Telling the truth to dementia patients is a controversial topic. There are arguments on both sides about whether it is better to be completely honest with someone experiencing memory loss and confusion or to follow a “therapeutic fibbing” approach. This article will explore the key considerations around truth telling for dementia patients and provide guidance on when honesty may be the best policy.
The case for telling the truth
There are several reasons why being truthful with dementia patients is often advocated:
- It maintains dignity and personhood – Lying to any adult, even those with cognitive impairment, compromises their dignity. Truth telling respects their personhood and humanity.
- It builds trust – Deception, even when meant benignly, can undermine trust between caregivers and patients. Honest communication fosters better relationships.
- It reduces distress from confusion – Dementia patients can become extremely distressed when they sense things do not add up or detect dishonesty. Truthfulness may reduce anxiety.
- It empowers people to deal with reality – Accurate information enables patients to better cope with and respond to their circumstances.
- It upholds wishes and preferences – Deception goes against a person’s right to know the reality of their health and make informed decisions.
- It avoids complications from deception – Maintaining an inaccurate story requires effort and risks contradiction. Truth telling is simpler for all.
Many argue that unless it is dangerous or overly upsetting, people with dementia deserve the dignity of truth just as much as anyone else. Even if details are later forgotten, being transparent and honest demonstrates respect.
The case for therapeutic fibbing
There are also reasons providers, caregivers and family members may opt not to share complete or painful information:
- It avoids causing unnecessary distress – There are circumstances where the truth could provoke severe anxiety, depression or behavioral issues.
- It redirects away from unsafe topics – Discussions around driving or Ability to live alone may agitate the person and pose safety risks.
- It provides reassurance – Fibbing to say a deceased relative is alive and well prevents re-living traumatic grief with each re-telling.
- It compensates for paranoia or misconceptions – Occasionally bending the truth can ease suspicions layered on top of reality.
If truth-telling seems to frequently upset the person or provoke dangerous reactions, some degree of “therapeutic fibbing” may be appropriate to help maintain calm.
Navigating truth telling with dementia patients
There is no universal consensus on truth telling in dementia. It requires balancing ethical considerations against the duty to support patient well-being. Some best practice tips include:
- Get to know the patient’s personality and history – This provides insight into what topics could potentially cause distress if confronted with painful truths.
- Evaluate capacity to handle truthful information – Gauge understanding and emotional state first to determine if truth is in the patient’s best interest in that moment.
- Redirect conversation if needed – If unable to tell the truth without severe upset, guide the subject elsewhere for now.
- Never lie to cover up wrongdoing – Dishonesty should never be used to hide negligence, abuse or exploitation.
- Weigh risks vs benefits – Consider whether white lies are truly serving the patient’s welfare and explore alternatives.
- Disclose diagnosis before progression – Sharing an early dementia diagnosis allows adaptation while cognitive abilities permit.
- Maintain regular open communication – Checking in frequently and inviting questions builds trust to have difficult conversations.
A case-by-case approach is often best, responding sensitively to each patient’s unique needs and abilities while prioritizing dignity. Small fibs may sometimes be appropriate, but truth should be the default.
Special considerations around specific topics
Certain subjects commonly arise where extra care is needed in deciding if and how to communicate truthfully.
Death of a loved one
Learning of a spouse or family member’s death can be shocking and intensely sad. Yet repeatedly inflicting this grief can be equally traumatizing. Some options include:
- Break the news again only if memories are still intact. Let it fade if the loss is forgotten.
- Answer gently focusing on positive feelings: “You loved him so much, I know you miss him.”
- Redirect to a warm memory: “Let’s look at your wedding photo and remember how happy you were.”
- Lie only if essential to avoid harm: “He’s away traveling but loves you very much.”
Inability to live independently or drive
Losing autonomy is difficult. When safety requires limiting independence, choices include:
- Explain changes incrementally – “Let’s start having caregivers help you with medications.”
- Emphasize that skills vary day to day – “Your driving seems a little off today, so let’s not drive right now.”
- Describe restrictions as temporary if needed – “The doctor wants you off driving for a little while until the medication changes.”
- Enlist trusted figures – “The DMV says it’s time to stop driving but I’m here for you.”
Repetitive questioning
Constantly answering “when is mom coming?” or “where are my car keys?” can be tiring. Consider:
- Rediscover patience – Remember each time is the first for them as memories fade.
- Provide consistent simple answers – “Mom isn’t here right now but she loves you.”
- Experiment with distractions – Change topic or shift to an activity.
- Maintain composure – Take breaks when needed.
Delusions or paranoia
Seeing deceit when none exists is common. You could:
- Avoid arguing – Correcting is rarely effective. Reassure rather than reason.
- Express empathy – “I know this is scary for you, I’m here.”
- Play along – In extreme anxiety, temporarily endorsing misconceptions may help.
- Distract and redirect – Shift focus to a pleasant conversation or activity.
- Ensure safety – If at risk of harm, seek medical advice.
Conclusion
Truth telling with dementia patients is nuanced. While honesty should be prioritized, some therapeutic fibbing may be appropriate to avoid distress in certain circumstances. Consider the individual’s needs, abilities and best interests when navigating sensitive topics. With thoughtful communication matched to each situation, it is often possible to find alternatives to lying while still supporting the person with compassion.
