"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.