Choosing not to tell the truth to a person with dementia may be justified in situations where it supports their wellbeing but should “not be taken lightly”, according to a new report by a mental health charity.
The Mental Health Foundation found there were varying degrees of telling the truth that could at times be acceptable but found certain practices – such as the use of artificial spaces like a painted wall depicting the seaside with sound effects of waves, or a bus stop where buses will not come – should be avoided.
“The choice to use an untruth in dementia care should not be taken lightly”
Mental Health Foundation report
Similarly, rather than using objects such as dolls or robot seal toys as a form of therapy – as has been tested – having real animals and children around to spend time with would be more beneficial, it found.
The charity set up an inquiry in 2014 to look at what different versions of reality – such as when someone believes their home to be elsewhere – meant for people with dementia and whether “non-truth” telling by staff and relatives could be justified.
It found that different realities and beliefs experienced by people with dementia were not only symptoms of their condition but could be understood as way of using memory to make sense of a situation, as an expression of unmet physical, psychological, social or emotional needs, or as a coping strategy.
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In a report published today, it identified a spectrum of truth-telling – including whole truth-telling, distracting, and lying – and some underlying principles in providing interventions to support people with dementia.
A “key role” of any practitioner is to find out what the meaning is behind the different realities the person with dementia is experiencing, according to the principles.
“Lies may only be used in extreme circumstances to avoid physical or psychological harm”
Mental Health Foundation report
“This is a fundamental aspect of good quality care, and should not be considered a luxury agenda item, ’if there is time’,” said the report called What is Truth? An Inquiry about Truth and Lying in Dementia Care.
Practitioners must have an open mind when exploring this meaning and use what they know about the person’s life story, personality and values, it added.
Staff should always provide interventions as close to whole truth-telling as possible, and should only move away from that if it would cause unnecessary distress.
“Lies – as in blatant untruths initiated by a carer or practitioner – as opposed to meeting a person with dementia in their reality may only be used in extreme circumstances to avoid physical or psychological harm,” said the report.
In addition, artificial spaces should be avoided, because they are designed to deceive, it said.
Responses and interventions should be kept consistent across family carers or staff teams, and what does and does not work should be documented and shared, according to the principles.
However, the charity acknowledged there were a range of challenges in providing interventions along the spectrum of truth-telling, including how to maintain trusting relationships, time pressures on staff, and the possibility of having to provide fluctuating responses to match different realities.
“Staff often find it simpler to cope with experiences of different realities and beliefs in relation to their own emotional investment”
Mental Health Foundation
According to the panel of healthcare professionals, academics and people with dementia that helped lead the inquiry, family members may struggle with telling untruths as it can feel as if they are doing something wrong.
However, it noted that “paid staff often find it simpler to cope with experiences of different realities and beliefs in relation to their own emotional investment, which is bound to be less”.
“The choice to use an untruth in dementia care should not be taken lightly,” said the report.
“There is always a balancing act between wanting to try to stay as close to whole-truth telling as possible and ensuring one is not causing unnecessary distress,” it added. “It is important to view the concept of untruths within the wider context of person-centred communication.
“Using this perspective, untruths can be seen as strategic therapeutic interventions. Their use is sometimes compared to use of psychotropic drugs in this area; for example, they should be employed with caution and only in situations where other approaches have been trialled first,” it said.