Is it always a good idea to not contradict a person with dementia?

Posted by bclane @bclane, Jan 26 10:29am

I recently saw a list of the three "golden rules of dementia care." They are:
1. Don’t ask direct questions.
2. Listen and learn from the person living with dementia.
3. Don’t contradict.
I have no objection to the second one, but I'm curious how others are handling the other two. I can see following all three when a person is in later stage dementia, but what about the early to mid-stages when there are times of clarity?

I guess I'm putting myself in their place, which may not be a good way to judge. But I would feel patronized if I said something that wasn't so and no one told me, then later I had a moment when I realized it wasn't so. Not to mention it's really hard for me not to correct something my husband says that's inaccurate and it's hard for me not to ask him if he remembers a particular thing, especially since sometimes he does. And when he doesn't, I explain it to him, and he seems okay with it. Other times something comes up and he doesn't know what I'm talking about. An example is that he can't remember who some of our neighbors are, and when their names are mentioned, he questions it. I explain who they are and where they live. He never seems offended or upset when I do.

I tend to talk to him as the adult he is and not as if he's a particularly slow child, which is what rules 1 and 3 make me think of. Now, as things progress, those rules might apply more. And I could see those rules being applicable if the person with dementia got really upset when asked if they remember something or if they're corrected. My husband doesn't get upset, so I know I'm lucky in that respect.

I'd love to hear how others are handling the early and mid-stages with this.

Interested in more discussions like this? Go to the Caregivers: Dementia Support Group.

My late mother-in-law developed early onset dementia when she was in her late 50's, but at the time, it wasn't a well known condition. As it got worse, my father-in-law was convinced that she just needed to be "reminded" when she forgot things. Unfortunately, in her mind, she was with her grandmother sitting on the front porch snapping beans. She was, in her mind sitting in church with her mother and grandmother singing hymns and praying. I also remember the look on her face when he sternly corrected her. SHE WAS SCARED. You could just see it on her face. Scared, confused, bewildered and MAD. She would get so mad at him and then she would be on the verge of tears. After a particularly bad episode, he called me and we went out to lunch, sat down and talked. He finally understood, that in her mind she was, at that particular time with her grandmother, or wherever. Her body was here, but her mind was there and when he corrected her - and not in a kind way - it scared her and confused her more than she was. He learned a new word that day - GENTLY. Gently agree with her and gently lead her to another thought, another place in the house; just let her have her moment and then GENTLY suggest another activity. He couldn't believe how differently she responded. This worked in our particular case and I like to think the word GENTLY added a little something to her life until she intimately passed away. Just my two cents.

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@robertwills

I have read about the "rules" online and have actually been chastised by family members when I said things that even didn't elicit a negative response from the patient!

What I found is best is look to the "real world" professionals who interact well with those with dementia patients, listen to others (including family who don't always get it right) but then make your own best judgments. I found that that worked very well.

I found that what I read online from authoritative sources proved to be mostly not applicable in my situation. For example, contradicting the patient. I did it and it was like contradicting anyone who is not correct in something. No problem at all, just like you found.

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@robertwills With my uncle, before contradicting him I’d ask myself whether it was helpful to him to do so. Most times putting him straight wasn’t helpful to him, and was just me making noise (and perhaps being bossy). So I didn’t do it. It served no benefit. He wouldn’t remember what he’d said or what I’d said.

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I have learned to not correct or contradict. Reminding folks with dementia of their short comings only aggravates and in some cases angers them. Just let it be. The conversation will most likely be forgotten.

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Best advice is treat your loved one with respect. Try to avoid any conversations that irritate. Sounds like you're already doing the right thing at the right time. You will adapt as the disease progresses. God bless you and your entire family.

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With both my father who had dementia, and a brother who had multiple traumatic brain injuries, I found the 'rules' to be a helpful starting point, especially for me, who can tend to want to 'make corrections' - :-), and to ask questions as a way of connecting (like "do you remember?") And the 'rules' made me ask myself - who was I doing it for ? - for the person who has the dementia or TBA (my father and brother)... or for me? The 'rules' just made me more aware, and to become more attuned to each of them, to take my cues from them, as well as using my own judgement, and of course the advice of professionals who were dealing with them. The changes we see in our loved ones are difficult (for us), and at least for me, having to fully acknowledge this, and to be aware of and modifying my own behavior to be more in tune with them was the challenge - a big one.

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Greetings!
I cared for my mother for 13 years with Alzheimers and I work at a nursing home with primarily dementia patients.
The main "rule" we follow is to Validate with Kindness. It's nearly impossible to make hard and fast rules since dementia changes day to day. We have to be careful with our tone of voice which is difficult with so much aggravation.
For example. My mother caught me off guard one day when she was in nursing home by asking "When can I go home?" She clearly did not remember that she had sold her house.
I simply said "I'll have to check with your doctor." This satisfied her. I did not have to say "you are never going home" or "don't you remember you sold your house?"

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@mimi1234

Greetings!
I cared for my mother for 13 years with Alzheimers and I work at a nursing home with primarily dementia patients.
The main "rule" we follow is to Validate with Kindness. It's nearly impossible to make hard and fast rules since dementia changes day to day. We have to be careful with our tone of voice which is difficult with so much aggravation.
For example. My mother caught me off guard one day when she was in nursing home by asking "When can I go home?" She clearly did not remember that she had sold her house.
I simply said "I'll have to check with your doctor." This satisfied her. I did not have to say "you are never going home" or "don't you remember you sold your house?"

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Kindness is the best option. Not easy to remember at the moment

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It’s sure isn’t easy. I never challenge my mom when she says where am I? Or get me out of this hellhole. It’s times like that when you have to breathe and remember it’s not their fault.

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I don't know what stage my husband has reached, but his decline is more and more noticeable. I'd say he started showing signs of impairment three or four years ago. He still functions quite well, drives to familiar places, helps around the house, and is generally mostly cheerful. He as an appointment with a neurologist tomorrow and I have no idea what to expect because hubs doesn't think there's anything wrong with him. If he's not happy, he threatens never to return to the neurologist. He's been diagnosed by our primary-care physician, so this is a follow up to that. The biggest problem I face at the moment is getting him to acknowledge what's happening. He's in denial, despite the many, many instances of his losses, and I hesitate to spell things out for him. Perhaps the neuro. will do that. Getting this out in the open would help me but I don't want to distress him. When he was not so obviously struggling, I could overlook things and wonder if I was exaggerating, but friends see what's going on, as does our doctor. I'm at a loss.

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@pamela78

I don't know what stage my husband has reached, but his decline is more and more noticeable. I'd say he started showing signs of impairment three or four years ago. He still functions quite well, drives to familiar places, helps around the house, and is generally mostly cheerful. He as an appointment with a neurologist tomorrow and I have no idea what to expect because hubs doesn't think there's anything wrong with him. If he's not happy, he threatens never to return to the neurologist. He's been diagnosed by our primary-care physician, so this is a follow up to that. The biggest problem I face at the moment is getting him to acknowledge what's happening. He's in denial, despite the many, many instances of his losses, and I hesitate to spell things out for him. Perhaps the neuro. will do that. Getting this out in the open would help me but I don't want to distress him. When he was not so obviously struggling, I could overlook things and wonder if I was exaggerating, but friends see what's going on, as does our doctor. I'm at a loss.

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Hope you get some answers at the neurologist. We are awaiting results of year 2 follow up testing. My husband is not in denial, he just doesn't realize he has issues.
Perhaps if the diagnosis comes from someone your husband trusts, maybe that will make a difference (not that he doesn't trust you, you are just too close to the situation).
Hugs to you.

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