How to talk to a dementia patient?

F. Frank LeFever flefever at ix.netcom.com
Thu May 15 21:43:03 EST 1997

In <3378f0ed.0 at news.dol.net> frank.logullo at dol.net (Frank Logullo)
>Father has multi infarct dementia and lives in nursing home.  He
>talks about buying a new car or house and I tell him that he is not
capable of 
>driving or living without constant observation and help.  I noticed
that other 
>visitors to nursing home essentially tell white lies to their parent
>others with dementia/alzheimers.  I'm curious as to what it is best to
>these poor folks.  Any comments?

Dementia can vary from person to person, not only in degree, but in the
exact form it takes--different combinations of deficits and residual
intact functions.

I'm always in favor of telling the truth unless there is a good reason
not to.  Making yourself feel more comfortable is not what I would
consider a good reason, so if it is simply a matter of your feeling
uncomfortable about a frank discussion of his plans to drive, I would
recommend some other way of dealing with your discomfort.

If there is any practical possibility of his doing what he says he is
capable of doing and which you coonsider dangerous or unwise, then this
has to be confronted before the possibility materializes.

If there is no practical possibility, there is no harm in letting him
talk this way, unless you feel that in some sense he is intact enough
to appreciate honesty, and to maintain a realistic sense of himself.  I
would in that case advise that you explore the extent to which he can
accept the truth without undue disturbance.

Sometimes we ALL of us need a "face saving" compromise: I have found
that I don't need to talk about (for example) impaired judgment if the
patient readily accepts the less-threatening idea that his vision or
his reflexes or his motor coordination might be a LITTLE below what  it
had been, so he should defer driving plans for a while.

Some patients might even be intact enough to realize more than that is
wrong with them, and accept this opportunity to agree gracefully.

Much, of course, depends on the patient's memory: no point discussing
long-term plans today if the discussion is forgotten by
tomorrow--unless it is with no practical intent, but simply to let them
feel they still have some autonomy.

Play it by ear.  

Frank LeFever
New York Neuropsychology Group

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