Why Experts Recommend Lying to Someone with Dementia

lying to someone with dementia

Stepping into their reality isn’t the same as lying

When your older adult has Alzheimer’s or dementia, their brain may experience a different version of reality because of the damage their disease has caused.

Dementia care experts recommend stepping into your senior’s reality rather than trying to correct them or bring them back into ours. That’s because their brain is steadily losing the ability to process information. Forcing them to join us in the “real world” only causes confusion, anxiety, fear, and anger.

This technique takes some getting used to because going along with your senior’s new reality can feel like you’re lying to them. But the reality is that honesty is not always the best policy when it comes to someone with dementia.




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Telling the truth can be cruel

Most of us are taught from a young age that any kind of lying is horrible and dishonest. On top of that, we’re told never to lie to parents, spouses, and people we love and respect. So when we hear about lying to someone with dementia, it seems cruel and wrong.

But always sticking to the truth, especially about an emotional subject, is what’s most likely to cause your older adult pain, confusion, and distress.

Plus, their problems with short-term memory mean they probably won’t remember the conversation, so it will come up again. Telling the truth each time forces them to experience the fear and anxiety over and over again.

The disease prevents people from properly processing and retaining information. Is it necessary to cause them so much distress, especially when the truth you tell them is likely to be misunderstood or quickly forgotten?

 

Therapeutic fibbing helps you step into their world

An effective way to step into your older adult’s reality is to agree with whatever they say or tell harmless untruths. Experts call this therapeutic fibbing. It means saying things that are not true to avoid causing your older adult distress and to make them feel safe and comforted.

In many ways, it’s similar to telling a friend that you love the thoughtful gift they gave you, even if you don’t actually like it. Telling the absolute truth in that case wouldn’t change the situation and would only hurt your friend.

Here are two simple examples that illustrate the difference between being completely truthful and using therapeutic fibs.

1. Being completely truthful
Your mom: School is over. My mommy is coming to pick me up now. I need to go outside to wait for her!

You: You’re 89 years old. You haven’t been to school in decades. And don’t you remember that your mom died 25 years ago? You don’t need to go outside because nobody is coming to pick you up.

Your mom: What? What do you mean my mom is dead? No! She can’t be dead!! I saw her this morning! She told me she would pick me up!!! I need to go outside to wait!! (She’s crying, agitated, and screaming.)

2. Using therapeutic fibbing
Your mom: School is over. My mommy is coming to pick me up now. I need to go outside to wait for her!

You: Oh yes, it’s almost time to go. Your mom asked me to give you a snack first so you won’t get hungry on the way home. Let’s have some juice and crackers.

Your mom: Ok, I’ll have a snack.

You: (Use this distraction as an opportunity to occupy her with the snack and a fun activity until she lets go of the idea of meeting her mother.)

 

Bottom line

Always telling the truth to someone with Alzheimer’s or dementia is most likely to upset or hurt them. Therapeutic fibbing is a technique you can use to step into their new reality and spare them unnecessary pain and distress.

Using untruths to validate their feelings and reassure them is not the same as lying for a malicious reason.

 

Next Step  Why it’s not helpful to force someone with Alzheimer’s or dementia back into our reality

 

Recommended for you:
3 Ways to Respond When Someone with Alzheimer’s Says I Want to Go Home
4 Ways to Respond When Someone with Alzheimer’s Keeps Repeating Questions
Q & A: Should You Correct Someone with Alzheimer’s?

 

By DailyCaring Editorial Team
Image: Female First


59 Comments

  • Reply November 2, 2018

    Anonymous

    I commend all of the caregivers tremendously for taking care of their patients with dementia. I understand that that task may not be easy most of the time, especially since communication and comprehensive skills may not be the same since the diagnosis of dementia. I would also like to say that I believe that your hearts and research may be in the right place in wanting to help others with dementia to the best of your abilities including lying to patients in hopes that this will be what is best. However, I do not believe this is always the best way to go about helping these patients without further information. I do not say this to insult but to enlighten you about the concepts of capacity. Capacity is determined by a physician. There are certain criteria that must be met in order for a physician to determine if someone has capacity. This includes that the patient is able to make and communicate a choice, the decisions are consistent with the patient’s values and goals, decisions are not from a delusion, and the patient is able to use reasoning to make a choice. Additionally, the patient must be able to understand their medical situation, prognosis, nature of recommended care, and alternative treatments along with the associated risks and benefits. The reason I wanted to discuss capacity was because I wonder if all patients with dementia are considered to no longer have medical capacity. In other words, one patient may still be able to meet the criteria to be labeled to have medical capacity, and I wonder if not telling them the truth about the condition is necessarily the right choice. Also, I understand that some patients may have a financial fiduciary due to the fact that they are unable to take care of their finances, but this does not necessarily mean that they do not have medical capacity. The legal consensus is that if a patient is able to provide informed consent then they have medical capacity. I believe you may be able to discuss with the patients’ physicians to determine if your specific patient has medical capacity or not, and you may be able to use that information to better help guide you when treating your patient at their home.

    • Reply November 7, 2018

      DailyCaring

      Thank you for sharing! Each person with Alzheimer’s or dementia is certainly different and will be at a different stage in the disease.

      Each family or caregiver needs to choose for themselves how they want to approach these important issues in the way that works best for their specific situation.

      For some, it may work well to explain everything to their older adult with dementia and get their input. For others, they may need to keep them feeling safe and secure and take over the decision making.

  • Reply November 2, 2018

    Arthur Webb

    I commend all of the caregivers tremendously for taking care of their patients with dementia. I understand that that task may not be easy most of the time, especially since communication and comprehensive skills may not be the same since the diagnosis of dementia. I would also like to say that I believe that your hearts and research may be in the right place in wanting to help others with dementia to the best of your abilities including lying to patients in hopes that this will be what is best. However, I do not believe this is always the best way to go about helping these patients without further information. I do not say this to insult but to enlighten you about the concepts of capacity. Capacity is determined by a physician. There are certain criteria that must be met in order for a physician to determine if someone has capacity. This includes that the patient is able to make and communicate a choice, the decisions are consistent with the patient’s values and goals, decisions are not from a delusion, and the patient is able to use reasoning to make a choice. Additionally, the patient must be able to understand their medical situation, prognosis, nature of recommended care, and alternative treatments along with the associated risks and benefits. The reason I wanted to discuss capacity was because I wonder if all patients with dementia are considered to no longer have medical capacity. In other words, one patient may still be able to meet the criteria to be labeled to have medical capacity, and I wonder if not telling them the truth about the condition is necessarily the right choice. Also, I understand that some patients may have a financial fiduciary due to the fact that they are unable to take care of their finances, but this does not necessarily mean that they do not have medical capacity. The legal consensus is that if a patient is able to provide informed consent then they have medical capacity. I believe you may be able to discuss with the patients’ physicians to determine if your specific patient has medical capacity or not, and you may be able to use that information to better help guide you when treating your patient at their home.

    • Reply November 12, 2018

      Kelly

      THIS! This is what I’m struggling with, just didn’t know it was called capacity. Because here’s my dilemma with my mom that l can’t see a way around. She’s a VA patient first of all, if that’s even relevant, but she’s been diagnosed with “mild dementia”. It’s going to progress. But at what point do her care choices fall to another person – namely me or my dad – because she’s in complete denial and we can’t get her any help because SHE has to ask for it. So FRUSTRATING. It’s like we have to wait for something catastrophic to happen. Her paranoia is worsening as is her shadowing of my dad, and he’s stuck because she’s still in charge of her own care.

  • Reply May 17, 2018

    Jamey

    A question, I often read of the importance of a support group for caregivers. How do you join a support group if you cannot leave the person you are caring for?
    I am my mother’s only care giver, even when she is asleep she wants me nearby as she wakes often and is frightened when left alone.

    • Reply May 17, 2018

      DailyCaring

      That’s a great question. There are many caregivers who aren’t able to leave their older adult alone and can’t get someone to cover for them on a regular basis. In that case, I’d recommend checking out online caregiver support groups. In some ways, it’s even better because they’re available 24/7, anytime you have time. Here are some of our top recommendations — http://dailycaring.com/11-caregiver-support-groups-on-facebook-youll-want-to-join/

    • Reply June 3, 2018

      Lmax22

      Sign up for AgingCare.com Newsletter.
      It has been a Godsend for me.
      Get help with Sitter, whenever possible.

      • Reply June 6, 2018

        DailyCaring

        In case it’s helpful, we have a free email newsletter as well 🙂

    • Reply November 27, 2018

      Jaz

      They need to start giving patients with dementia and/or Alz ANY drug that will help them with their immediate need, i.e., xanax, pain medicine or what have you. Caregivers should NEVER be put on the spot where we have to call Hospice to get the patient comfort. The doctors need to either open their eyes or quit practicing medicine. I’m so freaking tired of ‘try this anti-psychotic or that one’…. it takes up to 6 weeks for that to even help. And that’s IF they make it that long.

  • Reply March 16, 2018

    Amy K.

    My mom is 89 and has had some vascular dementia from strokes. She had a raging UTI a couple of months ago. It was treated, then came roaring back. She was in the hospital and is now in rehab. It looks like we aren’t going to be able to take her home. It’s just not an option.
    So far, I’ve told her if the therapy goes well, we can talk about her going home. She said several times she was going home on such and such a date, and when she gets it in her mind she is, there’s no dissuading her from the idea. About three times, she’s said, “I’m going home TODAY!” as soon as I get to her room. I try to say, no, she still needs more therapy, but she won’t let it go. She curses and yells and cries. I know it’s got to be frustrating and scary for her. I try to be sympathetic and not let my anxiety get the better of me, but it has a few times, and we’ve ended up yelling at each other, much to my regret.
    How in the world do I tell her she’s not going home? I don’t feel guilty about the decision for long-term care. That’s the best, most appropriate place for her at this point. I’ve agonized over this and I need some pointers. Thank you.

  • Reply January 10, 2018

    lynn

    My mother has always been, shall we say, unusual all of her life. If she did not like reality, she would just ignore it. Doctors have suggested she see a psychiatrist at their peril. For a good 20 or 30 years, she has argued that we are crazy, not her. My father is dead and my brother and I are not close to her.

    We took her to a neurologist but mom told us that the neuro told her privately that she (neuro) was really a psychiatrist who could not get a job, so she is masquerading as a neuro. She will not go back and there is no making her.

    Now, at 93, she has dementia and all she does is scream. By scream, I do mean at the top of her lungs. She screams about anything and everything, which is pretty much what my childhood was like. She screams about money, her invisible boyfriend, my brother, or me and it goes on and on and on.

    It really does not matter whether we go along (yes, you should marry your invisible fiancee) or tell her the truth (no, there simply is no more money) – she just screams. It is dreadful.

    • Reply January 20, 2018

      DailyCaring

      Lynn — I’m so sorry this is happening, it sounds like a very challenging situation. It sounds she’s in distress or discomfort, but clearly can’t articulate her needs. It sounds like she needs extra help from a doctor who’s experienced in treating people with dementia. Since she refuses to go to see a doctor, you may want to consider a geriatrician who makes home visits — someone who specializes in tough dementia cases. Explain the situation to them before they visit. They may be able to approach her in a way that doesn’t make it seem like she’s seeing a doctor. It’s possible that carefully experimenting with low doses of specific behavioral medications could improve the situation.

  • Reply December 27, 2017

    Valarie

    I’m not a caregiver but a newly diagnosed patient standing on the edge of what appears to be a nightmare. I’m so very sad for my husband and children and siblings. This is going to strain some relationships that are already not the best. I’ve already lost my driving privilege and it has been a horrible experience. I sorta wish I was less “with it” so I wouldn’t feel the loss so keenly. We live out in the country, where I am home all day alone with the goats, chickens and 5dogs. Both my husband and daughter work and at this point I understand the suggestion of not cooking (almost caught kitchen on fire). I’m scared of the future described here by so many caregivers.

    • Reply January 3, 2018

      DailyCaring

      I’m so sorry about your diagnosis Valarie 🙁 It’s great that you understand that your husband and daughter are looking out for your best interests by not having you cook any longer. Even though dementia is a very challenging health condition, there are still ways to enjoy as many moments as possible. Having discussions now with your family to let them know your wishes for quality of life goals and sharing your experience to help them understand can help you and them cope with the changes.

      You may also find it helpful to attend a support group for people with dementia. The Alzheimer’s Association may be able to tell you about ones in your area, call them at 1-800-272-3900

      Your family may also want to start learning as much as they can about dementia symptoms and how to support and care for you. We’ve got an extensive library of articles about dementia here — http://dailycaring.com/category/health-conditions/alzheimers-dementia/ They may also find the extensive local and online resources at the Alzheimer’s Association helpful — alz.org or 1-800-272-3900

    • Reply January 16, 2018

      Michelle Barkley

      Valarie,
      It must be so scary to know your diagnosis and what the future maybe bringing to you. As a caregiver, I would like to ask, how should we, “as future caregivers”, treat you when the diagnosis is so new? What would you like to talk about? About the disease, or treatments, or what your wishes are as the disease progresses? You would be a great resource for all of us! Your words are gold, I wish I had that knowledge when my mother was first starting to show signs and we didn’t know what it was. No doctor had diagnosed, so we were only guessing. It would be wonderful to know what you are thinking, how we could help the best now and in the future. Prayers for you and your family. I pray that you are able to talk with them and let them know early on what your wishes are.

  • Reply November 26, 2017

    Fern Whitaker

    Wondering how to handle this situation with my 92 year old mother with dementia. She doesn’t realize I am her daughter at times and will talk to me about me. I am an only child and she will talk about where her daughter lives, works, etc. I will play along but then the conversation usually takes this turn – she wants to know who I am and there has been times if I said my name to her she would get very confused or even agitated. I have an uncommon name so it would be hard to play off as having the same name as her daughter. I don’t know how to handle this question without upsetting her.

    • Reply December 5, 2017

      DailyCaring

      I can see the challenge in this situation. It’s great that you go along with the conversation, it sounds like it makes her happy to speak about you. To avoid upsetting her, you could consider calling yourself by another name on these occasions. Or, you could try saying something like “What a coincidence, I have the same name as your daughter.” It may take a little trial and error to find what works best.

  • Reply November 3, 2017

    Yvonne

    I have to get my comment in about lying to people with dementia. You say it is okay.
    Mom is gone now but she was living with me and always asking where dad was. I usually explained that he had passed away some time back and she seemed to accept that. One day I decided I was going to tell her he was just outside and I did. Some time later she came to me and screamed at me “you lied to me!” I can’t tell you how bad I felt. I am crying now thinking about it. It is hard to know the right thing to do.

    • Reply November 5, 2017

      DailyCaring

      I’m so sorry that happened. It can be so tough to know what the right thing is and sometimes the only way to find out is by experimenting to see what works best. Each person with dementia is unique and will respond in different ways — and their behavior and reactions may change, like what happened with you. It’s up to each caregiver to decide which response to use for that specific situation. It won’t always work out the way you hoped, but you always know that you’re doing your best in a difficult and unpredictable situation. Unfortunately, there are no easy answers and no solutions that will work 100% of the time for everyone.

    • Reply October 26, 2018

      sunny

      Lying to someone with brain issues shouldn’t be done.This is about the worst advice I have ever seen given in my life time.It should only be done as a last resort and used sparingly.Its one thing to smooth something over, its another to outright lie about something.Especially as important as her spouse being dead.if she could handle that then why lie to her?The best answer is to tell the truth softly but clearly.Only if the patient is very near the end of life and truly hopeless should lies be told to them.It only makes them feel helpless and betrayed.Especially if they are having good days they remember and know that you lied to them.Think they want you to care for them after that not a chance

      • Reply October 26, 2018

        DailyCaring

        Therapeutic fibbing is one of many options that people can use when caring for someone with dementia. The decision to fib or stick to potentially hurtful truths rests with the person who is caring for someone with dementia. They’re the only ones who are qualified to make the decision and they are the ones who will be handling the situation and the aftermath.

        How to respond to someone’s questions really depends on their personality and the stage of their cognitive decline. There are many situations where the person can no longer process complex feelings like grief and loss and also are prone to forgetting and then repeating questions. When that happens, telling them the truth about sensitive topics (for example: someone’s death) can only cause distress without bringing any closure. And then, the whole thing can happen again within hours or days, causing the person with dementia repeated sadness or distress. In these cases, it can be kinder to tell a simple fib about the person being away for a short time or busy with work — whatever would make sense to them.

        For some families, there is nothing else except going along with their reality (by telling fibs) that will work to keep the person with dementia feeling calm and safe.

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