"Therapeutic fibs" and caring for parent with dementia

This is the third in an occasional six-part series on how to plan for and talk about our — or our parents' — aging. Today's topic is about communicating with someone who has dementia.

Caring for a demented parent, friend or spouse is unlike anything we've ever done. Nothing prepares us for it.

As Virginia Morris says in her book, "How to Care for Aging Parents": "If marriage and children test a person's flexibility and patience, then caring for a person with dementia is the final exam. Rarely is one asked to give so much only to receive so much aggravation and anguish in return." Comparing healthy brain tissue with that of someone who had Alzheimer's tells why: The healthy brain is plump; the one with Alzheimer's is shriveled — it's lost millions of brain cells. The longer someone has dementia, the more shriveled it becomes.

Little wonder that people with dementia lose their ability to reason — or to be reasonable. They can't fathom the hardships they cause others or the fact that they can't take care of themselves anymore. They look the same — you can't see dementia — but their reality has shifted into a different dimension, and they're never coming back. They may put their watch in the freezer, forget what to do when their bladder's full. Their world has turned incomprehensibly upside down, making yours upside down as well. Some become agitated and aggressive — biting, kicking and punching.

You can argue, plead or explain in lengthy detail why something is the way it is or isn't — but it won't matter. Being rational with someone who's lost his or her rationality is frustrating, exhausting — and futile. Instead, you come across as an enemy, trying to thwart what they know is right. And soon the anger escalates.

Which is why the rules for communicating with someone who's demented are exactly opposite how we deal with the rest of the world. Forget about reality and long explanations. Instead, you need to learn new responses. One of the most important is the art of telling "therapeutic fibs."

"With therapeutic lying," writes Sue Shellenbarger recently in the Wall Street Journal, "The caregiver briefly pretends the elder's illusions are true and tells a lie as a distraction." For example:

Your mother insists on seeing her sister. Instead of reminding her that her sister died 10 years ago, tell her she went to the store and will be back soon. Then suggest you go for a walk together until she returns.

If your dad demands to drive despite losing his license (which he won't remember, no matter how many times you tell him), have the car disabled and taken to the garage "to be fixed." Then say it's still being fixed as the months pass. Time is on your side — demented people can't tell how much time passes, so you can say something just happened that really took place months ago. And, as their dementia increases, their memory of what they're missing diminishes.

Another important behavior is to slow down — demented people need calm, deliberate body language from the people around them to stay calm themselves. Rapid movements are too stimulating.

Offer a minimum of choices — keep everything as simple as you can. Don't ask your mom what flavor ice cream she wants — or offer her four choices. Say, "Would you like chocolate ice cream after dinner?"

Learn how to distract and redirect. Your uncle gets agitated about going to work. If you tell him he's been retired 20 years, you'll have an argument. If you suggest instead that you both walk outside, then go to the corner and return home, he'll probably be OK.

My mother who had Alzheimer's was fascinated with airplanes. I learned that when she became upset over something, I could point to the sky and say, "Oh, look at that plane up there!" in an excited voice — and she'd focus on the plane rather than her pain. Sometimes clouds worked.

Try to stay positive. People with dementia look to us, the people who care about them, for clues about what's happening, and they're alert to the slightest frown. So put on your brightest face and sound positive when you talk, even enthusiastic.

Most important, recognize that not everyone makes a good caregiver, especially for someone who's demented. Some family members can't lie, no matter how benign the purpose, and the need to argue and explain is indelible. But there are other problems as well. I was too impatient, too "Type A," to be a good caregiver for my mom. I took events too literally, had trouble thinking up distractions quickly — although I found that practice improved my skill. Don't beat yourself up if it's a job you can't do and, instead, find or hire others to do it.

Don't forget the wealth of information, education and support that's available through your local Alzheimer's Association. The phone number for the chapter serving Western and Central Washington is 206-363-5500 or toll free at 800-848-7097 (or online at www.alzwa.org).

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist on aging and long-term care, she consults with individuals and teaches workshops on how to plan for one's aging — and aging parents. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/