Why lying to people with dementia may not be in their best interests

Kate Irving, professor of clinical nursing at the School of Nursing in Dublin City University, and her colleagues carried out a study analysis of “therapeutic lying” in people with dementia.

Previous research indicates that therapeutic lying is practised by around 96pc of staff involved in the care of people with dementia, including not telling them their husband or wife is dead.

“Therapeutic lying is a term that is becoming popular among people who care for people with dementia. It is a lie that is told to avoid distress on the part of the person with dementia,” said Professor Irving whose analysis in “Aging and Mental Health” involved an examination of 37 published articles on the issue.

“I found that people with dementia often discover the lie even when it is told in their best interests – and that is disastrous.

“Also, we found that the term is growing in popularity. We are trying to stop this by re-orientating the carers not to think about a lie as therapeutic but to think about how they can best respect a person in their communication with them.

“Sometimes this might mean not being 100pc honest and sometimes it might mean lying. But more often it means being brave and letting people stay connected to their stories.”

At some point it could potentially become dehumanising and take from people’s identity and autonomy, the analysis suggests.

Prof Irving said: “There are benefits to not being 100pc honest sometimes. My point is it is never the lie that is therapeutic but the relationship that allows you to know what the person needs from you.

“Sometimes that is the truth – even if it is distressing. But sometimes the person just needs you to understand how they are feeling. We can’t fix everything but the relationship is the therapeutic part.

“But clearly if someone is very convinced they have just seen their mother – who you know died 20 years ago – it is often no use saying they are dead because all that will achieve is that they will think you are lying. Then they don’t trust you and you lose all the chance of being therapeutic.

“If you imagine yourself being lied to about your history, the present, the future – how does that feel?

“We all have sad things that have happened – I don’t want my sad memories sterilised away any more than I want my good ones.

“Also, if we placate someone with a lie, it doesn’t really solve anything.”

She gave the example of a person with dementia who wants to go home but is lied to and told they will do so later. It can avoid conflict but it can also force down their anxiety.

“But it does not really help the person. My experience tells me it often comes back later in a more extreme way.”

She said there needs to be better training for staff.

“We ask people to perform person-centred care, but we aren’t clear about what that is.

“The staff are also often very vulnerable – home care workers in particular have precarious work with zero-hour contracts. We ask vulnerable staff to work with vulnerable people and we have a recipe for poor care, yet the miracle is, it isn’t always poor care because people are good.

“They are trying to do their best, but these questions are very tricky and a lot of deliberation is required.

“We throw millions into other research, but we know very little about how to train staff and guide them in these difficult ethical matters.”