Therapeutic Lying With Dementia Patients - page 2

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... Read More

  1. 7
    "Lying" has such a negative connotation for many of us that it's just too darn difficult to give it the stamp of approval. Instead, we need to look at this therapeutic connection as meeting our patients where they are.

    Who are we caring for if we tell a woman she retired from a job she loved twenty years ago, or we say to a man that the cows he wants to go milk have been dead and gone for decades?

    Here are a couple of strategies to keep ourselves honest while not clubbing these tender souls with unwanted truth.

    Let the fabrication be mostly theirs. Work with the names and places and situations they supply. One of the very best pieces of advice I have ever heard on this subject is to ask the patient how old he or she is. The answer will tell you a lot about where they are in their own heads.

    Address the emotions at hand without dwelling on the details. Mid-stage dementia patients can't identify that they're losing their minds, but they can convert that anxiety into other feelings and attach the tension to the people and places they still have left. One patient's agitation over feeling out of control becomes worry that her husband won't know where to pick her up. You deal with the concern by saying that you'll be sure he gets the message and encourage her to have a light meal while she's waiting. Chances are she'll be distracted enough by the normal routine (and by her feeble short-term memory) that she'll move on to something else before too long.

    Ask open-ended questions about the people and things they talk about. This can come in handy later when some of the details begin to slip away. "You're worried about your car, Ed? Are you talking about the old Chevvy? The red one you told me about?" If he had indeed talked about such vehicle, your words--your connection--may help settle him or at least get him talking about something less stressful.

    Mostly, just put the patients' needs before your own. Join them wherever they happen to be and only attempt to re-orient if they're in harm's way. And even then, try to do it in such a manner that it's more of a gentle redirection than a harsh slap of reality.

    Thanks, Commuter, for this article on such an important subject.
    Last edit by rn/writer on Jul 9, '12
    DizzyLizzyNurse, Miss Lizzie, wooh, and 4 others like this.

    Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  2. 1
    This article is extremely poignant and realistic. I agree with all the other posters who find reality orientation generally useless and distressful for the confused pt. I esp agree with rn/writer that 'lying' is just too negative for healthcare workers to really feel comfortable using.

    I try my best to avoid fibs and/or little white lies; I just try to turn the conversation around to myself and I feign lack of information or the time, etc. I think I'd feel more comfortable if we could call it 'therapeutic aternative communication' techniques. I don't know that I'd like to write 'therapeutic lying' on a pt care plan!

    One other point of the article, I know what frustrates me most with pts having advancing dementia is their increasing aggresion and the loss of 'polite society social skills'. Gracious, mild mannered people who in days past would NEVER have struck out to hit, kick, bite, claw, spit, etc. Or use language that would make the devil blush. Or inappropriate toilet habits and sexual behaviours that would be arrest-able offences.

    There's NO amount of 'therapeutic lying' or 'therpeutic alternative communication' that will really help the situation much. If it's frustrating for me I can only multiply it exponentially for the pt. And as the population of dementia/Alzheimers pts increase in numbers and severitiy with the increasing longevity of this population, I remain troubled. I don't really see a good outcome.
    TheCommuter likes this.
  3. 1
    Thanks for this and the tips.. They will come in handy. Nice to have new "tricks" in my bag.
    TheCommuter likes this.
  4. 2
    I wish I knew this 2 years ago when my grandma experienced the loss of her last sibling. My aunts kept trying to re-orient her and saying that her sister died. This went on every 15 seconds for a long time. She would forget after 15 seconds, ask what happened to her sister again, and then strongly re-act in horror the same exact way every time. We just didn't know better. It was definitely an eye-opener. Now with that experience combined with what is recommended nowadays (therapeutic lying), I will never try to re-orient someone in the late stages of AD. I'll also make sure to educate family members on the benefits of living in their reality. Thanks for another great article Commuter!
    vintagemother and TheCommuter like this.
  5. 2
    In complete agreeance with this, I was taught that not breaking a dementia individuals 'reality bubble' was the most therapeutic for their mental health and feeling of well being. Which I believe to be true, if a lady is nattering on about how she just put all the chickens in their pen and if I knew if she remembered to put the soup ladle out? I don't see any harm with going along with her reality at that point in time. At most it'll make her smile or chat about something else, reorientating would create confusion and self doubt. Why bring that on a person unneeded? There really is no benefit it could bring her that I can see.

    I think there is a difference between going along with a persons perception and lying. To me it's like playing a game with a four year old in imaginery play. We're not (with intent) lying when we're agreeing that the cup of water is quicksand, it's more we're going along with a perception that makes them happy. It encourages happiness, imagination and good memories for the dementia sufferers I think, compared to harsh truths that won't bring about anything but pain and distress.

    Really liked this article, thanks for articulating it so well.
    TheCommuter and decembergrad2011 like this.
  6. 5
    Quote from Gold_SJ
    To me it's like playing a game with a four year old in imaginery play. We're not (with intent) lying when we're agreeing that the cup of water is quicksand, it's more we're going along with a perception that makes them happy.
    That's how I think of it as well. I used to have so much fun with my LOLs at the nursing home. Being in "their world" was much nicer than my world, the nursing home.
  7. 1
    I also went to nursing school during the Jurassic. It was drilled into my brain "always orient the patient to time, person, and place."

    This is a different situation, but I will never forget working med/surg and having an alcoholic patient who thought I was someone else and he was somewhere else (I can't remember the details). I spent the whole night trying to reorient him, reminding him of my name, his name, and where he was. It went over like a lead balloon.
    TheCommuter likes this.
  8. 0
    Sep 23 by JustKizzy I
    I could have sworn I commented here in Sept. as well, but... this has helped so much I'll do it now I was looking for anything new on this subject as we are still so lost, and it brought me back here... this has been so great for us. I have brought my family around to Therapeutic Lying as it makes their visits SO much less... I dont know, frustrating? Their personalities are still there, and easier to find when you 'pretend'; unfortunately, only some of the caregivers at the center even bother to try. I'm going to cheat and repost my comment from this article on not arguing http://allnurses.com/geriatric-nurse...ia-747317.html ... again; Bless you all. This is so hard.
    I know I'm years late to this discussion, however...
    God bless you all... it takes a very special person to do your job.
    I am not a nurse but, both of my parents are in a LTC facility with severe dementia. This issue of reorientation is very real for me; their health is very good (not even general geriatric issues) and we could conceivably carry on like this for years. The difference in their day-to-day mental health is very obvious depending on who is working their ward that day... reorienting NEVER works, and avoidance only causes more distress. The best caregivers take that extra two minutes to listen and placate and cajole. This is a no restraint facility, so they use drugs that specifically warn of dangers in use in elderly patients... very frustrating. Mom is in a locked ward; Dad is on a short hall (as they don't have a ward for males). The issues of reorientating and not letting them visit each other when family isn't there have caused all sorts of grief. Seems like it would be much easier on all involved to take 10 minutes to let them see each other and have a cup of tea than to argue for 3 hours and purposely avoid letting them have contact. Thank you for this article and all the comments; it is so reassuring and feels like validation!
    On the lighter side;
    They are in their 90's and spend most of their time in the 1940's; Mom was an RN and Dad a pilot in WWII. Mom is redirected with 'charts' of her own to review and 'making rounds' and spends her time comforting other patients... when she's not firing the 'girls' and sending exhausted aides home to rest, or 'lazy' aides off to clean "If you have time to lean, you have time to clean!" Dad often thinks he's in an military hospital, and is only redirected with reminders that he needs to 'recover' in order to return to his wife.
    This is such a sad, sad disease.
    Thank you, again, to all of you who choose to help these patients have some peace, and maintain a wee bit of dignity.
    Just,
    Kizzy.
  9. 3
    Quote from JustKizzy
    Sep 23 by JustKizzy I
    I could have sworn I commented here in Sept. as well, but... this has helped so much I'll do it now I was looking for anything new on this subject as we are still so lost, and it brought me back here... this has been so great for us. I have brought my family around to Therapeutic Lying as it makes their visits SO much less... I dont know, frustrating? Their personalities are still there, and easier to find when you 'pretend'; unfortunately, only some of the caregivers at the center even bother to try. I'm going to cheat and repost my comment from this article on not arguing http://allnurses.com/geriatric-nurse...ia-747317.html ... again; Bless you all. This is so hard.
    I know I'm years late to this discussion, however...
    God bless you all... it takes a very special person to do your job.
    I am not a nurse but, both of my parents are in a LTC facility with severe dementia. This issue of reorientation is very real for me; their health is very good (not even general geriatric issues) and we could conceivably carry on like this for years. The difference in their day-to-day mental health is very obvious depending on who is working their ward that day... reorienting NEVER works, and avoidance only causes more distress. The best caregivers take that extra two minutes to listen and placate and cajole. This is a no restraint facility, so they use drugs that specifically warn of dangers in use in elderly patients... very frustrating. Mom is in a locked ward; Dad is on a short hall (as they don't have a ward for males). The issues of reorientating and not letting them visit each other when family isn't there have caused all sorts of grief. Seems like it would be much easier on all involved to take 10 minutes to let them see each other and have a cup of tea than to argue for 3 hours and purposely avoid letting them have contact. Thank you for this article and all the comments; it is so reassuring and feels like validation!
    On the lighter side;
    They are in their 90's and spend most of their time in the 1940's; Mom was an RN and Dad a pilot in WWII. Mom is redirected with 'charts' of her own to review and 'making rounds' and spends her time comforting other patients... when she's not firing the 'girls' and sending exhausted aides home to rest, or 'lazy' aides off to clean "If you have time to lean, you have time to clean!" Dad often thinks he's in an military hospital, and is only redirected with reminders that he needs to 'recover' in order to return to his wife.
    This is such a sad, sad disease.
    Thank you, again, to all of you who choose to help these patients have some peace, and maintain a wee bit of dignity.
    Just,
    Kizzy.
    Kizzy- is there no way they can keep your parents together? It's sad that they have them separated!
    vintagemother, NurseQT, and nu rn like this.
  10. 6
    Hi newhospicern... It is so sad. However, dementia is an evil host. They also have Sundowner's. That being said, they have to both be on the same page, so to speak, at the same time... or all hell breaks loose. Living in the past as they do, they don't always recognize the other in their old age bodies, and tend to reject any inkling that THAT is who they're looking for. While still at home, Mom would have nights when she refused to go to bed in the same room with 'that man' as it was inappropriate. There are many days when Dad is ready for Mom to 'go back to her house' (when she's talking nonsense and he can't follow) and go looking for his wife. They just don't understand anymore. Evil, I tell you, it's just evil. I cry all the time at the lack of dignity, and the injustice, of it all.
    I like to end on a light note; There are days when they sit and chatter, hugging and kissing, and shine as themselves. They've been married 73 years. Mom can't use colored lipstick anymore (because it ends up all over the place lol) but she still uses her reflection in my father's eyes to apply her lip balm. "Look at me, Bob." "What, dear? Oh.. always, love." <3


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

A Big Thank You To Our Sponsors
Top