Should You Lie To Someone With Dementia
The grinding of teeth had ceased for a month. Moms disposition was cheerful and she seemed joyfully alert. Then my sister mentioned she was going on vacation for a week. Suddenly everything changed.
Between the Pond and the Woods
Our mom has always been a very sensitive person. Long before she was diagnosed with dementia, she was deeply influenced by the emotional states of people around her. That trait became more pronounced as her disease progressed. The idea of being left behind by someone she loves now prompts great distress. Her speech is very limited, so she cant quite express this. But the grinding, the lethargy, the disorientation all increased at exactly the same time that one caregiving daughter left for a well-deserved break.
This scenario might have been easier for my mom if she hadnt brainwashed us to always tell the truth. Medical professionals do not disapprove of engaging in therapeutic lying.Dr. Charles Atkins, describes this practice as the equivalent of telling a white lie in the interest of helping or soothing a person with dementia. Since my moms understanding of time and circumstance is already very distorted, a white lie about my sisters absence might have reduced the anxiety she seems to be feeling.
When Therapeutic Fibs Are Necessary
Although lying isn’t recommended as a regular approach, sometimes validation and redirection do not work. If your father insists on seeing his mother, and you find that he only calms down when you tell him that she’s gone to the store, that’s okay. There is no need to feel guilty about telling a “therapeutic fib” if he feels more at peace with the fib than with the truth.
Some authors such as Naomi Feil, who pioneered the validation approach, feel that it’s risky to tell therapeutic fibs because she feels that on some level, the person with Alzheimer’s does know the truth therefore, lying could threaten the relationship between the caregiver and the individual with the disease. However, others have suggested that this risk only occurs when the fib is actually an outrageous lie.
For instance, if your loved one insists that there’s a stranger in the bathroom, and you tell her, “Yes, that’s your favorite entertainer, Wayne Newton, and he’s come to sing for you!” there is a good chance that your loved one will be skeptical of your claim and perhaps even become distrustful of you. This is much different from a therapeutic fib such as, “I just checked the bathroom and he must have left because there’s no one there now.”
Should I Correct My Grandparent With Dementia
This implies that if a person is saying something that is not true, they may not be doing it on purpose because it is the illness speaking.
The reality of persons with dementia may be different from your reality.
This simply means that THEY BELIEVE what they are saying because thats what their brain is telling them.
Do Dementia Patients Lie On Purpose
Dementia is a progressive neurological disease that damages the brain and causes mental decline. People who are suffering from dementia have difficulty processing information, remembering the past, and understanding or making decisions.
The disease progression is divided into 7 stages, with the higher numbers marking more severe dementia.
In the early stages of dementia, people may experience short-term memory loss and forget information they recently learned. The person will often ask the same question multiple times or have difficulty remembering events that are important to them, such as birthdays or anniversaries. During the mild dementia stages, they might misplace items or put them in odd places .
Patients in mid-stage dementia begin to experience major memory deficits. They might forget their address. They may not remember where they live and may not be able to understand what day it is or the time of day. Dementia patients do not lie on purpose, per se, but by the mid-stages of the disease, they do lie because it is their disease talking. In their minds, they are speaking the truth.
In the later stages of dementia , anger and aggressive behavior may take over.
Because they have problems processing information and remembering things, the person in stage 6 may also become suspicious of others. For example, a common accusation when they cant find something they have misplaced is to believe that their dementia caregivers have stolen it from them.
Telling The Truth Could Be Cruel
Most of us are taught from a young age that any kind of lying is horrible and dishonest, especially lying to family and anyone we care about and respect.
So when we hear about using therapeutic fibbing to lie to someone with dementia, it might seem cruel and wrong at first.
But always sticking to the truth, especially about an emotional subject or something trivial, is more likely to cause your older adult pain, confusion, and distress.
That happens because dementia prevents people from properly processing and retaining information.
Plus, having short-term memory issues means theyll probably soon forget the conversation, so it will come up again.
Telling the truth each time forces them to experience fresh distress over and over again.
Is it necessary to cause them so much distress, especially when the truth you tell them is likely to be misunderstood or quickly forgotten?
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Telling The Truth To People With Dementia
Get advice on how to deal with difficult situations around telling the truth to people with dementia.
Making decisions and managing difficult situations
Situations may arise where a person with dementia asks questions that leave carers feeling unsure about whether to answer honestly. This could be because the answer would be distressing to the person for example, reminding them that a relative or partner has died. In cases such as these, carers can look for different ways of handling the situation.
If the person says something that you know is not true or possible, try to see past what they are saying, and instead look at the emotions behind it. For example, if they are asking for their mother, who is no longer alive, it may be that they are feeling scared or need comforting. By meeting the needs behind what is being said, it can be possible to offer emotional support while avoiding a direct confrontation over the facts.
In some situations you may decide that not telling the truth is in the persons best interests. If you do decide that the truth would be too distressing for the person, there are other options available.
Each case should be judged individually and the course of action should be chosen to suit the specific time and situation. An ideal solution is one that you feel comfortable with and also considers the persons interests.
Dementia Delusions And False Accusations Of Elder Abuse
I was fortunate that none of the elders I cared for ever leveled serious accusations against me, even in their severely demented states. Some caregivers arent so lucky, and some fabrications can have very grave consequences. False allegations of elder abuse and neglect arent just emotionally devastating they can have dire legal and financial ramifications for family caregivers as well.
If reported, Adult Protective Services or the police may investigate allegations of elder abuse. Even if it has been confirmed that a loved one has dementia, making up stories about being mistreated or financially exploited can still trigger a full APS investigation. This is often humiliating for family caregivers and may seem like a waste of time and resources, but elder abuse is a reality for many seniors. The National Center on Elder Abuse estimates that as many as 2 million seniors are abused in the United States. Proper authorities must look into all reports to protect vulnerable adults.
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What Do Patients With Dementia Want To Know
My aim was to explore what the patients think is wrong with them, whether and what they have been told by their physicians about their condition, and what they would like to know about their illness. Thirty consecutive patients seen by me between October and December 1997 in the Old Age Psychiatry Service in Worcester participated in the study. Twenty were women. The patients ranged in age from 63 to 92 years . At the time of examination, 11 participants were inpatients, and 19 were outpatients. They had been in contact with the psychiatric service from 1 day to 17 years . All had a clinical diagnosis of dementia based on International Classification of Diseases, 10th Revision criteria, including Alzheimer disease , vascular dementia , and other or unspecified dementias . In addition, consensus guidelines were used to make a diagnosis of dementia with Lewy bodies in 1 of the otherwise unspecified dementias. Participants’ cognitive states were assessed using the Mini-Mental State Examination scores ranged from 7 to 29 . All participants gave verbal consent and answered a set of standard questions regarding the information they had received about their illness . The answers were recorded verbatim and will be the subject of further analysis.
Is It Ethical To Lie To Dementia Patients
‘Lies‘ may only be used in extreme circumstances to avoid physical or psychological harm. Environmentallies should be avoided.
Furthermore, are dementia patients aware of their condition? According to a 2018 report from Johns Hopkins, many older adults living with dementia aren’t aware of their diagnosis. However, the earlier dementia is diagnosed, the more likely a person will be aware enough to comprehend what’s going on. As the disease progresses, this may change.
Keeping this in consideration, does someone with dementia tell lies?
It’s true that in the early stages of the disease, people with dementia might fib to cover for memory loss. But most examples of lying are dementia symptoms rather than intentional deception. Specifically, it’s called confabulation unconsciously replacing lost memories with fabrications.
Do you tell a person with dementia that they have dementia?
In general, if a person is aware that they are going for a diagnosis they will be able to make that choice. It is recommended that a person with dementia be told of their diagnosis. However, a person has a right not to know their diagnosis if that is their clear and informed preference.
Do You Remember? And other things not to say to someone with dementia.
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Ethical And Moral Considerations
The ethics and morality of therapeutic lying are key when discussing its place in dementia care. Currently, no official UK healthcare guideline justifies lying to patients.15 For example, the General Medical Council states that doctors must be honest and trustworthy in all communication with patients.25 These guidelines are based on fundamental elements of modern medical ethics. An example of one such principle is the patients right to autonomy, their right to make informed decisions regarding their care.26
This principle would seem to require total veracity with patients regarding their care and situation. However, autonomy is complicated in the case of dementia patients as it assumes competency. Competency requires the capacity to evaluate the risks and benefits of treatment, an ability often lost in later stage dementia. The ethical principles of non-maleficence, the duty to do no harm, and beneficence, the duty to do good, are also paramount in ethical debates surrounding therapeutic lying. However, these principles often conflict with autonomy, as the necessity to minimise patient confusion or distress is often antagonised by the moral obligation to tell the truth.27
Is It Okay To Lie To Someone With Dementia
The intention behind the act of telling white lies to a dementia patient is often to avoid upsetting that person with reality, which oftentimes causes unnecessary distress.
Focusing on the memories someone with dementia is talking about instead of correcting any untruths can help everyone involved.
When your parent has dementia, intention matters. The purpose of a lie is usually not to create false beliefs. Instead, lying in dementia care is designed to promote wellbeing, distract from upsetting circumstances, or protect a loved one from harm. This small but important distinction makes a difference when determining the best path forward.
Some other instances where it may be an appropriate response to lie for the benefit of the person with dementia are
- The car is in the shop or Its too expensive to fix are two fibs that can be told when the person with dementia is demanding to drive their car but its not safe for them to do so.
- I need to see my doctor, I need your help. is something that you can say to get your senior loved one to go to THEIR doctor. If they believe the visit is for you, instead of them it may be easier to get them there.
- Ill let you know when your mother/father arrive should be about an hour or so. is a fib that can be told when your aging loved one with dementia is wanting to know where their parents are and when they are coming to pick him/her up?
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Is It Acceptable To Lie To Someone With Dementia
Whether or not it is acceptable to lie to someone in the advanced stages of dementia is a moral dilemma faced by many carers.
Take, for example, the following two scenarios.
A woman with dementia is anxious because she believes her husband is late to pick her up. She doesnt remember that her husband died many years ago. Previously, when similar concerns have come up, carers have told her that her husband is dead, which has resulted in the woman becoming upset and distressed. So this time, the womans carer tells her hes at the shop and will be there soon, and asks her if shed like a cup of tea. The woman is reassured and calm.
Consider also the wife who hides her husbands car keys because doctors and authorities have told her its not safe for him to drive because he has advanced dementia. When she initially told him he cant drive he became furious, so now she tells him she doesnt know where the keys are.
In both these examples, carers have used white lies or therapeutic lies to prevent distress and agitation in a person who is living with advanced dementia.
Sometimes telling a white lie can also help the interactions between carers and people living with dementia, because it may prevent the need for a person with dementia to communicate distress through stress-related responses such as anxiety or tearfulness.
Ethical Codes And Telling The Diagnosis
The psychiatrist should inform the patient of the nature of the condition, therapeutic procedures, including possible alternatives, and of the possible outcome. This information must be offered in a considerate way, and the patient must be given the opportunity to choose between appropriate and available methods.
But does this mean that psychiatrists have the duty to provide the information when there is no treatment? And how truthful should be the considerate way? Does it imply the whole truth? As much as the patient wants? As much as the patient’s physician believes is sufficient? The General Medical Council recommends that physicians, to establish and maintain trust in their relationships with patients, must give them the information they ask for or need about their condition, its treatment and prognosis… in a way they can understand. In practice, patients with dementia rarely ask for the information, and many physicians seem to think that because there is no cure to offer, such knowledge may be only detrimental and, therefore, not needed in therapeutic relationships. But can the relationships be successful without telling the truth?
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Alternatives To Therapeutic Lying
The relative effectiveness of therapeutic lying may be evaluated in comparison to alternative responses to confused or distressed individuals. One such alternative approach is distraction. This involves diverting a patients attention away from misunderstandings, in order to avoid lies or further patient distress as a result of correction. Distraction is often used alongside transformation of questions, thus answering as if the patient had asked another question.22 This method could be effective in reducing escalation of situations, whilst still assuring patients feel valued and considered. However, this technique raises its own ethical dilemmas and can be criticised for its inability to meet patients underlying needs.
Some professionals prefer to address the emotion behind their patients words rather than employing techniques such as lying or distraction. This theory believes that statements made by patients with dementia can give healthcare professionals an insight into their needs. For example, anxiety may be expressed through questions about a patients deceased parents, showing an internal desire for comfort.
This requires the compilation of a timeline of life experiences, including those of great emotional significance. In doing so, the professional is able to consider the best approach to the patients care, which may involve assenting to a patients current beliefs. Here, there is a reduced risk of the lie being detected or further escalation of the situation.
Signs Of Dementia Why Some Dementia Patients Lie
By Darlene Ortiz 9 am on July 6, 2015
Lying is a normal symptom of dementia, and it happens for many reasons. Most of the time, lying is merely a symptom of the disease and not intentional deception. Lying, or untruths, may occur at any stage of dementia, but this symptom generally is more common among seniors with mid- to late-stage dementia and can worsen as the disease progresses. Home Care Lakewoods dementia care experts have put together the following information to help family members better understand why some seniors with dementia lie.
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