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Should We Always Tell the Truth to Someone Living with Dementia?

dementia care tips lying and protecting emotional well being

Living with Someone with Dementia

Dementia is a devastating and progressive disease that causes a decline in cognitive function, memory loss, and behavioral changes. One of the most difficult challenges for caregivers and loved ones of people living with dementia is how to communicate with them effectively. One question that often arises is whether it is ever right to lie to a person living with dementia.

Is it Okay to Lie to Someone with Dementia?

Your initial response to the title of this blog post may have been, “Yes, we should always tell the truth,” and “No, we should never lie.” After all, lying is generally considered to be unpleasant, negative behavior, and most of us are taught from a young age that honesty is always the best policy. Many of us will be familiar with the famous quote from Sir Walter Scott in his great 19th century poem, Marmion, “Oh what a tangled web we weave, when first we practice to deceive.”

However, when one is grappling with the day-to-day real world challenges of caring for someone who is living with Alzheimer’s or another form of dementia, carers often struggle with how to deal with or respond to situations or questions where the person they care for is being difficult, unresponsive, hostile or even seemingly absurd, or completely disconnected from reality.

Some might advocate that telling the truth is always the best course of action, no matter how painful it might be to the hearer.  However, when it comes to communicating with a person living with dementia, the issue can sometimes be more complex than a simple foregone conclusion.

People with dementia can often experience confusion, disorientation, and memory loss, which can lead to anxiety and distress. In some cases, telling the truth can actually exacerbate these feelings and make the situation worse.

Creative Lying and Therapeutic Deception

Imagine that a person with dementia is constantly asking about their spouse who passed away many years ago. Telling them the truth, that their spouse is no longer alive, may cause them to repeatedly experience the grief and sadness that flowed from that loss. This can be distressing not only for the person living with dementia but also for their caregivers and loved ones. In such cases, it may be more compassionate and beneficial to tell a “therapeutic lie” instead, such as saying that their spouse is out shopping or visiting a friend.

In other words, many carers believe that it is better to not challenge the absurdity, or reality disconnect in what is being spoken of, but rather to engage with the discussion and take it further, both to keep engagement and discussion going and to avoid the potential consequences of stress, agitation and upset.

Patti Davis, the daughter of US President Ronald Reagan, in her memoir “Floating in the Deep End,” coined the phrase “creative lying,” and how this would cause him to be less flustered when he was worried about missing what he believed to be an important obligation.” 

At a caregiver seminar that I attended in California, a young man who was caring full-time for his mother living with Alzheimer’s, addressed the group and shared that sometimes, usually towards the end of any given week, his mother would start to become difficult, unwilling to communicate with him and even hostile. She would refuse to take her medication. He prefaced what he was about to say with the words, “I apologize if some of you here are offended by this,” and then told the group that when his mother became difficult like this he would pop into the next room and put on a wig and a pair of clear-lens spectacles. He would then go back into the room where his mother was and would greet her by name and introduce himself as “Dr. Wilson” and say that he had come to remind her to take her medication. On every occasion, his mother greeted the “Doctor” warmly and happily took the medication.”

Interestingly, no one in the room full of professional and non-professional family caregivers offered any criticism of his actions at all, as he had clearly found a way to dissolve a difficult situation and achieve a successful conclusion, even though his actions were rooted in deception. 

I also heard a story once about a lady caring for her father who was living with dementia and how he became extremely agitated one day because a college had not sent him his certificate of achievement. This was impossible to resolve, as he had had no connection or involvement with the College in question and was certainly not due any kind of certificate. After a week of seeing her father become increasingly upset, agitated and angry about the failure of the certificate to arrive, his daughter created a Certificate of Achievement and presented her father with it when he enquired as to whether or not it had arrived. Once again, a piece of deliberate deception, but it diffused a difficult situation, dissolved agitation and removed stress.

Protect the Person with Dementia’s Emotional and Mental Well-being

However, it is essential to note that what we have referred to here as Therapeutic, or Creative lying, should only be used when it is necessary to protect the person’s emotional and mental well-being, to eliminate stress or agitation and maintain emotional equilibrium. The word “lying” itself seems so harsh, so absolute, yet we need to remember that, by selectively lying to the person they are caring for, a caregiver is actually supporting that person’s reality; lying to a person with dementia may be the right way to care for that specific person at that specific time because, depending upon the progression of the disease, they may be wholly unable to remember the truth, and repeatedly telling them they are wrong, or insisting on facts will simply cause them distress or pain. As the Alzheimer’s Association has stated, “it is important to put oneself in the shoes of your loved one, and acknowledge how frightening their situation must be.”

It must be noted that not everyone agrees that therapeutic or creative lying is ever the correct decision; they believe that distraction, or gently changing the subject, or rephrasing the question or issue can be just as effective at restoring calm or dissolving stress. This school of thought relies on a gentleness of response that soothes someone with dementia by essentially, avoiding or stepping around the problem or question that is causing anxiety. This approach does tend to assume that the person looking for their loved one, or worrying about a non-existent upcoming meeting, or waiting for a certificate in the mail, will either forget whatever is distressing them, or realize they were mistaken, or even eventually remember the correct facts and thereby peacefully move on.

A Complex and Sensitive Choice

In conclusion, the decision to lie or not to lie to a person with dementia is a complex and sensitive one and people may well have different and sincerely held views. But there does seem to be a significant body of real world evidence that suggests that therapeutic, or creative lying may sometimes be the best option to keep a person calm and maintain their emotional equilibrium. Ultimately, the decision to lie or not must be made on a case-by-case basis, taking into account the person with Alzheimer’s individual needs and circumstances.

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How Colors can impact Dementia Care

dementia and colors alzheimers

Dementia and Colors

Could it really be true that different colors can actually have an impact on our moods? Interestingly, a lot of research* has been done over a number of years on the effect of different colors on the brain and human behavior, and it is increasingly apparent that different colors are interpreted differently by our brains and that they can actually have a subliminal impact on how we feel at any given moment. As a result, it does appear that careful choice and use of color can be helpful in improving quality of care for people living with dementia.

Contrast

The use of contrast in colors can be used to help define objects more clearly. So using a color with high contrast with its immediate background will draw attention to key features. In fact, the use of contrasting colors is very helpful in marking the edges of things; it can draw attention to furniture, or hazards that might cause someone to trip, or even to more easily find the toilet seat in an all-white bathroom.

Extending this principle into other areas, you might differentiate the colors that you choose for pillows, sheets and blankets, or to using dinner plates that are a different color to a tablecloth, for example. Other suggestions include using a contrasting wall color, so that it will be easier for someone to locate switches, sockets and handrails.

Red

There are studies that suggest that the color red can increase brain activity. It can also lead to a perception that a room is warm. Additionally, red can increase appetite and encourage eating when featured in plates and cups. It also figures that any dinnerware that is a different color to the food placed on it is helpful to someone living with dementia. Further research indicates that the color red can also promote participation; for example, red shoes might actually encourage someone to enjoy a walk. Oddly though, a  caregiver might want to avoid wearing red clothes, as the color red can also sometimes be perceived as intimidating

Green

The color green is associated with nature, and lighter shades of green can promote relaxation and calm. It is perceived as a restful color and can help to reduce central nervous activity. The use of green may also lead a room to be perceived as larger than it actually is.

Lime green, more specifically, has been shown to be effective for people living with Alzheimer’s or other forms of dementia, in providing visual cues to the location of doors to bathrooms, or bedrooms.

In addition, research has shown that the color green is one of the last colors that we lose the ability to see, so placing a piece of green tape on a cane, or a walker, or other items that people need to use every day, can be very useful. Not surprisingly, green is a good color for Caregivers to wear as it fosters feelings of engagement, relaxation and calm.

Purple

Purple is a color that has been shown to stimulate the imagination and also spirituality. Purple objects are often perceived as being valuable.

This belief dates back thousands of years as the physical resources needed to create a purple dye was very hard to come by; purple is uncommon in nature and was therefore very costly to create. As a result, only the elite could use purple dye. The association of the color purple with royalty and extravagance persists even today.

So, it might be a good idea to choose purple as a way to encourage someone to think of an object as desirable.

Yellow

The color yellow has been shown to increase feelings of happiness; people tend to smile more in yellow rooms, and individuals with dementia tend to stay longer in rooms that are painted yellow.

Blue

Blue is a color that promotes relaxation; blue rooms can reduce any feelings of confusion and increase concentration. Blue has been shown to be a restful color, with a calming effect. Research shows that using blue in the physical environment can actually lower blood pressure, and that blue rooms are seemingly cooler than rooms painted in shades of red or orange.

White

This may seem like stating the obvious, but white is a difficult color to see. As a result, an all-white room can appear to be circular to someone with dementia. It might be a good idea to paint an accent wall in a different color or create a colorful focal point somewhere in a white room.

Black

Also perhaps unsurprisingly, the color black can be associated with fear or sadness. As a result, if you wear black it might make it difficult to communicate with someone who has dementia. A black carpet would also be a poor choice, as it may appear like a large black hole to someone living with the condition. Conversely, a black mat in front of an external door might be a good disincentive.

Caring for Someone with Dementia and Colors Used in their Environment

As you are able to select colors of objects and surrounding of your loved one living with dementia, keep in mind the findings of studies on color and its impact on mood and perception.  Some ideas of how you might utilize colors: Walls could be painted green or blue. Use plates that are red.  Mark important doors, like bathrooms and  bedrooms with lime green tape, but paint the door going outside black so they are less likely to wander out accidentally.  Be sure steps or any other potential hazards are clear with a high contrast color to its immediate surroundings. Wear green. 

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