Therapeutic Lying With Dementia Patients

Therapeutic lying is the practice of telling little 'white lies' or fibs to prevent from agitating the patient with dementia. Even though some of us were taught to never lie to any patient under any circumstances due to ethical issues, please realize that the truth often inflicts unreasonable pain and mental anguish upon the demented patient.

As caregivers, we want to be completely honest with our patients. However, when someone has dementia, honesty can lead to distress both for us and the one we are caring for (AGIS, 2009). For example, the 89-year-old female with mid-stage Alzheimer's disease asks about her husband on a daily basis because she has forgotten that he died more than twenty years ago.

The nurse has the option of reminding this lady that her husband is dead, but this will also remind her about the mental pain and profound grief associated with that loss. This female will likely ask the same question tomorrow because, due to her declining cognitive function, she cannot remember yesterday's events. The nurse may choose to provide these daily reminders of the spouse's death, which will only serve to reopen the demented lady's emotional wounds on a daily basis.

On the other hand, the nurse has the option of employing therapeutic lying to handle the situation. Instead of telling the demented patient repeatedly that her husband has died, the nurse reassures her by saying, "He has gone fishing with Uncle Bart." Uncle Bart also died many years ago, but the female patient has forgotten about that, too. Instead of collapsing to the floor in tears, our demented patient smiles and says, "I hope they catch some good ones!"

In most cases, telling the truth is the reasonable, moral, and ethical thing to do for all parties involved. The problem is that patients who are in the middle and late stages of dementia cannot be reasoned with. When someone is acting in ways that don't make sense, we tend to carefully explain the situation, calling on his or her sense of appropriateness to get compliance (AGIS, 2009). However, the demented patient has lost this sense of logic. Therapeutic lying works in these situations, whereas reasoning and logic fail miserably.

It is best to use therapeutic lying when the truth would incite mental anguish, anxiety, agitation, and confusion in the demented patient. Also use therapeutic lying when the demented patient is obviously not grounded in reality and is living in a different time than everyone else around him or her. People with dementia do not need to be grounded in reality (AGIS, 2009). If the 92-year-old gentleman believes that the year is 1962 and that John F. Kennedy is the president of the United States, what is wrong with allowing him to think it is 1962? Reality orientation would be more of a hindrance than a help in this situation. Instead of forcing him to live in the present day, the caregiver may wish to step into his world.


Reference:
Family Caregiver Alliance
Ten real-life strategies for dementia caregiving
Ten Tips for Communicating with a Person with Dementia

Validation Therapy & Redirection : How to Talk to Elder with Dementia