The Comforting Fictions of Dementia Care

Many nursing communities seek to comfort and ease residents with dementia by maintaining the illusion that they are in a familiar place, such as their childhood home, with props and simulations, reports the New Yorker . Such practices are endorsed by people like senior-care administrator Barry B. Zeltzer. "I believe that deep down, they know that it is better to lie," he wrote in the American Journal of Alzheimer's Disease & Other Dementias . "Once the caregiver masters the art of being a good liar and understands that the act of being dishonest is an ethical way of being, he or she can control the person's behaviors in a way that promotes security and peace of mind." Although loved ones and caregivers often lie, many of them are uncomfortable with it. To mitigate this "deception guilt," lying in dementia care has been assigned euphemisms such as "therapeutic fibbing," "brief reassurances," or "stepping into their reality." The earlier practice of reality orientation, in which people with dementia are constantly reminded of their actual situation, is losing adherents. However, ethical lying comes with its own complications, as noted by author Sissela Bok. "You need to be very careful," she advises. "What other kinds of harm might there be in lying? The most important effect is on yourself."