Illogical Communication: Responding to the Dementia Patient

Grandma’s face would brighten each time I walked into her room. I am so thankful to say that even with advanced Alzheimer’s, she knew me every time she saw me; just two weeks before her death, a nurse asked her who I was and she answered clearly and immediately that I was her granddaughter.

That being said, one day I came in and asked Grandma how she was doing and what she’d been up to that day. Her answer caught me completely off guard. She looked me straight in my eyes and said, “I just put little Ray to bed.”

What??

Ray was her only son—and my biological father. The answer she gave was impossible because chronologically, there was no way she could have put little Ray to bed and then turned around and told his adult daughter about having done it. I couldn’t understand how this statement made sense to her—even in light of Alzheimer’s.

A couple of years earlier I’d had a similar experience with my grandfather. It was when I first brought my grandparents into their new independent living apartment. I had gone to a great deal of trouble to bring in their own furniture, and I had painstakingly arranged it so they could feel “at home” immediately. Grandpa walked in, and after a brief inspection he turned to me and said, “Sweet, this isn’t our furniture.”

Again…what??

If you’ve ever dealt with a person who has any type of dementia, you know they will often say things that just don’t make sense. In addition to repeating stories or questions—and their all too frequent inability to find the right word—it’s not unusual for dementia patients to say something that is either completely untrue or utterly impossible. When these things first started happening with my grandparents, my greatest difficulty was trying to figure out how to respond.

Should I Correct Them?

I learned pretty quick this didn’t work; I could see by the looks on their faces that I had offended, or worse, embarrassed them. It was also ineffective because of the nature of dementia; short term memories just don’t stick, so in five minutes (or sometimes less) they would be telling me the same impossible story all over again.

How About Getting Angry and Snapping Out?

Really bad choice. After hearing something repeatedly within a short span of time, my patience would wear thin, and with aggravation in my voice I would tell them that what they were saying couldn’t possibly be right. But far from settling the matter, the response I often got was tempers flaring as they argued back!

So What Was the Right Response?

Thankfully, a day came along when I actually posed that very question to one of the nursing home social workers, and she gave me a gem of an answer.

“Therapeutic Lying”

This is a technique whereby you calmly go along with whatever the patient says, even when it’s inaccurate; there’s no correcting, no arguing, just pleasant agreement. For example, when Grandma would say she had just put her little son to bed, I learned how to say, “I’m glad you were able to do that; it’s a special time when you can put your little one down to sleep.”

Firsthand experience taught me that “therapeutic lying” accomplished two things:

One—Grandma’s dignity was protected; I wasn’t making her feel foolish for having said something that, had she been fully cognizant, she would never have said in the first place

Two—It kept the peace; there were no flaring tempers or entrenched arguments, just a calm, comfortable conversation  

While I do not recommend using the “therapeutic lying” technique with our loved ones who are fully cognizant, it is a wonderfully helpful tool when communicating with dementia patients. Keep in mind that they won’t remember what you said, but they surely will remember how your responses, tones and facial expressions have made them feel.