Monday, June 30, 2014

Helping a parent with dementia

Two weeks ago, I presented a shiur on halachic issues involved in caring for a patient who is experiencing a level of dementia. Along the way, I cited responsa addressed to people who felt they could manage their parents' physical needs, but who were concerned that they would violate the mitzvot of honouring and revering their parents by losing their temper with them.

One of the attendees asked me: What if one's mother has advanced dementia, and she asks for her deceased husband? Clearly, one should not upset her by telling her the truth - but even if the falsehood is appropriate, isn't it still a violation of the mitzvot of honouring and/or revering one's parents?

I wasn't sure how to respond to this. I suspect that there would be no violation of kavod (honour), but one could contend that this violated mora, reverence, a category of behaviours which includes not sitting in a parent's place or contradicting him/her. So I put the question to a group of rabbis, and received an interesting response from a veteran chaplain.

The chaplain stated that in his work, they tell facility staff to practice "validation therapy". When a resident asks after a particular relative, or says something like, "I need to be here, my children are coming home from school soon," she is clearly interested in turning the conversation in a particular direction. This direction may be good for her, especially since her long-term memory will be far more reliable than her short-term memory. So others who are present should not shut down the conversation; rather, they should embrace it, expressing interest in the subject and so validating her interest in it, and helping her to continue the thread to the extent she can. Asking appropriate questions - questions which won't frustrate her in her dementia, presumably - is a positive way to go.

I hadn't thought of this at all, but once I heard it, it made so much sense! And, it solved the halachic problem.

1 comment:

  1. I heard a great answer from an elderly gentelman, now deceased, who was a real ohev es habriyos:
    Tell her that he's not here right now / went out for a little bit. Later she won't remember asking. And if you tell her the truth she might cry and be sad because she forgot he died. And every time she asks for him and is told the truth she will cry and be said again. This way she won't be sad.