To tell the truth, the whole truth, and nothing but the truth…
This is a familiar oath that most of us live by, but when living with or working with someone with Alzheimer’s disease or other dementia, it is not always the best approach. As many of you well know, communicating with a person with dementia can be very difficult. As the disease progresses, their reality changes. They are no longer John Smith, husband of Mary, father of Suzie and Jim, retired from XYZ company for 18 years. They may become John Smith, son of Paul and Edna, just starting out at XYZ company. John Smith may wake up one day, 18 years after retiring, put on his dress clothes (or multiple layers of his dress clothes) and tell you he is headed off to work. For most, the immediate response is, “oh John, you aren’t going to work, you have been retired for 18 years”. For those of you who have tried this approach, the response is generally an agitated John arguing that that is ridiculous and he must get going or he will be late, and an exasperated you trying to keep him from heading out the door.
I’d like to suggest to you that when communicating with someone with dementia, it is ok to bend the truth a bit, in fact it is actually preferred. I call them fiblets, a term I learned from a trainer at a dementia care conference some years ago. Fiblets is defined on the internet as “an untold truth told to a person with dementia to make him feel better”. The object isn’t to lie for devious reasons; it is to bend the truth to fit in to the demented person’s reality. For example, in John Smith’s case, I might have said “oh John, today is Sunday, the office is closed to day. Let me get you a cup of coffee, you can relax with the paper”. I might even pull a Sunday paper from the recycle bin. Hopefully, as you get John some coffee, or a muffin, or the paper, or whatever, he will become distracted in that new task and forget that he was headed out the door. You have met your objective, that John not leave the house, and he is relaxed, and hopefully you are relaxed. A very different result than the first example.
Bending the truth, or telling fiblets, can be hard at first. I have heard from more than one spouse “I have never lied to my husband in 50 years”. Sadly though, dementia has changed your partner, or your parent, or your friend, and their brain no longer operates like it did, or like yours does. Trying to orient them back to reality with hard truths doesn’t work, their brains won’t allow it. Better, and easier in the long run, if you enter their reality and work from there. Give it a try and see for yourself how it works. Take a deep breath before responding to something your loved one says and think about the effect that your response may have. The objective is to keep them safe and keep them calm, not keep them in the here and now. You don’t want to engage in an argument. Consider where they “are” and go with it.
It may be hard at first, but I assure you, it really does work and it really is “OK”.
Christina Forbes, LGSW from the Daybreak Newsletter 7/2009