When people with dementia experience a different reality

Sometimes people with dementia say things that suggest they have a different idea of ‘reality’ – or sense of what is really going on – from our own. A person might, for example, ask to see his wife (who is no longer alive) or tell us that he sees insects in his bedroom (that aren’t there).

When we build up this awareness of an individual’s ways of communicating, it helps us to find an effective response and also address the person’s needs.

This is partly because the person’s memory and ways of seeing things have been altered by dementia. Memory about current or recent events tends to become damaged, while memory about the past remains relatively intact – so the past can seem more real than the present to the person with dementia. A person might see things that aren’t there because they are experiencing a hallucination or are having difficulties making sense of what their eyes are seeing.

Why is this happening?

Some reasons why a person with dementia may have a ‘different reality’:

Truth and lies

It is important to recognise that the person’s beliefs about reality are usually just as real to them as our reality is to us. So it is often unhelpful to confront a person with the truth when they believe something different. Insisting on the truth can cause unnecessary distress – for example, if we remind a person that his wife, who he has been asking to see, is dead.

But problems can also be caused by lying. For example, if we raise the person’s expectations that his wife will be coming home soon, he will feel even more upset when she doesn’t arrive. Instead, it’s often better to respond sensitively to the person’s feelings.

Tuning into feelings

In fact, the person’s beliefs about what is real can give us some very important clues about their feelings and needs, and the kind of response that could help. So, if we avoid truth and lies and focus instead on feelings and needs, we can try to find out the reason why the person spoke about their different reality in the first place. For example, the person asking for his wife might be doing this because he feels lonely – in which case we can try to provide company and friendship. Or he might be feeling unwell and his wife used to look after him at such times.

Seeing things

When a person sees something that isn’t there, again we need to be aware that their feelings about this are real and important. If someone is frightened because he believes his bed is crawling with insects, he is likely to need us to be understanding and take his concerns seriously. Since we can’t see the insects, we’ll also need to find out from him where they are, and through this we may find out that he has a practical need. Perhaps he is experiencing a hallucination brought on by an infection and needs to see the doctor. Or maybe the pattern on his duvet cover is confusing to him and we need to change the bedding.

Responding to individuals

The better we know a person, the more we can build up knowledge of what they might need when they say a certain comment or question. We may know that when Doris talks about needing to collect her children from school, it’s usually because she’s feeling bored. If Arthur talks about his wife, it’s often because he’s missing her and would like to talk about her. And when Olga asks for her mother it’s most likely to mean that someone has upset her and she needs support.

Conclusion

When we build up this awareness of an individual’s ways of communicating, it not only helps us to find an effective response to a tricky question, it means we can also put plans in place to address the person’s needs.

For more on these ideas, look at the section on ‘Communicating well’.

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