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How to Talk with Someone who has Dementia

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Updated November 06, 2005

How to Talk with Someone who has Dementia

Forcing someone with Alzheimer's or another form of dementia to face reality can be a frustrating experience. While it's difficult to see a family member lose touch with reality, arguing with them often makes things worse. A recent Wall Street Journal article by Sue Shellenberger suggested some alternative approaches that may ease the frustration.

Instead of constantly correcting the person, Shellenberger proposes three alternative approaches that are more empathic and less argumentative. She provides the following example:

For instance, if Mom insists that she and her long-dead friend Mavis are going out dancing, here are some possible responses:

  • Therapeutic lying: "Mavis won't be here until later, Mom. Let's go to the mall for a while and take a walk."
  • Aikido: "I can see you miss having outings with your friends. I share your frustration. The senior center is offering waltz lessons. Would you like to sign up?"
  • Validation Therapy: "You wish you could go out dancing again. I remember how beautifully you used to dance. What was it like to go out dancing with your friends? Isn't that how you met Dad?" (Shellenberger, 2004)

At first glance these approaches may seem counter-therapeutic. They all share a focus on validating the person while not trying to force them to face reality. Trying to reorient a person with dementia to reality can be exhausting to the caregiver and it is usually futile. Techniques such as temporarily entering their reality, or distracting them from their question succeed in avoiding confrontations, but there is sometimes a price.

"Therapeutic lying" is probably the most troublesome of the techniques. It can work in a pinch, but it can also destroy some trust. The person may remember the lie and the dishonesty can then undermine the relationship. "Aikido" and "validation therapy" are not quite as simple to use, but they are more honest on an emotional level.

As straightforward as these approaches sound, they are not easy to put into practice. My father is in the early stages of dementia, and I find myself correcting him and even arguing with him. If you find yourself doing the same, remember that there are other approaches. With time and practice they can take some of the stress out of the relationship.

Reference: Shellenberger, Sue "'Therapeutic Lying' and Other Ways To Handle Patients With Dementia" Wall Street Journal, November 11, 2004.

Last updated 11/5/05

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