There is an elder woman I know of Russian descent; her husband passed away a few years ago. She has dementia and lives in an alternate reality now. One day she was telling me about her husband who is still alive in her mind. “He is the Russian President,“ she told me sadly, “and he is there in Russia now with his children. He came for me and asked me to go with him. I said no. Now I’m sorry I didn’t go with him.” She cried and I felt sorry for her. I wanted so much to ease her pain.

“Why don’t you go with him the next time he comes for you?” I suggested. “It’s okay if you go with him. Would you like that?” She seemed to be somewhat comforted by the thought of joining her husband on his next trip though I knew she would not remember our conversation for long and would be emotional again soon.

While I was talking with her, I made the decision to enter her world and take it as seriously as I would with any other adult. Trying to snap her out of her fantasy would be a waste of energy on my part and possibly upsetting to her.

I knew another woman with dementia who had lost her husband many years previously. She believed he was on a business trip and she had no concept of time. One day someone told her that her husband had died. For weeks, the thought that he had died became her obsession. Daily she wanted confirmation that he had died and daily it was confirmed by a well-meaning friend. Each time she heard the news, it was fresh and devastating to her. It was heartbreaking to witness. What was the value of telling this woman the truth over and over? Her dementia was advanced to the point that she could not make any headway in grieving.

Unlike a healthy person who can move through grief and, ultimately, into healing, a person with advanced dementia may not be able to move past the initial shock of bad news.

When is it appropriate to be the bearer of bad news to a person with dementia? If someone is in early-stage dementia you can gently remind them of what they have temporarily forgotten. If you can see that the person with dementia understands what you explained, then setting the facts straight for them is helpful. Lying to or misleading someone who is able to process information isn’t a good idea and can cause them to mistrust you. That’s not a good basis in a caregiving relationship.

But sometimes, it is better to avoid the truth.When people with dementia become confused with reality and fantasy, there comes a point when it is no longer ideal to remind them of reality when reality is unpleasant. What is the value in saying, “You already told me that story five times!” The person not only will likely forget that they told you the story but they may very well tell you again no matter what you say. And though they might not remember the frustration in your voice each time you express your exasperation, they will feel it anew every time you say it. Just because someone is forgetful it does not make them emotionally numb. You don’t want them to feel embarrassed or stupid every time you remind them that they are repeating themselves so it is best to stop reminding them.

I do not recommend repeating the same news unless it is positive news. “Your daughter is coming to visit next week!” Share the good news with the person with dementia as often as necessary to watch them smile.

The foundation of kindness you will build in your caregiving relationship will serve you both well as the disease of dementia progresses.

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