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

Posted by bclane @bclane, 4 days ago

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.

I used my judgment. It was good to be aware not to argue. I had a list of do's and don't that was more extensive, but no longer have it! I would avoid using any hard and fast rules but keep them in mind as the disease progresses.

My mother always wanted me to buy gin. I took her to stores that did not sell gin, pretending to try to help her get some. Eventually I just told her I would get it "tomorrow" but then she forgot.

Yielding works best but in early stages I think you are right to respect cognition and dignity that is still there. Trust yourself!

REPLY

This may not be the right place to ask this, but is there an expected timeline for dementia or is it completely open-ended? Usually when you're sick you're told it will take three weeks or six months or whatever to get better. Is there such a thing for dementia, particularly brain atrophy?

REPLY

There are many different types of dementia and the earliest signs include math difficulties are often overlooked. My guess is from the first time the average person notices until the end of life is approximately 10 years.

REPLY

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.

REPLY

Your post sounds like my life and I agree with the others. Use your best judgement in the moment. I have told “white lies” many times - so do what works best for you.

REPLY

Thank you to everyone who's responded so far. @robertwills, you mentioned being chastised by family members, and while I'm not sure I'd say I was chastised, I was cautioned by family members about saying "remember" to my husband when talking about something we did or something that happened a while back. It's an automatic thing with me to say that to anyone who was present when something happened, not just him, and it's a hard habit to break. They dealt with their mother having Alzheimer's, but for most of the time they had to deal with it, she was in a care center (after her husband who was her caregiver died). They visited frequently, but it's not the same as living with a person 24/7.

And I'm not even sure if I understand the caution about not asking direct questions. I just asked my husband if he wanted a piece of the cake I was getting for myself. That's a direct question and it requires him to make a choice, and it was an easy one for him (yes, obviously!). The few times I suspected he didn't know who I was, I've asked him that directly and he was able to say he didn't. And he didn't get upset when I explained who I was and that we'd been married over 30 years, although he was surprised by that.

I guess all a person can do is read the advice and apply only what works, as well as being able to adapt as the condition progresses. Which sounds like what a lot of us are doing anyway. I think I'm just feeling particularly bummed out the last few days because I haven't been getting enough sleep thanks to an old dog who is starting to have problems sleeping through the night. I have to take him out, and then it's hard to get back to sleep before my husband gets up (early, unfortunately).

REPLY

Some family members had trouble with white lies. Luckily they lived far away and weren't involved too much 🙂

I always felt grateful to be the one person my mother was not embarrassed with about memory lapses/loss. I would say "It's our secret," for instance when she had the wrong season clothes to go to storage.

REPLY
@bclane

Thank you to everyone who's responded so far. @robertwills, you mentioned being chastised by family members, and while I'm not sure I'd say I was chastised, I was cautioned by family members about saying "remember" to my husband when talking about something we did or something that happened a while back. It's an automatic thing with me to say that to anyone who was present when something happened, not just him, and it's a hard habit to break. They dealt with their mother having Alzheimer's, but for most of the time they had to deal with it, she was in a care center (after her husband who was her caregiver died). They visited frequently, but it's not the same as living with a person 24/7.

And I'm not even sure if I understand the caution about not asking direct questions. I just asked my husband if he wanted a piece of the cake I was getting for myself. That's a direct question and it requires him to make a choice, and it was an easy one for him (yes, obviously!). The few times I suspected he didn't know who I was, I've asked him that directly and he was able to say he didn't. And he didn't get upset when I explained who I was and that we'd been married over 30 years, although he was surprised by that.

I guess all a person can do is read the advice and apply only what works, as well as being able to adapt as the condition progresses. Which sounds like what a lot of us are doing anyway. I think I'm just feeling particularly bummed out the last few days because I haven't been getting enough sleep thanks to an old dog who is starting to have problems sleeping through the night. I have to take him out, and then it's hard to get back to sleep before my husband gets up (early, unfortunately).

Jump to this post

I will also add that I believe the medical science, diagnoses and the practicality of dealing of dementia is in general very far from being understood, say compared to heart disease or diabetes. I say this because I've seen diagnoses from medical doctors specializing in the subject get it so wrong. In some cases it can be, for example, medications or lack of the right ones, not totally dementia. That may or may not be discovered, even over time a long period of time. On the other hand sometimes they get it, or some of things, right. There are diagnostic tools that can confirm certain conditions, too. I always listen to medical doctors (MD's) first.

I know how incredibly difficult this can be. I'm fortunate we found a good memory care facility with caring and competent professionals. You sound like a winner. All the best to you. I have confirmed there's lots of good factual and practical information from others on this forum but you obviously shouldn't believe everything you read, particularly when it comes to medicine.

REPLY
@minniem

Your post sounds like my life and I agree with the others. Use your best judgement in the moment. I have told “white lies” many times - so do what works best for you.

Jump to this post

Ok -now we really are on a similar path because I do the same with our old dog. At one time both my husband and my dog were sick and they incontinet and I was cleaning up after both of them. I had to make a joke out of it.

I ask my husband his choices for dinner, dessert, etc. I am learning what questions work and which ones do not- but everyday is a new learning experience.

Hang in there and know you are not alone.

REPLY

My husband has moderate Alzheimer's and he's quite lucid. Most of the time, he's amenable to my suggestions and corrections. If he is resitant or gets pertrubed, I let it go, especially if it's not important.
If he's resitant to doing something that he really needs to do, like brushing his teeth, I tell him that if he doesn't brush his teeth, he'll get cavities and his teeth will fall out. Then he relents.
So, my best suggestion is to play it by ear. Alzheimer's and dementia manifest themselves so differently in different people. I think a good caregiver goes with whatever works, tries not to antagonize the person they're caring for, and uses white lies as necessary to achieve the desired goal, which is giving the best care possible.

Also, I use his loss of memory to my advantage. On occasion, my husband has taken an extreme dislike to one of my friends, but he does forget about it, and then is open to her company again. I sometimes think about what I need (company), too.

REPLY
Please sign in or register to post a reply.