We had this interesting question from a member that would make an interesting discussion for our members:
"I have been reading about white lies or truth [with a person who has dementia] I have difficulties sometime,usually sunset [sundown] symptoms, when my husband says he must get back to his regiment or he will be in strife.He gets very agitated when I tell him he is no longer in the army,he won't believe me.
I have tried telling him also a white lie,saying he is not due back yet till next week.Please let me know how to handle this as it occurs frequently and upsets both of us

Here is part of my response but it would be great to hear from other members who have faced this challenge.

People with dementia may recreate a past memory such as a job or role in society to meet an emotional need. This memory comes alive in their imagination and becomes the reality in which they live and interact. Telling the truth does not work in these situations due to our reality and their reality clashing. What you perceive as the truth does not match the perception of truth by the other person.

You may have been taught that it is okay to tell a small white lie to the person who can't remember. At first glance, white lies can seem like a simple solution to difficult and challenging situations. You may have even had a positive experience in stopping certain behaviour - at least for a while. While a white lie may stop the behaviour momentarily, the same behaviour almost always returns, sometimes even stronger and more persistently.

Unmet emotional needs are often behind these strange and unusual behaviours. Click here to read more in our members article, 5 Universal Emotional Needs. We also have an article specifically on white lies called Truth or Lies - The Great Reality Divide.

This is an extract of a report I wrote for a CPN doing a Clinical Leadership course - hope it helps

... you need to behave and talk accordingly. This requires you behave ethically. Ethics is the systematic study of moral choices. In the case of Alzheimer’s , whilst there are many moral choices, two dominate.

First, should you always tell the truth? Bear in mind that the Alzheimer’s patient can hold emotional memories for days, behave badly, be depressed and be frightened, whilst factual memories last for only minutes. Your patient will have no idea why they feel so awful and the information you gave them will have served no useful purpose - other than to relieve your conscience.

Second, should you always strive for the good of the patient even if that means lying? If you choose this path (I did) then you must do so openly and transparently. All the people around you must know. It must be entirely for the well-being of the patient and there must be nothing malicious in your intent. You should seek to have your approach properly supervised and audited. It must be seen as part of the necessary treatment - not some cheap ‘get out’ to avoid conflict with the patient or to make your life easy. This is the more difficult path but, with love, can be the most contented for both you and your patient.

With a horrible brain disease like Alzheimer’s , contentment is far more important than truth.

I hope this helps

Post edited by: Fellman, at: 11/10/2011 02:17

I am an RN, work night shift in an Aged care facility. This is a strategy that I have used repeatedly with 2 men with Alzheimers who were determined to leave the unit during the night. One thought he had a job to go to; the other wanted to go home.
Both would become agitated, entering other peoples rooms, banging doors, and could become aggressive if told the truth.

I tell them that the place is in "lock down" over night for security reasons and that none of us can get out till morning. I chat about the safety issues - nothing to alarm them - about looking after all the people and emphasise that I can't get out either. We are all in this together. They seem to relate to this and calm down. They stop seeing me as the enemy.
I always stress that Security will be back in the morning before breakfast to unlock the place. Then suggest hot drink, snack, spend time chatting to them etc, and they usually settle down and go back to their rooms - maybe not to sleep but they stop trying to leave. In the morning they no longer attempt to leave.
Not the truth, I know, but works well and they do not spend an anxious, agitated night. Also less need for sedating meds. Would welcome comments.

Maggie48
Sounds like you are doing a wonderful job.
Just make sure you are open, transparent and monitored by others.
There are those who don't understand the the unique and complex task of caring for people who live in their own world, not ours. They need to be happy in their world - not miserable in ours.