Truth and Lies in Alzheimer’s Care

When it comes to caring for patients with Alzheimer’s, is honesty the best policy?

Anne Stone used to know the difference between truth and lies; now she’s not so sure.

Ever since the assistant professor of communication began studying the interactions between the families of Alzheimer’s patients and the nursing professionals tasked with caring for them, the lines have started to become a little blurry.

“A few years ago when my grandmother was diagnosed with dementia, I became interested in looking at nurses working with Alzheimer's patients,” Stone says. “Nurses are the number one support for family members in these situations, and are relied upon to answer difficult questions.”

Stone was curious about how nurses handled these interactions, so she interviewed 32 nursing care providers at eight Alzheimer’s residential care facilities across the U.S. She asked study subjects open-ended questions about their communications with residents’ families, including dilemmas they had in communicating information about the patients addressing how to best provide emotional support, as well as their strategies for managing these challenges.

Honesty, Stone reported in her findings published in the Journal of Applied Communication Research, was often open to interpretation.

Nurses and care assistants, for example, described times when they felt confronted with the choice of either honestly depicting a discouraging situation or communicating a more encouraging and positive slant. “They didn’t call it lying,” she says. “In fact, it turns out the medical field calls it ‘therapeutic privilege.’ But the reality is that these nurses had to make hard choices every day and were often faced with burnout as a result of coping with the stress of these interactions.”

Furthermore, Stone discovered that the blurring of truths and lies often caused feelings of guilt and shame in the nurses she interviewed. “There is a lot of complexity regarding what it means to lie and how difficult it is to tell the truth. The struggle with the choice of being positive but dishonest, or candid but disheartening is a difficult one.”

As part of her research on this unique communication challenge, Stone uncovered several strategies used by nurses to help them deal with the challenges of communicating with patients' families, including developing a common set of care expectations.