This past week I had an interesting discussion with some of my team members (registered social workers and occupational therapists ) on whether or not it is appropriate to tell a white lie with individuals living with a dementia. “Therapeutic fibbing is a controversial yet very effective method of dealing with the anxiety experienced by many people with Alzheimer’s and other dementias. In essence, it is telling a “fib” in order to avoid increased anxiety and agitation in a person with dementia.” (Source: Therapeutic-Fibs-and-Creative-Communication-Techniques.pdf (ocagingservicescollaborative.org).
This is a technique that is frequently used when working with a person with dementia who is experiencing anxiety or if the truth was in fact told, it would cause tremendous anxiety and hurt.
For example, how do you deal with an individual who is living in a secure setting and keeps standing at the elevator saying they must go and meet their parent or their parent will be very angry with them for being late? Telling them that their parent is long dead may be the truth but certainly it would not be helpful to say this to them. What if you were to advise them that there was still plenty of time left and that you would remind them when it was time to leave? What if you were to ask if you could go and check for them if their parent was waiting? Or what if you were to tell them you would go with them but first you needed to have something drink and would they like something to drink as well?
Must we always tell the truth even if it causes pain and anxiety that continues in a cycle of confusion? Teepa Snow (Source: Ready for Some PAC Homework? Change These Lies into Supportive Truths – Positive Approach to Care www. teepasnow.com) says that there is a third option and that is ‘going with the flow’. Basically it means connecting with the individual in their world and allowing the situation to work itself out. ‘Going with the flow’, by acknowledging their reality and slightly reshaping their perception so that they do not have to relive a trauma or unpleasant memory ( ie death of spouse or other family member) time and time again can be beneficial to both the caregiver and care recipient.
I think that it can be beneficial to both parties when we don’t have to lie but when we don’t have to tell the whole truth either. Not telling the truth can be difficult however this interaction is usually not about the caregiver but rather about soothing the care recipient.
As my colleague stated: “In the end less is more and trying to find a truth that fits in with the reality of the person with dementia is not lying. It is helping keep them comfortable and secure and that is the most important thing.”
The New Yorker wrote an article a few years ago that discusses this issue in more detail.
Some communication tips to consider when interacting with someone with a dementia: “Caregiver/Person with Dementia Interaction Tips • Use simple and exact words • Reassure, reassure, reassure • Do not disagree or argue with made-up stories • Respond to the person’s feelings, not their words • Use distractions • Do not try to reason with the person • Give yourself permission to alter the truth for your loved one’s sake • Avoid asking questions that rely on memory • Break down all tasks into simple steps • Respond calmly to anger; don’t contradict. • Try to stay relaxed and SMILE.” (Source: For additional information or to request a copy of Compassionate Communication and Communication: Best ways to interact with the person with dementia, contact the Alzheimer’s Association Orange County Chapter at 800.272.3900)