Therapeutic Lying With Dementia Patients
by TheCommuter Asst. Admin
The intended purpose of this article is to further explore the practice of therapeutic lying to demented patients.
- 21 Published Jul 8, '12
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.
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Validation Therapy & Redirection : How to Talk to Elder with DementiaLast edit by TheCommuter on Jul 21, '12
TheCommuter is a moderator of allnurses.com and has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a registered nurse.
TheCommuter joined Feb '05 - from 'Fort Worth, Texas, USA'. Age: 33 TheCommuter has '8' year(s) of experience and specializes in 'acute rehab, long term care, and psych'. Posts: 25,351 Likes: 34,406; Learn more about TheCommuter by visiting their allnursesPage Website
3Jul 8, '12 by merleeExcellent article. When I was in nursing school during the Jurassic age, we were being taught to re-orient, and sometimes it didn't seem right to me. But to get my grade, I went along. Later, I learned the art of being in their world.
Now I watch my MIL in her other world. Her son is heartbroken, but sees the point of not agitating.
It is sometimes just a matter of 'going along to get along'.6Jul 8, '12 by brilloheadI was just talking to my 12yo son about this last night. I don't remember how we got on the subject of Alzheimer's, but in the process of explaining the progression of the disease, I also explained the difference between being able to reorient someone in the early stages versus not causing further emotional anguish for someone in the later stages.
If an 80yo woman thinks she's pregnant with her husband's baby, what's wrong with saying, "Congratulations! I'm so happy for you!"??? It's different, of course, if she's wanting to eat the "chocolate candy" she retrieved from her brief -- then it's time to distract her and wash her hands. But if going along with her story doesn't cause any harm, you can bet your sweet bippy that I'm going to go along with her story.6Jul 8, '12 by bonster71Wonderful article. Just the other day in memory care, nearing the dinner hour, perhaps 4:30p, I noticed two female residents whispering and clearly making "plans". I am charting at the computer during this time. After a few minutes, they leisurely stroll up to me in their sunhats and beads, and claim that they "need to make a reservation on the sundeck," and the ringleader tells me that I "need to have the boys pull the car around." She advises that they will also "need drinks." Clearly, these two lovely ladies were in high style on vacation (I like to imagine the 40's or 50's) with huge glasses and hats, perhaps a strapless glamourous white swimsuit, while the men were golfing. It was such a pleasant, happy thought for them, AND for me, after a long day, and I wouldn't dare take them out of that dream. I advised that dinner was being served in the "banquet" room, and that perhaps they should have a bite to eat first before heading into the hot sun. They went, they did, and unfortunately for me, their trip was over.
I have both Alz/Dem organic cognitive decline as well as behvaioral/mental health on my lockdown unit. Some require reorientation, and some do not. The two lovely ladies were just FINE where they were.2Jul 8, '12 by DizzyLizzyNurseI've found theraputic fibbing to be helpful sometimes. I've had patients think I am their mother. It came in very handy if they didn't want to bathe or eat. Why put a LOL through the pain of her mother saying she's not her mother or that her husband is really dead?2Jul 8, '12 by VickyRN Asst. AdminI don't look upon it as lying, per se, but entering into that patient's reality, which is probably much more pleasant to them than the present. AD is such a cruel disease, dismantling the personality and memories a bit at a time. Hope they find the cure soon!1Jul 8, '12 by demylenatedI try and tell people... Imagine the pain of finding out your husband is dead. Now, imagine reliving that ever 10 minutes, every hour, or daily depending on how often they ask. They grieve all over again. Stress level increases... stress can lead to sickness.
We were taught a long time ago to re-orient as well. I saw way to many tears.3Jul 8, '12 by JZ_RNIf someone wants to wander out in a storm, I tell them the truth. If what they are doing will harm them, I reorient, or at least spin their ideas into something safe. If it doesn't hurt to let them stay in their own, safe, comfortable, or at least non-terrifying reality where they are younger, healthier, or in a happier time and place, why drag them back to ours, where they are sick, helpless, vulnerable, and living in a nursing home? If it hurts nothing, let them stay happy where they are! Good article!