Caring Currents

Talking About Sad Things With a Person Who Has Dementia

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How do you share bad news or bring up sad occasions with someone who has Alzheimer's or other forms of dementia?

Today, for example, is my mother's 82nd birthday -- the second she'll miss since her death in December 2007. And the one family member unlikely to note the date is her husband of 57 years. My dad's dementia is in the moderate zone now. He didn't remember her birthday or their anniversary last year; in fact, he didn't remember she had passed away by the second morning after it happened. (He's seemed to remember ever since that he's a widower  -- at least, we're pretty sure. He seldom talks about it.)

So should we mention this date to Dad? Some families might worry about upsetting the person with dementia unnecessarily. That's not my issue so much as realizing that he's not likely to register much response at all and therefore, why bother? On the other hand, if there were bad news about a loved one, such as a death, I wouldn't hesitate to share that with him, regardless of how we thought he might take it. My father may have moderate memory loss, but he still has memories and feelings. He still has a right to know what's happening with the people he loves, even if he may not retain this information. On a deep emotional level, I know he would want to know.

That's the challenge for every family about discussing sad things with people who have cognitive problems -- trying to sort out what's okay to talk about and how to approach it.

Here are some insights I've gathered on how to discuss sad events:

  • Don't censor yourself unnecessarily. It's almost always easier to be up front about things rather than try to conceal them. It's easy to underestimate the ability of people with dementia to be attuned to the moods of those around them, or their desire to be included.
  • Tell, but don't dwell. It's usually best to be candid about sad news but that doesn't mean you need to hammer it home again and again if the person with dementia becomes confused. You may reach a point where you just go along with their version of reality rather than correcting them every time.
  • Pick the person's "good time of day" (usually morning) to break news, not necessarily the minute you learn it.
  • Expect anything. Some people have extreme reactions but this is less common than people fear; melancholy or tears, on the other hand, are normal grief responses for anyone and can be cathartic. Others may immediately forget. Or there may be a delayed reaction.
  • Try reminiscing as a way to help process grief. It can be helpful for the person with dementia to talk about the deceased person, or look at old photos. (Hmm, maybe something to do with Dad while remarking on Mom's birthday.) This activity can make caregivers feel better too, though there's a slight downside: It's also potentially distressing for you if, while reminiscing, the person with dementia forgets the fact that the loved one is gone.
  • See more useful insights from experts.