Should we tell Dad he's sick?

A fellow caregiver asked...

Should a person with severe cognitive impairment be told about a cancer diagnosis? My father is in a nursing home after suffering a serious traumatic brain injury. He was recently diagnosed with a lung tumor which may have already metastasized. Due to his frail health, surgery or chemo are not feasible options. We have thus enrolled him in hospice. How much should we tell him about his current medical situation and end-of-life issues he is facing?

Expert Answer

A social worker and geriatric consultant who specializes in dementia care, Joyce Simard is based in Land O' Lakes, Florida, and in Prague. She is a well-known speaker and has written two books, one focusing on end-of-life care and the other, entitled The Magic Tape Recorder, explaining aging, memory loss, and how children can be helpers to their elders.

The answer to your question is how much do you think he understands. For Alzheimer's patients with severe cognitive impairment in a hospice program we would just reassure him that he is loved and cared for. We would also be sure that he is not in pain. It is a bit more challenging to do a pain assessment on someone who has difficulty communicating, however most hospice programs are quite skilled at this; some nursing facilities are not. The PAINAD scale is available on the Internet if you are interested.
Continue to provide pleasurable sensory activities such as massaging his hands, arms and legs, and offering sweets if he has no problems swallowing.