One of the biggest challenges in the care of people with dementia is the breakdown of communication. “Reawakening” was originally the popular practice that was used when difficulties arose. Conventional wisdom was to bring a person in an alternative reality into the real world by stating the cold hard facts. “No, you can’t have the car keys, you don’t even have a car. You can’t visit your mother. She has been dead for twenty years.”
For obvious reasons, this strategy is not effective. Not only does it cause distress to the affected person, but the caregiver could also feel angry and frustrated. If it’s a family member, it could bring back memories about who the person used to be and regret for the current situation. Even if people live in a dream world, they retain their self-identity and will sense a conflict. Constantly being told that they are wrong could be psychologically damaging and could result in an escalation of the conflict.
Lying is a word that is difficult for most people to swallow, but, apparently, it is a technique used by some in the care of patients requiring memory care. Sometimes, caregivers feel that telling white lies or fibs is justified if it keeps people with dementia peaceful. According to Wall Street Journal reporter Sue Shellenbarger, therapeutic lying works for many people caring for sufferers of dementia who can be aggressive, unreasonable and agitated. According to this model, in the above example, blatant untruths “You can drive the car after lunch. Mom has gone to New York for a wedding,” are perfectly acceptable responses to keeps a delusional person quiet.
Others feel that this is condescending and unethical. At some level the person will sense the falseness and will feel patronized. Psychiatrist Dr. Sperber, feels that it’s a contradiction in terms. Lying, he says, cannot be therapy when it breaks the trust in a relationship between a patient and a provider or care-giver.
Patient autonomy is essential in the practice of medicine. Cognitively impaired people may be intuitively able to sense deception. According to him, validation is a more compassionate practice than lying.
Validation was developed by Naomi Feil in 1982. This is based on understanding the underlying reasons behind the way disoriented seniors behave. Past trauma may be responsible for certain behaviors. Feelings of fear, guilt or anger about past issues can play a role. Early soothing behaviors such as thumb sucking can return when speech and memory fail. Painful feelings will decrease if they are supported and validated, but will increase if criticized. So using the same illustration, validation may involve asking the person about the car he owned a long time ago. He may reminisce about the old days, the make of the car, places visited. And you can ask them something about their mother and share your own memories with them. The person may share underlying feelings that created this thought – perhaps loneliness or even a difficult relationship with the mother. This way, no one is disputing the fact that he has stopped driving or that his mother is no more.
Redirection is another method that Dr.Sperber recommends. Distracting an angry and agitated person with an alternative soothing activity may involve saying something like “Remember how you always liked to drive to the beach. Would you like to look at this album of pictures” This might help get the person’s mind of car keys or visiting his mother.
Another method drawn from Aikido is to avoid the issue altogether and go for the underlying emotion.
“It must be hard for you to always have to ask me for things.” Whatever the method, the idea is to not stand your ground, but accept that the elderly person is in their own world. This may be a good concept for communication in general.
NVC (non-violent communication) is a communication process that was developed by Dr. Marshall Rosenberg in the 1960s based on the principles of empathy towards the self and others. The idea is to tap into a well of compassion when talking to someone. Really listening without judging and evaluating fosters empathy. In close families, familiarity can lead to demands, but requests are more effective to get co-operation. The same principles can be applied to seniors who have Alzheimer’s or memory problems. To connect to others and create mutual understanding, it is often better to be kind rather than right. And you don’t have to lie to do it.