Dementia reality—accepting their reality
When I talk with families or dementia caregivers about the need to recognize and accept the alterations to reality caused by dementia and Alzheimer’s, someone invariably expresses reluctance to be untruthful. Most of us find it difficult at first to go along with and support our loved ones’ confused beliefs about what has happened or is happening.
Are we being dishonest when we support the altered sense of reality that results with memory and rational thought losses? To tell a lie is to say something we know to be untrue with the deliberate intent to deceive. If we are in a situation with another person and we both comprehend what’s happening, we would be acting deceitfully if we then chose to mislead the other person. It would be especially egregious if we misled them with the intent to benefit ourselves at their expense.
Deciding whether and to what extent the truth is appropriate
When we go along with the increasingly altered sense of reality that dementia causes, we are, strictly speaking, being dishonest. With our healthy minds, we know what reality (the truth) is. They don’t, and can’t, because they have lost the very cognitive skills needed to keep them grounded in reality: memory and rational thought. And yet, in most social interactions, we decide whether and to what extent the truth is appropriate anyway. We take into account more than just the strict veracity of the statement: we consider the hearer’s cognitive development as well.
We respond to a six-year-old’s question about terrorism or where babies come from differently than we do to the same question from a twelve-year-old. We do this as a kindness—because a six-year-old is not able to understand and process information in the same way a preteen can. We would give a more detailed and truthful answer yet to a twenty-two-year-old, provided the twenty-two-year-old wasn’t living with developmental disabilities that had impeded his or her normal cognitive development.
It is kind to go along with altered realities in dementia and Alzheimer’s
When we go along with the confused reality of someone who has dementia, we are exercising kindness. When a wife cannot remember that her husband has died, is it kind to remind her repeatedly, so that she experiences fresh grief each time she asks and is told where he is? When she does not have the cognitive ability to retain the information, should we demand that she function as if she does?
When a wife cannot remember that her husband has died, is it kind to remind her repeatedly, so that she experiences fresh grief each time she asks and is told where he is?
We accept other disabilities: we don’t demand that someone who needs a hip replacement join us jogging, or expect someone who is blind to enjoy the art gallery with us. With the same kindness and respect for limitations, we should accept the disability people with dementia experience—loss of memory and rational thought, and the impaired sense of reality that results—and help them function despite their impairments. When we do so, we are extending our cultural practice of limiting or altering truth to meet a child’s cognitive limitations to those whose cognitive abilities are being ravaged by dementia, not being dishonest.
When we accommodate someone’s lost ability to perceive reality, we do so out of kindness and a desire to support their abilities while making allowances for their disabilities.
For more on the topic of altered realities, you might like our blog, “How should I respond when she doesn’t make sense?“
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FAQs about altered realities in dementia
What are altered realities in dementia or Alzheimer’s?
When people are experiencing dementia and/or Alzheimer’s, they lose not only memory skills but rational thinking skills as well. When people lose their memory skills, they may become unable to recall what has happened minutes ago, days ago, or even years ago, and so will inadvertently misinterpret and draw the wrong conclusions about what’s true and happening in the present. (And trying to jog the memory of someone who’s lost memory skills won’t work, just like pointing to something won’t help if someone’s lost vision skills.) However, because they are also losing their rational thinking skills, it doesn’t help to try to correct their inaccurate view of reality. Losing their rational thinking skills means they’ve lost the ability to compare their own version of reality with ours, and to analyze which view of reality is more likely, logical, or true. The result is that people who are experiencing dementia live in an altered reality and may believe that very illogical things are true, including dreams.
Is it dishonest to go along with altered realities in dementia or Alzheimer’s?
When we go along with the confused reality of someone who has dementia, we are exercising kindness. When a wife cannot remember that her husband has died, is it kind to remind her repeatedly, so that she experiences fresh grief each time she asks and is told where he is? When she does not have the cognitive ability to retain the information, should we demand that she function as if she does? I don’t think so. It would be kinder to say that he must be at work or out on an errand and then change the subject to a happier topic. When we do so, we are extending our cultural practice of limiting or altering truth to meet a child’s cognitive limitations to those whose cognitive abilities are being ravaged by dementia, not being dishonest.
