this interaction but it would have just repeated itself and honestly, in my personal opinion, what’s the point?

What Should You NOT Say To Someone With Dementia?

Any relationship counselor will give you a list of things to avoid saying when you are in an argument or any other situation with someone. The same is true when engaging with someone who has dementia.

There are certain phrases and things that you simply should try to avoid.

  • Don’t you remember? – this is especially harmful for someone at the beginning stages of a cognitive decline. This phrase just reminds them of what is happening to them.
  • Oh no, she/he is dead – as in the example I said earlier – it does not help anyone to keep reminding your senior loved one that the person(s) they are longing to see is dead – you are forcing them to relive that traumatic moment again and again.
  • What? You are wrong! – many elderly with cognitive decline will confabulate – they make things up to help fill in the holes in their memory of an event.  Pointing this out only increases their awareness that they are “losing it” cognitively.
  • No, the car was red, not blue. – when someone with dementia is recalling a story and they get a factoid in the story incorrect – no need to correct them – even if it impacts the story. Let them continue – let them tell it their own way.
  • I already told you that a hundred times. – it’s very common for someone with dementia or Alzheimer’s to repeat themselves over and over, day after day.  I do understand this requires alot of patience from the caregiver but telling them you’ve already told them (and worse, yelling it to them) doesn’t do anybody any good.
  • What do you want for dinner? – basically, giving anyone with cognitive decline open ended options is a very bad idea. You want to limit it to two options at the most. This makes it much easier for your senior loved one to make a decision.
  • Her brain is on the fritz. – or any phrase in front of the aging adult with dementia that is derogatory about them. It can be humiliating and embarrassing. (and yes, I heard a daughter say this about her mother in front of her mother).
  • Let’s make some breakfast, then go do some laundry and then we need to go to the pharmacy to pick up your medications. – this is just too much information for someone with dementia to absorb. Keep your instructions extremely simple. One thing at a time.

One key element to caring for someone with dementia is the interaction when they experience a different reality from their carer or families, especially as the condition progresses. This is one of the most challenging aspects of the condition and can be particularly difficult to manage by the carer. – mentalhealth.org.uk

Recommended Books

Some books that I can recommend that may help you to be the best caregiver you can be for someone with dementia are…

The Caregiver’s Guide To Dementia: Practical Advice For Caring For Yourself And Your Loved One by Gail Weatherhill, RN, CAEd

The 36-Hour Day: A Family Guide To Caring For People Who Have Alzheimer Disease, Other Dementias, and Memory Loss by Nancy L. Mace and Peter V. Rabins

What To Do Between The Tears…A Practical Guide To Dealing With A Dementia Or Alzheimer’s Diagnosis In The Family by Tara Reed

In conclusion – although technically you may need to tell a lie to the person you love – think about the intention behind that fib. Parents lie to their children often to protect them – this truly, in my opinion is no different.

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