When The Truth Doesn’t Matter

Probably the hardest thing about having dementia…is having dementia.  Everything is confusing.  And the worst part, as some of my patients tell me, is that they know they should remember and understand things that they just don’t anymore.

Well-meaning caregivers – often the family members – frequently have difficulty realizing that correcting someone with dementia is almost always the wrong approach.  Same for reiteritating something so they’ll “remember it this time,” like where the salt is located. In such circumstances, the patient will dutifully pay attention, looking astute and interested.  But, depending on how bad the dementia is, they probably won’t remember it if they couldn’t in the first place.

If you care for a person with dementia, my advice is to resist the urge to help them get details of truth correct unless absolutely necessary.  I can’t think of an example where the actual truth of situations is less important than in an environment of progressed dementia.

Recently, a patient of mine declared that his food was “poisoned” because he saw white flakes in it.  The flakes were actually a protein supplement added to help them keep his weight.  The patient’s friends and family having dinner with him that night quickly tried to correct the notion by denying the patient’s claim.  Their resistance to his thinking is totally understandable, especially because they were involved with placing him in the facility and they don’t want him to second-guess their commitment to him.  But opposing the claim with something seemingly innocuous like, “Oh, no, don’t worry about those flakes.  That’s a protein supplement to help you maintain your weight.  Just go ahead and eat it.” is this not only an unwise response…it’s exactly the wrong way to handle this situation.

The patient believes what he thinks.  Like Curt Cobain once said, “just because you’re paranoid doesn’t mean they aren’t coming to get you.”  In the case of demented people, you can almost never convince them of the truth of a situation and you can rarely help them remember details of even simple things that they weren’t able to remember already.

And really, who cares anyway?  Pointing out reality just makes them feel as demented as they really are.  With the food example, instead of correcting their worry about being poisoned, it’s better to take a sharp, critical look at the food, and then agree with the patient, “yeah, this might be bad.  Let’s try something else.”  The go get a similar plate of food, sans the protein flakes.

Dementia is a terrible ordeal, for everyone involved.  It’s one of the few instances where playing along with a person’s perception of reality – even one you know to be totally false – can be reassuring and calming.  Correcting mistakes often effectively draws the dementia into the open and exposes it, which only makes the patient more aware of their deficiencies.  Or it just makes them feel more confused and isolated.

If you ever wanted to be an actor…take care of an elderly person with dementia.  Most of the time, you’ll find yourself going along with the stories, perceptions and beliefs of the patient.  You just might feel like a kid again.

One thought on “When The Truth Doesn’t Matter

  1. Matt

    I spent nearly four years working in an Alzheimer’s/Long Term Care facility in Utah and I know the difficulties and pains associated with this disease. I personally got to know some great people afflicted with Alzheimer’s and I also became close with some of their families. I’ve seen a lot of resources that help. One in particular seems to be a great benefit: http://www.thecaringspace.com
    Please pass this link along to anyone you feel could benefit from it.


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