Is Honesty Really the Best Policy for a Loved One With Dementia?
Sometimes telling a "white lie" can actually be therapeutic when faced with an upsetting situation
The day before my adult daughter moved out of state, she had a 10-minute phone conversation with her grandmother. The next day, her grandmother emailed me in panic because she didn't remember speaking with my daughter.
We were conflicted about how to respond because my mother-in-law suffers from dementia. My husband was convinced we should tell her the truth, that she had spoken to our daughter. But I wasn't sure if, in this case, honestly really was the best policy.
Dementia is a collection of symptoms related to cognitive decline. Noticeable cognitive decline can include cognitive, behavioral and psychological symptoms due to biological changes in the brain, including loss of memory, language and problem-solving ability.
Although sometimes used interchangeably, "Alzheimer's" is not synonymous with dementia, explains Robyn Kohn, director of programs and services at the Alzheimer's Association.
"Dementia is an umbrella term we use to describe a group of symptoms related to cognitive decline," she says. "Alzheimer's disease is the most common form of dementia — about fifty to seventy-five percent of all diagnoses and the one we hear about the most. Since dementia can be an early sign of Alzheimer's or other conditions that can cause dementia, getting a diagnosis is important, and it is vital to see a physician if you notice these symptoms."
"Sometimes being brutally honest can cause a person who has dementia a great deal of pain. But a little white lie or fiblet can keep the person safe, happy and calm."
In the early stages of dementia, gentle reminders can be beneficial. Being surrounded by photos and other personal items can trigger positive memories. Keeping a calendar can help avoid confusion about the day of the week, date and upcoming plans.
Writing things down, rather than trying to remember, is also a good idea. Caregivers can remind them to refer to their list when they get confused.
While it may human nature to want to help someone struggling to remember words or problem-solve, experts caution stepping in too quickly.
Kohn says, "At the early stages of dementia, the person may just need a little more time to get their thoughts together. Give the person time to formulate a response. Or you can ask, 'Is it okay if I jump in?'"
As dementia progresses, patients tend to become more forgetful, especially when it comes to short-term memory. When other methods become less effective, therapeutic fibbing (also called emotional truths or a fiblet) can become a useful tool for caregivers.
Lori La Bey, founder of Alzheimer's Speaks, explains it like this: "Sometimes being brutally honest can cause a person who has dementia a great deal of pain. But a little white lie or fiblet can keep the person safe, happy and calm."
"The fib is a better alternative than telling the person that their loved one has passed away and them having to relive that terrible memory over again."
But being dishonest with someone you love can feel morally wrong or like a betrayal of trust.
"I have spoken to caretakers who say, 'I never lied to my mother or my spouse, and I am not going to start now,'" says La Bey. "What I explain is that even if you value truth, you also need to value your loved one's pain points. If they can't process the truth, being honest can upset or frustrate them. The truth may cause them more pain than if you told them a fiblet."
Why a Fiblet May Be Better Than The Truth
Let's suppose a person forgets that their spouse died several years ago. "Telling them the truth will cause them to go through the grief process all over again," says La Bey. "The pain will be fresh from the beginning, from before they had a chance to process the loss."
Rather than telling the person the truth, a caregiver can tell a fiblet such as "He went to the grocery store and will return later." Kohn says "The fib is a better alternative than telling the person that their loved one has passed away and them having to relive that terrible memory over again."
If the person still seems agitated, try changing the conversation or moving to a different room to distract them.
Therapeutic fibbing is also effective in health and safety situations. If your loved one gets agitated going to the doctor, the caregiver can say they are going out to lunch or for a drive.
"While the caregiver may feel guilty or uncomfortable lying, it's a supportive way to ensure that the loved one remains safe by going to the doctor," says Kohn.
Therapeutic Fibbing Can Be a Form of Self-Care
"When someone says something untrue or inaccurate, it's an instinctual reaction to want to correct them," explains Kohn. However, when someone is suffering from dementia, being told they are wrong isn't helpful and can be detrimental.
"No one wants to be constantly corrected," says La Bey. "It makes the person feel bad about themselves. Caregivers have to ask themselves, 'Is the truth worth upsetting the person?'"
Rather than pointing out the truth, caregivers may be more effective if they insert themselves into their loved ones' version of reality.
"Therapeutic fibbing can be the most compassionate way to respond in some situations."
La Bey recalls a caregiver whose wife had Alzheimer's disease. "His wife kept telling him that she wanted to 'go home' even though she was home, " explains La Bey. "He was getting increasingly upset by the situation. I suggested he tell her a fiblet."
The man was reluctant to be dishonest with his wife. But then one day, exasperated, he told his wife that they were on vacation and would go home soon. He even packed a suitcase and left it by their door to remind her.
"Constantly having to explain that they were home was taking a toll on him and the time they spent together," says La Bey. "Not only did this emotional truth calm her down, but it calmed him, too. Telling the fiblet lightened his emotional load."
Understanding the Truth
Sometimes, one of the most difficult things for a caregiver is being honest with themselves. My husband was in denial about his mother's cognitive decline.
He wanted to believe that if we corrected her, my mother-in-law would remember. But this was not the case.
"Watching someone you love struggle with dementia-symptoms is heartbreaking," says Kohn. "It is important that caretakers take care of themselves too and have a good support system."
Remember, dementia is a journey and what works at one point may not work as the symptoms progress.
"Therapeutic fibbing can be the most compassionate way to respond in some situations," says Kohn. "While it isn't the first approach, it is something to keep in your toolbox."