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Talking with PWD

Hello! My Dad has Alzheimer's and is pretty far along. His MMSE scores have been getting noticeably lower every time and are now in the more severe range. However, there are some parts of his mind that still work pretty well. Dad hears perfectly, which helps most of the time (unless someone doesn't want him to hear!). I don't argue with him, and I don't reason with him, but I have trouble with the whole "fiblet" concept. When something is important enough to him, my dad doesn't forget it, even as bad as he is in so many other ways. He is also acutely aware of when someone is lying to him. It is like a seventh sense. I have found that it is better to approach him by trying to see things (even the crazy hallucinations) from his point of view. I also look for things that might be bothering him—pain, dirty clothing, physical needs, etc.—and then addressing those things. It has been really difficult, but I have built a relationship with my parents through all of this that allows them to trust me with their care. There are frustrations from time to time, but, overall, they know that they can count on me to be there and to help. I have found that my parents' emotional needs and responses to the emotions of others are still very much intact, so I put my focus there, which works well. Perhaps it will change some day, but I am hoping that I won't have to tell them an outright lie. Does that make sense?

Comments

  • M1
    M1 Member Posts: 6,788
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    What are you worried about lying about? Or is it just that you are wishing that your relationship doesn't have to change? Wishing that the disease won't change who he is?

  • trottingalong
    trottingalong Member Posts: 413
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    An “outright lie” can sometimes save the person from experiencing grief, or expectations or any number of things. It can also help avoid a violent outburst for example. There are so many instances when a lie, fiblet or any term you use, is beneficial to everyone when dealing with a disease of the brain. It’s coming to the realization that this progressive disease in the person you knew, makes that person change.

  • dancsfo
    dancsfo Member Posts: 297
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    edited April 5

    @Smilescountry Reading your post carefully, I see you are in quandary. I presume that telling a lie can lead to being "busted" (due to the uncanny ability to tell a lie) but telling the truth can cause problems — perhaps explosive anger, or a tremendous sadness.

    Perhaps you can say something non committal to avoid the above problems, and to preserve the trust. Can you get away with saying "maybe", "I don't know", when asked something?

    I think the ability to detect a lie so well is what distinguishes your Dad from other PWDs. If you give a non committal answer, will your Dad just forget about it, or do you think he will repeatedly ask until he is satisfied?

  • GothicGremlin
    GothicGremlin Member Posts: 857
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    @Smilescountry - I understand how you feel. It was kind of like that with my sister. All through her journey with dementia I validated her whenever I could, tried to see things from her point of view whenever I could - just like you. We always had a good trust relationship, and that never changed. But…..

    At a certain point, in my experience/opinion, you're going to reach a point some day where you're going to have give in to the fiblet. I wasn't super comfy with it either, but I had no choice. One of fiblets I felt terrible about - she had a cat and cats aren't allowed in memory care, so I had to find a home for it. I couldn't possibly tell my sister that I gave her much loved cat away, so I told her that her veterinarian was caring for her cat, until later ("later" was never defined). I told her vet my fiblet and the vet went along with it. End result - the cat was safe in a new home, and Peggy (my sister) believed that she still had her cat and that it was in good hands with her vet.

    I could have told Peggy the truth, which would definitely have caused a meltdown. She would have forgotten our conversation and would have asked me again, I would have told her the truth, another meltdown - forever. It would have been cruel to do that to her - so I gave her the fiblet.

    Maybe talk to your mom about it and explain why a fiblet may be necessary? You're not doing this out of malice or cruelty, you're doing it out of caring and love.

  • harshedbuzz
    harshedbuzz Member Posts: 4,475
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    @Smilescountry

    A couple of thoughts came to mind reading this.

    It is not unusual for PWD to recall information that has a strong emotional content. Dad couldn't recall what he'd had for breakfast or the state in which he was living, but he absolutely could remember vividly being told by his neurologist that he could no longer drive until about 2 months before he died. For context, he wasn't sure whether my sister was sick or had died, but driving? That stuck.

    Emotional intelligence remains well into the latest stages. This makes sense if you think of dementia in terms of regression. Very young infants can pick up on a parent's mood; so can PWD. Tam Cumming 7 stage model offers a developmental age equivalency for each stage for reference.

    It's likely you are telegraphing your discomfort with telling him a truth rather than a gentler explanation and he's reacting to that rather than the actual lie. You seem very invested in honesty which isn't always the kinder option. If you wish to be kinder, being proactive about anticipating explanations could make you better at it. Perhaps you've not had an emotionally charged situation as yet. My MIL, my friend's mom and my one aunt really leaned into ceding independence for giving up the responsibilities of adulting. Dad? Not so much.

    I came to dementia with the experience of raising a son with high functioning ASD. It's interesting how often the lessons and skills I took away from that served me in dementia caregiving. When my son was much younger and struggling, his psychologist admonished my permissive-style approach to parenting. He said there wasn't anything wrong with that approach for many kids, but that my son needed a more authoritative approach with clear expectations and structure built into our lives. I resented the ever-loving crap out of this— I didn't want to change my whole persona at home. I struggled with this mightily, but his psychologist, dev pedi and specialist teachers all said the same as I continued to do what was comfortable for me with predictable results. When I finally committed to it, the kid relaxed and blossomed.

    TL;DR. My son couldn't adapt at 6, so I had to. It wasn't about me. My dad couldn't either. In both situations it wasn't easy, and I dearly wish there was some other way, but it was what worked.

    I sincerely hope you can get through this without compromising, but I would keep kindness top of mind. If your parents no longer have the bandwidth to process upsetting information, it's better to wrap them in the protection of a gentler narrative.

    Stepping off my soapbox—HB

  • housefinch
    housefinch Member Posts: 396
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    @harshedbuzz captured better than anyone else what is so difficult about dementia. The person looks the same but suddenly has completely changed and your approach has to be the opposite of what you have been taught, sometimes by them, to do. We also have 2 children with autism and I couldn’t agree more with the description of the cognitive dissonance between my wishes for a parenting style and my children’s needs for a very specific type of household. It’s definitely a daily challenge, and one that has actually helped me see my PWD with new eyes. Hugs to you.

  • Hope5757
    Hope5757 Member Posts: 150
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    I don’t routinely lie/fib. It’s difficult for me and my MIL is with it enough to remember some of the lies. But recently I absolutely lied and it was the right thing to do and solved the problem. MIL got lost between a dream and reality and was yelling for her long deceased sister. She was positive Sis was in the kitchen. I was only able to convince MIL to go back to bed by lying to her - “let’s get you back in bed and I’ll go find Sis and bring her to you.”

    Other times, I routinely use non answers “is that right”. “I’m sorry you feel that way.” “it’s not fun to see/hear that, is it?” It’s amazing how many ways there are to answer someone without actually saying anything.

  • dancsfo
    dancsfo Member Posts: 297
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    That's a great help on how to say things without saying anything. I think that in many cases, the PWD isn't really asking for something specific, but just wants to converse. So it doesn't always matter what you say in response

  • Hope5757
    Hope5757 Member Posts: 150
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    1000% agree with you that most of the time, it’s an attempt to engage and be relevant.

    As @harshedbuzz has assured me often, these middle stages are often the most difficult.

    You sound like an amazing child who’s trying hard to help your parents. They’re very blessed to have you.

  • harshedbuzz
    harshedbuzz Member Posts: 4,475
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    @dancsfo

    My DS went through a phase when he was little where he had the vocabulary of a high schooler but zero in terms of the pragmatic use of language. He asked questions as a means to connect with others and get attention. I suspect dad did this as well.

    HB

  • Smilescountry
    Smilescountry Member Posts: 109
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    Thanks, everyone. I appreciate all the comments and points of view and apologize for taking so long to get back to them. I think that his professional background and his emotions are probably playing a big part in this. I am doing my best to do and say the kindest things for him. It is just that when he identifies a lie it makes him much more agitated, and because he probably gets so emotionally involved, he doesn't forget, which makes things less pleasant for everyone. I really do appreciate all the comments, though, and will keep them in mind.

  • ButterflyWings
    ButterflyWings Member Posts: 1,752
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    HB said:

    "I sincerely hope you can get through this without compromising, but I would keep kindness top of mind. If your parents no longer have the bandwidth to process upsetting information, it's better to wrap them in the protection of a gentler narrative."

    Beautifully put.

  • Smilescountry
    Smilescountry Member Posts: 109
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    I am not worried or wishing. I am just noticing that some things aren’t working for my dad so I am starting a conversation just to hear ideas.

  • Smilescountry
    Smilescountry Member Posts: 109
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    Yes, that makes sense, and I can see being there soon. I try seeing Dad’s reality from his point of view, which does, indeed help. I haven’t had to talk to him about his car, his license, or where he lives for quite a long time. Well over a year ago I took him to the license branch to renew his driver’s license. Of course, he didn’t pass, but he didn’t realize that. However, they gave him an ID that looks like a driver’s license. Mom and Dad decided together to sell their car to my son because he needed it more than they did. That took care of the car problem, and I keep Dad’s “license” for visits to doctore.

  • Smilescountry
    Smilescountry Member Posts: 109
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    Yes, vague answers sometimes help, but I have to be quick because he can sometimes see through those. I have learned that there are certain answers that calm him most, particularly those that make him think that he is helping others. I have noticed that he isn’t as easily distracted as other PWDs. However, we work hard at keeping everything positive for him because he can get very agitated when he tries to solve everyone’s problems!

  • Smilescountry
    Smilescountry Member Posts: 109
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    Yes, what you say is true. There have been lots of emotionally charged situations, and we have come through them pretty well. One good thing about my dad is that he has a strong desire to help others. We capitalize on that. I have found that he becomes the most agitated when he is physically uncomfortable (to put it mildly). He definitely doesn’t want to hear fiblets when he has a kidney stone, nor would I. I just have to get really good at figuring out what he is actually trying to communicate.

  • Smilescountry
    Smilescountry Member Posts: 109
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    I think that you did a very good thing with the cat, and I understand what you are saying. However, we are taking baby steps with Mom. My parents have been married for almost 71 years and went to school together and lived close to each other about nine years before that. They are a team, and they went as a team to assisted living. Mom is learning not to talk to dad about a few things and not to argue with him. But fiblets probably aren’t something that she can say .

  • Smilescountry
    Smilescountry Member Posts: 109
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    I was thinking the same about the emotional intelligence.

  • Smilescountry
    Smilescountry Member Posts: 109
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    Hello, Everyone!

    As I said before, I really appreciate all the comments, and they have caused me to think. However, I Googled my question awhile ago and came up with this link: https://teepasnow.com/blog/3-tips-to-help-you-avoid-therapeutic-lying-in-dementia-care/

    It was a perfect fit for what I am going through. I do have a dad who remembers what I tell him, even though just about everything else gets confused. This article and attached video answers just about every concern that I had. Perhaps it can help someone else, too.

  • concerned_sister
    concerned_sister Member Posts: 425
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    thanks for sharing that.

Commonly Used Abbreviations


DH = Dear Husband
DW= Dear Wife, Darling Wife
LO = Loved One
ES = Early Stage
EO = Early Onset
FTD = Frontotemporal Dementia
VD = Vascular Dementia
MC = Memory Care
AL = Assisted Living
POA = Power of Attorney
Read more