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Should You Lie To Someone With Dementia? Arguments For Therapeutic Fibbing

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One of the hallmarks of dementia or Alzheimer’s disease is the loss of memory. At first, the person may have problems with short-term memory, but as their cognitive abilities decline, the their memory will become more and more impaired. Memories of the person’s life and important pieces of their family history will drift away.

When this happens, should you lie to someone with dementia? Sometimes it is better to lie to a dementia patient for their greater good. A loving deception by adult children or those providing care can keep dementia sufferers from feeling distressed, angry, and frightened. The use of therapeutic lies can help them make sense of the world as they currently see it.

What Is Therapeutic Fibbing?

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 family members will approve of therapeutic fibs 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

Therapeutic lying just makes sense, when you think about it. But I do understand that it can be an ethical dilemma. One of the hardest things to do is to purposely tell an outright lie to someone you love and are caring for, even if it’s in their best interests.

Is It Okay To Lie To Someone With Dementia?

The intention behind the act of telling white lies to a dementia patient is often to avoid upsetting that person with reality, which oftentimes causes unnecessary distress.

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 it may be an appropriate response 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?

It’s important for the family caregiver to understand the difference in lying to someone that is cognitively intact and lying to someone that has dementia.

In a letter to a woman who was arguing with her brother about lying to their elderly mother with dementia, Carol Bradley Bursack responded with…

Dementia changes this because the person with a compromised brain can no longer make decisions that reflect their best interests. Since your mom’s capacity is limited, I feel that while the conflict is about respect, part of that respect is compassion. If you consider that compassion demands that we don’t make a vulnerable person’s life harder than it needs to be, it might be easier for you to accept your brother’s point.

thedickinsonpress.com

I thought this was an important distinction to make and one that many family members don’t see right away.

Do Dementia Patients Lie On Purpose?

Dementia is a progressive neurological disease that damages the brain and causes mental decline. People who are suffering from dementia have difficulty processing information, remembering the past, and understanding or making decisions.

The disease progression is divided into 7 stages, with the higher numbers marking more severe dementia.

Early Stages Of Dementia

In the early stages of dementia, people may experience short-term memory loss and forget information they recently learned.

The person will often ask the same question multiple times or have difficulty remembering events that are important to them, such as birthdays or anniversaries. During the mild dementia stages, they might misplace items or put them in odd places (such as putting the car keys in the freezer).

Middle Stages Of Dementia

Patients in mid-stage dementia begin to experience major memory deficits.

They might forget their address. They may not remember where they live and may not be able to understand what day it is or the time of day.

Dementia patients do not lie on purpose, per se, but by the mid-stages of the disease, they do lie because it is their disease talking. In their minds, they are speaking the truth.

Late Stages Of Dementia

In the later stages of dementia (stage 6), anger and aggressive behavior may take over.

Because they have problems processing information and remembering things, the person in stage 6 may also become suspicious of others. For example, a common accusation when they can’t find something they have misplaced is to believe (and tell others) that their dementia caregivers have stolen it from them.

Patients in stage six are also faced with increasingly severe cognitive disabilities, which begin to affect their ability to function.

This is a difficult stage for family and caregivers.

The person will likely have forgotten close friends. They won’t remember family members by name at this point; they also find it difficult to remember events or information from long ago.

At a certain point, the person may even have considerable difficulty using objects they’ve used all their lives (for example, they may not remember how to brush their teeth of comb their hair).

This stage is often when the family decides the best course of action is to find long-term care for their family member.

Final Stage Of Dementia

By the final stage of dementia, the person will likely be unable to communicate and will need help with every aspect of their care.

In my experience, most seniors in the late stages of dementia benefit from Therapeutic Doll therapies. Read more here.

Are You Supposed to Correct Someone With Dementia?

Aging adults who suffer with cognitive decline such as dementia or Alzheimer’s disease 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 one of the worst things family caregivers do is to correct someone who has advanced 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 open-ended questions 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 a lot 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 a nursing home 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 for family caregivers 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 a lot 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.

According to mentalhealth.org.uk, one important thing in caring for someone with a diagnosis of 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.

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

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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