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  • In dementia care, never ‘reality orient’ a loved one

    In all the years that I served as an administrator of a dedicated community for those with Alzheimer’s and other memory disorders, one of the many things that I became so proud of was becoming known as a resource for those families looking for answers. Many were the times that I’d be speaking with a family and it was clear that we were not going to be able to help them — their loved one required a higher level of care than my community was allowed to provide.

    In spite of that, I would end those conversations by saying to families, “Even if we’re not the answer for your loved one, if I can help you navigate through this process, I’ll be happy to do that with you.” They were very appreciative, and most of them welcomed my feedback and the information I provided them. I guess that’s why I enjoy writing these columns so much.

    A number of years ago, a distressed son came into my office to talk about a situation that had developed with his mother. She was in a local nursing home and, apparently, every time that he went to visit her (which was three to four times a week), she would ask where her daughter Arlene was.

    Arlene had passed away four years ago. It’s important to remember that one of the key “don’ts” in dementia care is you never want to “reality orient” your loved one. Their memory loss also means they forget important things like their parents or their soul mate of 50 years has passed away. So the question is, what does the gentleman tell his mother when she asked about Arlene?

    He gained nothing by telling her Arlene is gone, because you don’t want her to mourn the death of her daughter three or four times a week. Depending upon the depth of her dementia, she may remember she’s dead for five minutes to hours at a time, but why put her through that?

    The answer is what we call therapeutic fibbing, and I’ll get into greater detail about that in a future column. Here’s how I handled this particular question. I asked him if he was a man of faith and he answered that he was. Based on that, I told him the next time that mom asks where Arlene is, tell her that you haven’t seen her in a while, but one thing you do know is that she’s very happy. I went on to suggest to him that he tell her that she may come by and see her later today, but meanwhile, she has nothing to worry about because the one thing he’s sure of is that Arlene is very happy.

    In some dedicated communities, you may see a woman walking around holding onto a doll like it’s her child. Because her mind is confused, it will often take her back in time to a place where she had more clarity, meaning and purpose. What’s more meaningful than being a mother? Did the caregiver go up to her and say, “Martha, you’re 94 years old. If you had any children, they’d be in their 70s?”

    No, experienced caregivers would say something like, “What a beautiful baby you have, Martha. What a good mother you are. You’re taking such good care of her.” The result is that Martha walks off feeling very good about herself with a smile on her face. Remember, you can’t reason with someone who’s lost the ability to reason.

    If you have any questions, please email me at and I’ll answer them directly or in a future column. And remember, “Join the Journey.”

    Robert E.P. Elmer III, of Stonington, is a senior care adviser, lecturer and Alzheimer’s care specialist.

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