As dementia progresses, people with dementia may well lose the sense of how old they are, or where they are in their own life story. It would be devastating for a person with dementia who believes their mother to still be alive to be repeatedly told that her mother has died. To force a person with dementia to experience that grief again and again would be cruel. If a person is missing their mother and wondering where she is, it is much kinder to provide a question or a comment that validates the person’s affection for her mother, i.e., “You sure do love your mother! Tell me more about her!” might do the trick. If the person is fixated on where her mom is at this moment, see if you can coax out a reasonable possibility, i.e. “What does your mom like to do?...Oh, she’s a gardener! It’s such a nice day, do you think she’s tending to her vegetables?...What does she plant?” Then divert the person’s attention further as you talk about vegetables, flowers, food or wherever the train of thought takes you both.
In the book, Talking to Alzheimer’s (an excellent, easy to read resource book that has served me well since I first got hold of it many years ago), Claudia J. Strauss discusses this issue and provides a great deal of clarity. She says there is no hard and fast rule about telling the truth to a person with dementia, but her advice is as follows:
“If you can’t give a truthful answer that is believable or acceptable at the cognitive level, then tell an emotional truth.”
How does one offer an emotional truth? By validating the emotion behind the person’s comment, question or request. And expressing interest in something related to the person’s fixation.
For example, if the person is distressed about their living situation and needing to get “back home,” one might reply, “Well, there’s no place like home, is there! What do you like best about home?” We often are afraid that if we encourage such conversation it could make the person more upset, but I have found the effect is quite the opposite. Human beings need and want to express the things that are on their mind. Persons with dementia are no exception.
If your loved one asks for something it is simply impossible to give them, i.e. “Take me home, right now!” you can say, “Oh, I wish I could, Mom.” Then take a pause. Breathe. Key into the person’s emotional state. Offer some empathy. “I know you miss your old place, and this one seems new and strange. What do you miss most about the old place?” Be brave! You just might learn something by their response to that question that gives you a clue about making them feel more at home in their new environment. Think less about “fixing” all of the person’s anxieties or complaints and more about validating them. “I can see why you feel that way,” “I’d feel that way too, if I were you!” and “I’m so sorry. I know this is hard” may all come in handy. I recommend practicing saying these things when you are alone, so that they may spring to your lips more readily when you are with your loved one!
When we are stuck in “I have to fix this for them right now” mode, we end up conveying our own anxiety, unhappiness and stress to the person with dementia in the form of an argument, or through a valiant but ultimately futile attempt at logic. What the person needs from us is quite the opposite. When we visit, they need us to slow down, and to be where they are. In their moment, accepting the emotions they are feeling right now.
See Talking to Alzheimer’s, by Claudia J. Strauss and Validation Techniques for Dementia Care by Vicki de Klerk-Rubin for more insight on this topic.
--Marysue Moses, Ebenezer Dimensions Program Coordinator