Dementia Care: the Benefits of Staying In Their Reality​

timeIndividuals living with dementia or Alzheimers will often speak of their younger years as if it was their current reality.  They tell stories of their childhood home, their parents, and will even feel the need to go home and make dinner for their young children.

Sometimes the need for this reality is so great that they become anxious and even angry when they can’t find what in their mind should be there.

How trapped and powerless they must feel in these moments!  Imagine if we woke up one day and everyone we know and loved were no longer there or if our once routine and purposeful lives were now only a distant memory.

If you’ve cared for someone with dementia you’ve most likely had to “fib” at one time or another. When asked where their mother or father was, you may have said they were at the store; When asked to go home, you may have said it’s too cold to go outside; Or when asked when their kids will be here, you may have replied they are at school today.

These types of answers may not always work as well as we hope they do, but more often than not these responses offer them comfort and a peace of mind in knowing that their mother is still alive and will soon return.

I’ve had many people ask about the ethical implications of lying to someone with dementia or Alzheimers.  However, there are multiple benefits from the practice of being in their reality for both them and us. Because when we engage them in their stories of the past, we learn and connect on their terms, not ours.

Reality Orientation

First, I want to mention the practice of Reality orientation, which is the method of reminding the person with dementia or Alzheimer’s the facts of their current situation. If they wonder where their parents are we tell them that their parents are no longer living or that they can’t go home because they no longer live in their childhood home. We will also remind them of the actual date and time and their current living situation. 

In my experience, reality orientation causes anxiety and can even scare the person with dementia or Alzheimers.  Arguing with someone who has dementia is futile and will often exasperate the situation.  Whether we think they are making up these stories or not when we attempt to correct them we are essentially calling them a liar and taking away any sense of control they may have in telling these stories. 

The Alzheimers Association also stresses the importance of communication with those living with dementia and Alzheimer’s and notes that communication requires patience, understanding, and good listening skills.

Read more: http://www.alz.org/care/dementia-communication-tips.asp#ixzz4r9g3YquZ

Nostalgia

Therapeutic Lying

There are several names we can give to the practice of staying in someone else’s reality:  therapeutic Lying, embracing the reality, or empathy.  No matter what you feel comfortable calling it, the practice itself has multiple uses and benefits for those living with dementia or Alzheimer’s.

Therapeutic lying reduces stress and pain of loss for both the caregiver and the person receiving care.  The Family Caregiver Alliance notes:

People with Dementia Do Not Need to Be Grounded in Reality.
“When someone has memory loss, he often forgets important things, e.g., that his mother is deceased. When we remind him of this loss, we remind him about the pain of that loss also. When someone wants to go home, reassuring him that he is at home often leads to an argument. Redirecting and asking someone to tell you about the person he has asked about or about his home is a better way to calm a person with dementia.”

No matter what strategy or answer we find works best for our loved one staying within their reality rather than bringing them into our own will make them feel more safe and secure at this moment. This practice has a beautiful way of redirecting them so they are no longer concerned about the safety and whereabouts of their loved ones and they can then, in turn, enjoy the moment with you.