Dementia And Lying: Caregiver Tips For Tough Moments

One of the most difficult dilemmas dementia caregivers face is whether to always tell the truth to the person they’re caring for. We are taught the value of honesty throughout our lives. However, there are moments in dementia care where bending the truth, or even telling a “therapeutic fib,” may be the most compassionate approach for the person you’re caring for. It’s not about deception for personal gain; it’s about prioritizing your care recipient’s well-being, safety, and emotional comfort.

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Benefits Of Therapeutic Lying

It can be difficult for someone with dementia to process the truth due to cognitive decline, memory loss, or challenges with judgment. Confronting them with the truth can cause significant distress or even pose safety risks. In these instances, what is sometimes called “therapeutic lying” can be a powerful tool in a caregiver’s toolbox for providing person centered care. 

Here are some key benefits of therapeutic lying:

• Avoid re-experiencing loss and grief. For example, for a person with dementia who repeatedly asks for a deceased spouse or parent, being reminded of their death each time can be like hearing the tragic news for the very first time, over and over again. Because this can lead to unnecessary emotional pain, a gentle fib, such as “He’s at the store and will be back soon,” can provide immediate comfort and prevent a cycle of heartbreak.
• Promote safety. For example, a person with dementia may insist on driving even though they’re no longer able to do so safely. Arguing about this or reminding them they got their driver’s license taken away can lead to agitation and other challenging behaviors. Parking the car around the corner and telling a therapeutic fib or white lie, like “The car is in the shop for repairs,” can de-escalate the situation and prevent a dangerous scenario without causing a confrontation.
• Reduce distress and agitation. Someone with dementia might believe they need to go to a job they haven’t had in decades. Instead of correcting them, which can lead to confusion and frustration, you might say, “Your boss called and said you have the day off today.” This validates their sense of purpose while guiding them to a more peaceful state of mind.

3 Types Of Therapeutic Lying

Not all “lies” are the same. In dementia caregiving, these 3 types of communication strategies keep compassionate care at the forefront. 

Here are 3 common approaches to therapeutic lying:

1. Withholding The Truth 

This involves keeping information that could be distressing to yourself. For example, if a beloved pet passed away years ago, and your care recipient brings it up, you might choose to tell them the pet is at the groomer’s. This isn’t about active deception but protecting the person from unnecessary pain.

2. Redirecting 

This technique involves shifting the person’s focus away from a difficult topic or a potentially harmful action. If your loved one is fixated on going “home” when they’re already in their own house, you might say, “Before we go, could you join me in the garden while I water the flowers? I need someone to make sure the hose doesn’t tangle up.” This acknowledges their desire while gently moving their attention to an enjoyable, purposeful activity.

3. Entering Their World

This powerful approach is often explained as “validation therapy”. This is where you acknowledge the person with dementia’s feelings, temporarily enter their reality, and then redirect their attention. An example is, “You’re right, that sink should be looked at right away. Let’s take a look.” Followed by joining them to take a look, then distracting them with an enjoyable or purposeful activity that can redirect them successfully.

Essential Tips For Caregivers

Navigating complex moments in dementia care for older adults can be difficult. Here are 5 tips that can help you keep a thoughtful and compassionate approach when considering using a therapeutic fib:

1. Assess before you act: It’s true that bending the truth is sometimes necessary to preserve safety and mental health. However, there may be some instances where you may not need to rely on the strategy. 
2. Keep it simple: You may have decided a therapeutic fib is the best course of action. To avoid causing more confusion or mistrust, keep any narratives or fibs straightforward and as close to reality as possible. 
3. Stay consistent: To avoid confusion, mistrust, and paranoia, other family caregivers, team members in an assisted living facility, or relatives should be on the same page about what you’re withholding or sharing with your care recipient. 
4. Focus on the emotion: You may find that responding to your care recipient’s emotions about a situation will work better in some cases than providing a factual correction. For example, “I’m not sure why your sister still isn’t here! I am so sorry, that must be so frustrating. I know you miss your family,” which can be followed by redirection.
5. Manage your guilt: It’s normal to feel “icky” when you’re not being completely truthful. You are not alone. Remember to:

• Reframe your thinking. You’re choosing a compassionate approach that avoids distress and harm. 
• Connect with other caregivers who are going through similar experiences. 
• Prioritize breaks when you need them. 

Conclusion

Caring for someone with dementia requires a flexible, person-centered approach, as cognitive abilities constantly shift. According to medical ethics, therapeutic fibs, when used appropriately and compassionately, can be a valuable tool to enhance the care recipient’s quality of life. This approach prioritizes their well-being, safety, and emotional comfort, even if it means bending the truth in certain situations.

To learn more about caring for someone with dementia, check if you have free access to Trualta.

References

1. Alzheimer Society of Ontario. (2023). Care partner tip: Validation Technique. Alzheimer Society of Sarnia-Lambton.
2. Jon Marcus. (2023). How therapeutic fibbing and diversion can help loved ones with dementia and alzheimer’s. AARP. 
3. Gionta, J. (2021). Therapeutic Lying in Dementia Care.