Can Lying to Someone Living with Dementia be Therapeutic and Compassionate; and Not Morally Wrong?

Can Lying to Someone Living with Dementia be Therapeutic and Compassionate; and Not Morally Wrong?

Many caregivers wonder whether it’s OK to lie to someone living with Alzheimer’s or another kind of dementia. When they realize that trying to convince them of the truth isn’t working.

Many years ago, it was thought that strict reality orientation should be used when individuals living with Alzheimer’s became confused. In other words. If the person thought their parents were still alive. It was recommended that the person be told the truth—that their parents are dead—in order to bring them back to reality.

Obviously, this approach doesn’t work. As it only serves to upset the person more. Regretfully, Alzheimer’s affects the brain in such a way that trying to reason or use logic may no longer work.

Reality Orientation versus Therapeutic Fibbing:

When Stepping into their reality isn’t the same as lying!

A family member or friend living with Alzheimer’s or dementia may experience a different version of reality. Due to their brain’s steady loss of the ability to process information. To help deal with the situation, dementia care experts recommend stepping into the person’s reality. Rather than trying to correct them or bring them back into ours. Forcing the person to join us in the “real world” can cause confusion, anxiety, and fear.

I recently came across the term Therapeutic Fibbing — little white lies — and realized that I have used this technique before. With my daughter when she was an infant, and with my Mom during her later stages of living with Alzheimer’s. Therapeutic fibbing takes some getting used to. You may think that playing along with the person’s new reality can feel like you’re lying to them. However, honesty may not always be the best policy when it comes to someone living with dementia.

On a recent trip to Montreal I unconsciously found myself using the technique to deal with my Dad’s constant request to ‘I want to go home’. In this case, home is back to Greece. Here’s an article you can read on How to Handle the Situation When Someone says “I want to go home”.

Telling the truth can be cruel for them.

From a young age we are taught that lying is horrible and dishonest. On top of that. We are told never to lie to our parents, spouses, and people we love and respect. So, when we hear about lying to a vulnerable person it seems cruel and wrong. When it’s us doing the lying we can feel sad and wrong.

Sticking with the truth, especially with an emotional subject, can cause pain, confusion, and distress. To someone living with dementia. Furthermore, short-term memory loss means they probably won’t remember the conversation. Resulting in the conversation coming up again. Telling the truth each time forces the person to relive the fear and anxiety over and over again.

Dementia prevents people from properly processing and retaining information. As caregivers we should ask ourselves –> Is it necessary to cause them so much distress? Especially when the truth we tell them is likely to be misunderstood and quickly forgotten?

Therapeutic fibbing helps you step into their world

In a nutshell, Therapeutic Fibbing is lying — or not correcting a misconception — to decrease agitation and anxiety in a person living with Alzheimer’s or dementia. Always telling the truth to someone with Alzheimer’s or dementia is most likely to upset or hurt them.

Therapeutic fibbing is a technique you can use to step into the person’s new reality and spare them unnecessary pain and distress. Using untruths to validate their feelings and reassure them is not the same as lying for a malicious reason.

In many ways, it’s similar to telling a friend that you love the thoughtful gift they gave you. Even if the gift resides in the closet. Telling the absolute truth wouldn’t change the situation. The truth however can hurt their feelings.

World-renowned for her breakthrough Validation Therapy, Naomi Feil, advises that to better empathize and communicate with cognitively impaired people suffering from dementia, that we enter their reality. This four-minute You-Tube video overviews the approach. There is no harm in believing the sky is orange. Sometimes, when the sun is rising or setting and the clouds are just right, it does have hues of orange.

Some caveats

Although doctors and medical ethicists are generally proponents of truth-telling, dementia experts tend to support these kinds of white lies — with certain caveats. “For people who are cognitively impaired to a level where they cannot absorb or process information well enough to understand it, therapeutic fibbing is a way to avoid upsetting them in ways that serve no purpose

However, as caregivers we need to be cautious that we do not justify therapeutic fibbing to avoid difficult or painful conversations

Jason Karlawish, co-director of the University of Pennsylvania Memory Center. Karlawish prefers calling this approach “loving deception” and says whether or not to lie is about intent. Reminding us that “the moral role of the caregiver is to respect the person’s sense of identity and self.” He strongly advises that “the default is the truth and that the mere fact that the truth may be painful isn’t sufficient to avoid it.” Only if the patient cannot process and make sense of a particular truth is it okay to lie. After all, he said, “truth and trust are two important virtues of behaviour that allow us to get on in life.”

Two examples illustrating the difference between Therapeutic Fibbing and Being Completed Honest:

Being completely truthful:

Your mom: School is over. My mommy is coming to pick me up now. I need to go outside to wait for her!

You: You’re 89 years old. You haven’t been to school in decades. And don’t you remember that your mom died 25 years ago? You don’t need to go outside because nobody is coming to pick you up.

Instead of “Don’t you remember, she died a half-dozen years ago?” I’d say, “She went to the store. She said she wanted to make us a special meal.”

There are variations when using this approach from telling an innocent lie to diverting attention toward a pleasant memory.

Your mom: What? What do you mean my mom is dead? No! She can’t be dead!! I saw her this morning! She told me she would pick me up!!! I need to go outside to wait!! (She’s crying, agitated, and screaming.)

Using therapeutic fibbing

Your mom: School is over. My mommy is coming to pick me up now. I need to go outside to wait for her!

You: Oh yes, it’s almost time to go. Your mom asked me to give you a snack first so you won’t get hungry on the way home. Let’s have some juice and crackers.

Your mom: Ok, I’ll have a snack.

You: (Use this distraction as an opportunity to occupy her with the snack and a fun activity until she lets go of the idea of meeting her mother.)

What else you can do

Therapeutic fibbing is not the one-size-fits-all answer. As caregivers we can consider these additional strategies:

  • Try changing the subject. Instead of lying or getting into an argument, redirect the person to a new topic.
  • Listen for the emotion driving the patient’s behaviour and validate it. Rather than argue with the facts. For instance, if the person is angry or agitated, acknowledge those feelings as real. Which they are. Even if the object of their distress is not.
  • Do not try to force a person living with Alzheimer’s to see things through your eyes. They simply may not be able to do so, and any efforts may lead to greater agitation or suffering.
  • Accept their reality even when it differs from your own. If your loved one is okay and not in danger, let them be in their own world.

Bottom line

Always telling the truth to someone living with Alzheimer’s or dementia is most likely to upset or hurt them. Therapeutic fibbing is a technique you can use to step into their new reality and spare them unnecessary pain and distress.

The benefits of therapeutic lying with validation allow the person with dementia to maintain dignity and elicit a continued sense of purpose and the desire to communicate for as long as possible.

At times companionship can go a long way. It can help deal with loneliness and provide comfort. You can always hire a companion keeper from uCarenet. By hiring direct. You can personalize a care plan to your family’s needs and budget. You can join uCarenet’s home care marketplace, and create your job post or Care Provider profile here: https://ucarenet.com/join now

 

Some additional articles you may find interesting:

Alzheimers – Creating a Daily Plan

 

Are Canadians (Notably Millennials) Ready to Care for Growing Senior Population? The Survey Results Are In

 

The Brampton region is home to a fast-growing number of clinical trials and tests, centred on diabetes, cardiac care, long-term care and home-care technologies.

 

 

 

Share this post