Home' Australian Ageing Agenda : AAA Jan-Feb 2012 Contents she needs to get the dogs walked, as she
did throughout her teens.
Clearly the worker needs to respond
here with intelligent understanding and
great sensitivity to reduce Mary's anxiety
and avoid increasing her stress.
There are three options: to use 'reality
orientation', to use a 'validation approach'
or to tell an untruth.
Reality orientation means finding ways
to orientate people to reality. This can
be fraught with problems. The purpose
has to be to enable people to retain
control, as far as possible, to reduce
stress and facilitate their hold on reality,
if this is what is in their best interest.
Unfortunately, reality orientation is often
used where it has the opposite effect.
To remind Janet that her mother is
dead, that she is now in her eighties and
there are no dogs to be walked, would
certainly tell her about reality, but to what
purpose? If Janet says that her mother is
waiting for her, then for her, her mother
exists. To remind her of the truth is to
plummet her into grief. Janet would be
pulled into a world that reminds her of her
loss. Because of her memory loss she will
forget the told 'truth' but will be left with
the feeling of loss and anxiety that may
remain throughout the day. What has been
gained? Nothing but distress for Janet.
It is concerning that such practice
still occurs and, indeed, is sometimes
encouraged by practitioners who insist that
we must not 'collude with false reality'.
To tell someone with dementia
the truth, when it is going to cause
immense stress and grief, is cruel and
unacceptable. This is not to refute the
correct use of reality orientation with
people with dementia. It certainly has
a place, particularly in the early stages
when people are a little confused and
disorientated. People will often benefit
from gentle reminders.
This is a way of working that gives
validity to the person's perception of
reality. It respects their need to feel in
control and unthreatened. In essence, it's
a way of relating and communicating that
requires the person without dementia to
step into the reality of the person with
dementia, to walk in their shoes. The
technique requires us to listen to what
the person with dementia is saying and
to pick up on their concerns, needs,
feelings and reality.
To return to Janet: A way of validating
her reality would be to say, "wait while
I get my coat and I will walk down the
street with you". You are not taking her to
her mother; it is simply engaging with her
need to leave. It is a way of empathising
with her feelings of not 'being at home'
or 'wanting her mummy.' Often in such
instances, the walk outside will prove
distracting. The attention she receives
will hopefully counteract her feelings of
being alone and lost. Janet will forget
what triggered her need to 'go home' and
a suggestion that 'perhaps the kettle is
boiling by now', may be sufficient for her
Another option would be to engage
with Janet by talking about the dogs:
"What were they called?"; "How old were
the dogs?" etc. This may allow her to
feel that she is being taken seriously. If
her agitation is reduced, she may forget
the cause of it and then be diverted to
The person with dementia may well
perceive themselves as being much
younger. They may be at the stage when
they could reasonably expect their mother
to be around and their home still there.
It is worth acknowledging that people
with dementia use the terms 'mother '
and 'home' probably more than any other
emotive words. We convey our reality
through words. The worker must attend to
the implications of the words used.
TELL AN UNTRUTH
This option should be considered only
if it is the only way to avoid stressing
It is possible that a statement such
as, "The dogs have already been for
their walk today", might deal with the
problem. It might, on the other hand,
make Janet angry that someone had
done her job.
The problem with telling an untruth,
apart from the obvious ethical dilemma, is
that people with dementia will have times
of increased lucidity. They may remember
that you lied.
The debate here is no different from
the one that would pertain to the telling
of 'white lies' in our daily lives when we
may choose to tell an untruth if it would
save someone from unnecessary hurt
and anxiety. The decision however, is
not an easy one.
It is important to know that there
are no absolute answers. What might be
right in one situation with one person
may be wrong in another situation with a
Decisions about how to respond
should not be left to individual staff
members but should be discussed,
reviewed and embedded in good,
coherent and consistent practice. n
Diana Kerr is research fellow at the
Centre for Research on Families and
Relationships, University of Edinburgh;
and associate consultant at the Dementia
Centre, HammondCare. Colm Cunningham
is director at the Dementia Centre. Diana
will be speaking on night-time care at
the international conference, Risky Business
- Facing up to dementia, in Sydney, 27-29
June 2012. Details at:
Australian Ageing Agenda's regular
dementia supplement is compiled
by Colm Cunningham, director of
HammondCare's Dementia Centre.
For further information, email
go to: www.dementiacentre.com.au
"It is important that those
who support people with
dementia, understand the
way that their responses
and actions can exacerbate
feelings of fear, confusion,
anger and loss for the person
with dementia. "
AAA | JANUARY -- FEBRUARY 2012 | 49
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