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Alzheimer's Disease

Being Honest with an Alzheimer's Patient

10/26/2007

Question:

My mother in law is 82 and about a stage 5 . My father in law could not look after her any more so we all decided to put her in a home. My question is should we be telling her the truth about what she thinks or just let her go on thinking what she`s thinking. An example (a few days ago she thought she was at The Legion and she wanted to go home because her son was home by himself (my husband now 40). And she was getting really upset. So my husband went up there to try and calm her down and she would not give in she was all over the place (in her mind) and at moments she didn't know him. She also thinks she`s at a hospital because she always said she never wanted to go in the home so no one has told her. Please help.

Answer:

It is common for patients with Alzheimer's to have abnormal thoughts such as delusions, which are fixed false beliefs, along with the fact that the Alzheimer's person's thoughts can be progressively more confused because their short term & long term memories are fading. Overall, I would recommend not telling your mother-in-law the truth when she has thoughts like she's in a hospital versus the nursing home. If she has a thought that is upsetting to her or frightening to her I would definitely try to reassure her emotionally and tell her everything is okay.

In her mind she may think of your husband (her son) as being a young man and can be fearful for him or feel she's being a bad parent, if she's not at home taking care of him. Obviously, it can be difficult to reassure her that her son is okay, especially when she doesn't always recognize him, but I would still try and tell her this and tune in to her emotional state and be very loving.

In a case where she doesn't recognize family, one could tell her that they have called home and checked on the child and he is okay (sometimes families will pretend or act out like they're making a call or leave a room and say they talked to someone, etc.). Sometimes changing the subject or taking the patient for a ride or a walk can be enough to redirect their focus and get their mind off the abnormal thought that might be upsetting them.

Sometimes delusions can be comforting to the patient and they are pleased with the thoughts (for example a person may think that their deceased parent is still alive and this can be comforting for them to believe this). Many families work too hard on trying to remind the patient of reality, but it is often kinder to enter the world the patient is in and hear their thoughts and the emotions connected to these thoughts. I tell families all the time that it can be okay to not tell the truth to your loved one, we call this "therapeutic fibbing or white lies."

If she believes she's at the American Legion having a good time, let her think that. There is not always a right response in every situation, but continue to understand that these behaviors are very common in Alzheimer's and other dementias and can be challenging. Good Luck.

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Response by:

Rebecca A Davis, RN, LISW Rebecca A Davis, RN, LISW
Clinical Research Nurse of Neurology
College of Medicine
The Ohio State University