Alzheimer’s Disease: When to tell an Untruth

We’ve all been raised as kids to never tell a lie, yet isn’t there a gray area in many instances? Especially when it comes to telling vulnerable people the cold hard truth. Most of us don’t see the harm in telling a white lie, like telling someone their new haircut looks nice when it really doesn’t suit them at all. Or saying you can’t make a PTO meeting because you have to work when you really just want to sit on your couch and put up your feet after a long day of adulting. We’re all guilty of this. But there are degrees of lies, right? Keeping a big lie like hiding money from your spouse or an affair is greatly frowned upon, to be sure. Yet somewhere in the middle is another gray area, having to do with how we handle delicate situations involving our aging loved ones — particularly those suffering from Alzheimer’s disease. If you have a loved one in end of life care in Santa Clara and elsewhere, you may have come up against this very same issue.

About 5.7 million people are living with Alzheimer’s disease in the U.S. It’s the most common type of dementia, affecting memory, thinking, and behavior. Caregivers provide more than 18 billion hours of care at a value of more than $323 billion. As a caregiver yourself, you understand just how taxing, upsetting and frustrating it can be to witness your parent declining into the madness that is this disease. As they start to lose their memory and cognitive abilities, it gets more and more difficult to know the ideal way to respond to their repeated questioning.

Here’s an example: How do you respond when your parent with dementia keeps on asking about a child or a spouse who has died? How many times can you tell them the truth as you watch them suffer the same loss over and over? So, this brings up a very valid moral question…what is worse in the big picture: telling a lie, or telling your loved one a crushing truth every time they forget and ask again? Withholding information, redirecting their attention or outright telling a lie all make up an approach psychologists call therapeutic fibbing. An effective yet controversial strategy, therapeutic fibbing involves lying — or deliberately not correcting a misconception — to decrease the level of anxiety and agitation in a patient with Alzheimer’s.

Therapeutic Fibbing: A Common Strategy

Most people can understand why therapeutic fibbing is common. Not only does it spare the patient repeated despair and anguish as they are advised of the facts yet again, it saves vital time and energy put into the grieving process that could be put to better and more productive use during a visit. Experts point out there really is no benefit in repeatedly correcting loved ones with dementia. A fib, in fact, can actually draw the caregiver closer to the patient, says The Washington Post. It assists the caregiver in joining the world of the person with Alzheimer’s, giving them all more time to connect in a meaningful way without wasting time rehashing past events.

The Caveats

Most dementia experts support these types of white lies. That being said, they do come with caveats. For people who are cognitively impaired so much so that they cannot readily absorb or process information enough to understand it, therapeutic fibbing can prevent them from getting upset unnecessarily. However, caregivers should keep in mind that there is no justification in telling a therapeutic fib so they can avoid the initial difficult or painful conversation. Alzheimer’s patients should be told, once, perhaps twice so they can grieve for their lost loved one, despite the fact that the caregiver knows they will not retain the information.

Many families who don’t feel comfortable lying to a loved one may also hesitate to entertain fantasies and stories that the patient spins on a daily basis. This is another common practice in Alzheimer’s patients: to weave elaborate stories and observations that they truly believe are fact. The result can put caregivers in a moral free-fall: do they simply go along with the stories or point out their flaws every time? This can get exhausting for the caregiver. According to Alzheimers.net, you should avoid arguing with a loved one who has Alzheimer’s, as these spats won’t change their minds; in fact, they will only agitate them more and increase their frustration. Don’t criticize or correct them. Rather, be there in the moment to listen and focus on feelings rather than facts. You don’t always have to be right — you just have to be there for them.

Contact Pathways Home Health and Hospice

To learn more about our Alzheimer’s care, please contact Pathways Home Health and Hospice at 888-755-7855. Our dementia care services and care for caregivers programs are comprehensive and designed to provide compassion and skill.