A common misbelief that someone with dementia can’t understand what’s going on around them is something that may only be partly true in the later stages of dementia. Many people in the early stages of dementia are fully able to understand their situation and what is going on around them. They are able to live successfully in the present with the appropriate support from loved ones and their care partners. Things may become more difficult to understand or to remember in the middle stages, but keep in mind that each stage affects a person differently so it is difficult to say exactly when the confusion or forgetfulness may present itself and how. Typically, in the later stage someone will experience major signs of confusion and a lack of awareness. When this happens it is not always possible to rationalize with the person or alert them of their current situation so it is important that we allow them to live in their reality as long as it is not causing harm or distress to themselves or the people around them.
Here are a few things to consider
It is okay to:
Think a loved one is still living - this might be difficult for the people who know the truth but for a person living with dementia thinking a loved one who has passed on is still alive may come and go. One day they may believe they are still alive and the next they may have no memories of the person. Telling them otherwise would only cause pain and confusion, let the moment pass and allow them to live in this reality for the time being.
Think they are at a different location - it is common for people with dementia to be confused about time and space, therefore if this occurs it is ok to allow them to live in their own reality. Reliving a childhood memory or relocating to a favourite diner may bring them peace and comfort- why wouldn't we want them to relive these moments?
Express habits of the past- we often see displays of behaviour that may represent an earlier time in their lives, it may seem strange at first, especially if you are unfamiliar with their life before dementia but this can be a positive display of behaviours. For example; if a person was a carpenter for a large part of their lives, they may display behaviours similar to a carpenter. They may find peace in “fixing” things around their home or surroundings. It is important to encourage this type of behaviour, let them know they are doing a great job or provide materials to help them get the “job” done in a safe manner.
Help redirect if:
They are causing harm to themselves- For example, for someone living with dementia shiny blue floor tiles may be misconceived as a body water or simply a wet surface. This may cause them to panic and feel as though they need to get to safety or higher grounds. They may climb on top of furniture to find a safer location, or this may cause them to become unsteady on their feet; but in reality, neither of these options are in the best interest of the individual so redirecting them to a safer state of mind is the best way to handle a situation like this.
They are causing harm to someone else - mistaking a person's identity is a common sign of forgetfulness or confusion and although this can be a positive experience for the person living with dementia it can also be experienced as a negative encounter as well. If they believe you are someone from their past who may have caused them harm they may display signs of aggression and violence towards you because their reality has them believing that you are not someone to be trusted. This isn’t safe for you or the individual living with dementia. It can cause you bodily harm and cause them emotional, mental and physical stress if the situation gets out of hand.
Mistaken location - if they believe they are somewhere unsafe or in harms way they may become panicked, confused and feel the need to escape their current situation. This can become dangerous, if not corrected. We want to remain calm, speak in a soft tone, and display positive body language in order to redirect the reality to a safer, more welcoming atmosphere.
When it comes to correcting someone with dementia it is important to evaluate the situation, show compassion, and ensure their safety is the number one goal. Correcting them when they are wrong will only cause more confusion and frustration for the person living with dementia so as long as their reality provides a safe state of mind there is no need to force them out of it. Take a minute to put yourself in a person who is living with dementia’s shoes. It is important to remember that people living with dementia are experiencing many changes in their brain that may cause them to have an altered reality. What may seem out of the realm of understanding to us may be very real to them so it is important that we support them and meet them where they are at.