How Therapeutic Fibbing and Diversion Can Help Loved Ones with Dementia and Alzheimer’s

A patient in her 80s in a nursing home where Monica Moreno once worked would often ask about her mother. Well-intentioned staff would remind the woman that her mother had died, says Moreno, who is now senior director for care and support at the Alzheimer's Association.

Because of the emotional toll that took on the patient — after all, “her reality was that she was 37 years old and her mother was still alive,” Moreno says — the workers changed their tactic. “I want you to know that everyone who loves you knows that you’re here and that you’re safe and you’re happy,” they would say.

“Really it’s about connecting in the moment and trying to connect to what the person is feeling,” Moreno says. “It’s about their reality and us putting ourselves into their world and their reality rather than trying to get them to be part of ours.”

The challenges of telling well-meaning mistruths

Entering that world can sometimes include telling lies, Beck says. But just as medical professionals use some medications only when there isn’t any other option, she says, she recommends against lying in all but the most extreme situations.

For one thing, lying to a loved one can take a toll on a caregiver, as research at the City University of New York (CUNY) has found. “It is the reflex not to lie, especially to a parent, and the emotional hurdle of overcoming that, which is the greatest difficulty surrounding this technique,” the research concluded.

For another, even people with short-term memory loss might be able to sense a lie.

“It's often experienced as disrespectful to think that people with dementia don’t know the difference between the truth and the fib,” says Susan Wehry, associate professor of geriatrics at the University of New England College of Osteopathic Medicine. “People who have memory impairment retain a lot of their sensibilities, a lot of their awareness about interpersonal connection. There is a level at which they can sense that something shifted in a relationship that was heretofore based on trust.”

And since some dementias cause paranoia, Beck adds, “they’re already suspicious. You’re going to worsen the situation if you lie.”

Wehry uses the example of a resident of a congregate living facility who tries to leave every day at noon believing that it’s time to fix lunch for long-grown children. “Instead of saying, ‘No, I’m fixing their lunch’ or, ‘They’re going to a neighbor,’ you can say, ‘You have three kids, right? Remind me of their names.’ You make the assumption that their kids are on their mind. That’s a clue to where their reality is right now.”

Sometimes even distraction doesn’t work. If a person with dementia misplaces something, for example, a caregiver may try to change the subject, Wehry says. “What I teach instead is to say, ‘I’m sorry your watch is missing. Would you like me to come and help you look for it?’ You’re validating that they’re worried. Then as you’re walking with them, you say, ‘I think you told me you were knitting a sweater for your niece,’ or anything you know is a positive connection. And now you’re working with a person in a different mood.”

Finding a middle ground

Wehry acknowledges that there are times when a caregiver might sidestep the truth. “I’m not someone who says you need to keep reminding someone that their spouse has died or that they don’t have to worry about taking care of their children.”

In separate surveys in the U.K. and Australia, therapists, nurses and other health care professionals said they generally believed it was in the best interest of dementia patients to occasionally lie to them. One U.K. study asked early-stage dementia patients themselves about this; they said they supported lying if it was done with good intentions and at the more advanced stages of memory loss.

“In many cases, therapeutic lying can actually create a feeling of safety for such patients,” the CUNY research concluded, based on interviews with nonprofessional caregivers of people with Alzheimer’s. “For a mid-disease person, who finds comfort in the belief that he is living in his childhood home along with his parents and siblings, it serves absolutely no purpose to remind him that he is living elsewhere and that his parents have been long deceased.”

People with dementia are often frightened and emotional, notes Marina Martin, clinical associate professor on the geriatric medicine faculty at Stanford University’s School of Medicine. “The most respectful and compassionate approach to that is to meet them as much as possible in their reality to soothe them a little bit. You don’t have to participate in some elaborate set of lies, but maybe skirt the question of what the truth is and get at the emotion.”

At her practice, for example, Beck says patients can be agitated at being put through memory tests they weren’t aware were part of an examination. “They know they’re going to see a nurse practitioner or physician but the intention of the family is to delve into memory problems. You have to handle that very carefully,” she says. So the staff explains that every new patient undergoes a memory assessment, averting the potential for feelings of anger or betrayal.

One caregiver tells of overcoming her husband’s resistance to enrolling at an adult day facility by telling him he was going there to volunteer. In cases such as that, Moreno advises making sure that the staff at the center also knows about the tactic, and gives the husband small tasks to do. “It’s really an act of kindness rather than deception,” she says. (The Alzheimer’s Association offers other communication strategies and caregiver support groups; the Family Caregiver Alliance provides practical advice on relating to someone with memory loss.)

Even after 15 years, says Mangi, it can be hard to be less than honest with his wife.

“The important thing is, what is the most loving thing to do? There’s no virtue for the caregiver to say, ‘Well, I have never told a lie in my entire life.’ Isn’t it more desirable to say. ‘I’ve always been a loving person?’ ”