One of the most common questions about how to interact with someone with dementia is this:
Is reality orientation the best way to get my person through a moment of distress?
Let’s examine this and what ramifications there might be with reality vs. ‘joining the journey’.
What is reality orientation?
- My mom keeps looking for her mom and dad, they have been gone for decades, I keep reminding her that they have died, and she keeps asking and gets severely agitated, even screaming at me and lashing out.
- My dad keeps asking for my mom but she passed last year. I remind him, because I don’t feel like lying is the right thing to do, but he gets so upset.
- My grandma keeps confusing me for her sister, and I try to remind her that I’m her granddaughter, but she looks so confused and tells me she doesn’t have grandchildren, she doesn’t even have kids yet…I don’t know what to say.
The heartbreak that we experience in these moments-especially considering we are the ones who know the truth, is very real. It is not fair or easy, but the onus is on us to come up with a way to protect our loved ones from this repeated heartbreak…since them hearing the reality isn’t going to jog a sad memory, it might feel like they are hearing the sad news for the very first time.
Each time we remind a person with cognitive impairment/memory loss that someone has died, or that they are thinking it’s the wrong day, or that they’re actually in a different state than they think they are, we are risking ripping off a proverbial band-aid, and in fact are risking making a person feel ‘like they are stupid’, or ‘like they are losing their minds’.
We need to explore for ourselves whether it is so important to be right that we are willing to compromise someone else feeling safe in their world. You might say, well isn’t that a little extreme? Not really. For a healthy brain, we are comforted by reality; by what we perceive to be the truth. But for someone who’s brain is compromised, who is missing pieces of their world, expecting them to embrace reality and to hold on to it is asking an awful lot. Especially since the reality they are experiencing is as real as real has ever felt.
Should we try to have a reasonable conversation with someone who has lost or is losing their ability to reason?
Please understand that we know it isn’t easy. This person may be the one who raised you, raised an entire family, led a corporation…the list of possibilities goes on. Dementia is unrelenting though, and it doesn’t care how smart our loved one is. Dementia’s cruelty doesn’t have boundaries. It’s on us then, to remind ourselves that as our person continues into their journey of dementia, we have to find a way to give them grace. They have lost the ability to be that version of themselves that we have come to know, love and trust. That person now lives in our hearts. We have become detectives. We are learning a new language that might continue to change. We do all of this at the same time as we work to meet the needs of the person we love.
Be kind to yourself. No one asked for this.