November is Alzheimer's Awareness month. Worldwide it is estimated that about 16 million people have Alzheimer's disease, including 4.5 million Americans.
Telling whoppers is not a good practice in most professional arenas, but in an Alzheimer's daycare facility, you'll hear some tall tales from staff throughout the day. When you are caretaking a person with Alzheimer's disease -- whether it is your parent, a relative, a friend, or a client - there will come a point, perhaps daily, even several times an hour, when it is healthier to fib than to tell the truth. In fact, those who can fabricate, falsify, and fictionalize reality, have a much better chance of maintaining connection in a relationship with a person suffering from dementia than one who insists on being truthful.
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Is this a betrayal? Not at all. It is sometimes necessary in order to protect the person with Alzheimer's from acute and intense anxiety or an emotional breakdown. By letting a person with Alzheimer's enjoy what they perceive to be reality, you provide a safer environment. It also lessens stress for the caregiver.
For example, one friend gets her mother and aunt to their dreaded doctor appointments without a battle by suggesting they go for an ice cream cone. Once they are dressed and in the car, she "remembers" she needs to stop by the doctor's office on the way to get ice cream.
One of the most common situations caregivers face is when the person with Alzheimer's disease thinks they need to drive somewhere, not realizing they no longer drive. You can always say the car is being serviced and will be picked up later, or that a close relative is borrowing the car. With advanced Alzheimer's you can say that as many times as you want without the person remembering you just said that. Excuses rarely wear thin for people who have no sense of time or short-term memory.
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A challenge caregivers may face daily is when the demented person does not recognize their house as being the home they live in. Instead of arguing and reasoning as you pull into the driveway, sometimes it's easier to say, "We're visiting so and so today" or "Your house is being painted so we're staying here til the paint dries," and then redirect the subject to a different topic. Often the inability to recognize home is due to the anxiety of transitioning from one place to another. Once in the house and settled, it's possible the client or relative will feel so comfortable that the familiarity of home will start to grow on them no matter where they think they are.
There is one instance in which it can be too uncomfortable to lie, even if it is for the comfort of the confused person. When your relative or client asks where their deceased spouse is and why they don't visit, there's a distinction among therapeutic fibbing, redirection, and validation. A therapeutic fib might be as benign as saying the spouse is on a trip and will be back soon. But some people don't like to fib in regard to death. Redirection would be to change the subject to something more neutral, like "You and your husband are such an attractive couple in this photo. Let's look at some more pictures." Validation would be acknowledging the unspoken loss with something like "You must really miss your husband."
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A good therapeutic fib is a version of the truth that could be true on any given day if it weren't for the linear time frame in which we live. Practice makes perfect.
About the Author: Judy Kirkwood has practiced therapeutic fibbing with her mom and dad.
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