Hmmm...this is a sad scenario indeed. Can she be given something that will help her retain the information? In any case, it does not seem right to not tell her the truth. I'm curious to hear what ideas others have.
Mia...interesting that you pose this scenario as this is very much like what we dealt with with my grandfather after my grandmother passed away. Worse for me, I was named for my grandmother, so when he would ask for "Alicia"I would say, "Im right here". Even with end stage dementia he knew what I was doing and would ask for HIS Alicia. So because of my name, this task always fell to me. After a while, when he asked for her, I would "reorient" him to his mashed potatoes ("those potatoes look good, Grandpa!"), to the TV program, or whatever activity he was doing. Maybe not the most ethical, but it was also hard for me to always be the one to tell him. I miss you at work! Hope the new position is treating you well.
Sometimes reality is not kind. Why reapeatedly cause pain?
Short term reality becomes uncessary long term pain and distress for all involved.
Reality belongs to those who can HANDLE the truth. Just because something is true does not mean it has to be said. "Mrs. Hornton your son is dead" is like dying a thousand deaths.
If distraction does not work for our pts. redirect the conversation.
"Mrs. Horton, your son was unable to come today, let's go outside and feed the dogs while we talk about him...did your son ever have any dogs"?
Creative nursing without chemicals.
Dear Mia,
I always refer to the classics for this type of scenarios.
King Lear was granted madness by GOD to preserve him from the pain of living.
Personally, I would believe that dementia patients should be told the truth , but only the once if the disorder is degenerating and is obviously getting worse with time and cannot be cured.
If however the patient is of other types that respond so well to treatment and have reversible symptoms , then one would wait for a reasonable moment to tell her.
I feel very sorry for mrs. Horton. Is there any problem or disease to mrs. horton?
This scenario is very much like what was happening to my father when he was diagnosed with brain cancer. His short term memory was gone so every day he would say that he was going home and the doctors would remind him that he had cancer. I think when it finally sank in, he gave up. I wouldn't continually tell the patient that their loved one was dead. Why do that to them? Especially if their memory was so far gone.
Extremely interesting however unfortunately a very common scenario. I believe that ethically the truth should always be told in all instances. Mrs. Horton should be told the truth once, twice even possibly a third time and then the truth should be changed. Perhaps something on the order of "He's gone to see his grandmother" or perhaps his "father" might be enough to ease her mind. In her severely confused state I don't feel that she needs to be constantly reminded of the fact that her son has died and that she is all alone. But this is only my opinion. I did something similar with an aunt of mine who was in the last throes of Alzhiemers and I can only hope that I did the right thing. At least I know that after the second day when my story changed she was no longer in tears after she asked for her sister.
DS
My mother has demetia I,ve learned when she asks when my father is coming to see her( he's been deceased for 20 years) I just tell her soon. I think it's cruel for her to relive his death every time you tell her he's dead. Reality is not there and just as quick as she asks for him she forgets so I appease her with he'll be here soon. It works!!!!
This is similar to our situation. My mother-in-law is a middle stage dementia. One of her two sons died suddenly. We (her other son and myself) decided not to tell her that he died. Mostly because it is so hard to grieve and she did not have the mental capacity to handle anything so complex. Depending on the question asked, these are good responses.
X is in Kansas. (Truthfully, he is buried in Kansas.)
Y sends her love. (She fought a long battle with cancer and died before her mother with dementia.)
I have not seen Z for a while. (I never met Z.)
In our case, we did family centered care at home. Reality is nice, but we are not truthful all the time. You would not tell a coworker that their new haircut looks bad, or their scrubs make them look fat. Just because they have dementia do not make them face painful reality.
Sorry I am so belated in writing my response. Some ideas I've heard are to:
1. Focus on the patients feelings. You miss your son, don't you? Acknowledge the feelings behind the question.
2. Redirect her to telling stories about her son. This nostalgic recall may help her to feel a connection with her son again.
3. Have an altar or photos of her son to provide a visual reminder of the loss and a place to direct her attention when she is asking after him.
Thanks for your thoughtful responses to this scenario!
Those are all wonderful ideas. When I originally read your post I immediately thought of writing something on the whiteboard, chalk (or marker) it up to only having practiced in the med/surg setting as a student.
Linked, by the way. Love the questions!
I had a patient ask me every 4-5 mine utes about her husband, mother, etc (all dead). If we told her the truth she would cry and scream and get physical. If we distracted her, told her they were busy doing..... etc she would be calm for another few minutes. I believe for her sake and mine and the other patients, ethics also involve reasonableness. Ethics can be strained to the point of vanities.
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