Navigating Their Reality - Conversations With Dementia - August Newsletter
- Kate Helmore
- Aug 4
- 6 min read
I was recently listening to a conversation in which someone was sharing the difficulty of communicating with her mother-in-law who lives with dementia. She lives in an aged care facility and repeatedly expresses a wish to go home. She was also fixated on getting her hearing aids fixed, despite the family explaining repeatedly that they’ve already tried and had multiple appointments with the audiologist.
I’ve seen this situation play out endless times - loved ones gently trying to explain the truth to someone who simply cannot grasp it. The person living with dementia wants to see their Mum (who died 30 years earlier) or needs to get to the bus stop to get to work (when they retired 40 years ago). Sometimes people might try to lie to them to ease their worries. Other times you might choose to be honest, but this may only cause them to double down and escalate things.
So today I want to unpack a third option, which initially feels more complex but gets easier with time and has infinitely better outcomes.
For this reason, the theme I’ve chosen for August is
‘Navigating Their Reality - Conversations With Dementia’.
Here’s a quick scenario with the common truth vs. lie options.
Side note - please know I say this as someone who has tried out all of these options over the years, so no shame if you have too!
‘I can’t find my car keys anywhere! Have you seen them?’
OPTION 1 - TRUTH
‘Dad, you haven’t had a car in years. Remember we sold it to your neighbour?’
OPTION 2 - LIE
‘It’s at the mechanics. I’ll pick up the keys tomorrow and bring them back to you’
Both of these sound like reasonable things to respond, however they are likely to cause further issues. The truth scenario is at odd’s with Dad’s reality, so he is likely to double down and argue further.
The lie may buy you some time, but will likely lead to further questions and honestly doesn’t feel great.
It’s important to remember that whilst you or I know what they’re saying is untrue, it is their truth and their reality.
If I were to hand you a blue cup and tell you it’s red, you would likely argue with me because you know I’m wrong. In their world what they believe is very real, so it’s important to keep this in mind when we’re navigating these conversations.
SO, WHAT IS THE MAGICAL SOLUTION?!
Option three sounds complex to begin, but I promise the more practice you get the easier it flows and the better the outcomes are.
Option three involves five elements - recognise, acknowledge, redirect, ask questions and creative change.
(As a side note, but one that may resonate for some of you… it’s virtually the same model recommended for tantrums with young kids. You know the moments when you cut the toast the wrong way or the banana breaks in half and they’re having a total meltdown… same model applies).
RECOGNISE
The first thing we want to do is recognise what emotion or deeper message sits underneath the request. This might sound obscure at first, but gets easier with practice.
Often when someone with dementia is getting upset about a particular topic, there is an underlying unmet need (emotionally or physically). Whilst we can’t ever know the exact reason why, we can have a fairly educated guess about the potential meanings.
E.g. ‘I’ve lost my car keys!’ - loss of control and feeling stuck in one place.
‘I need to speak with my Mum’ - missing a loved one that’s no longer there.
‘I’m late for work’ - loss of purpose or meaning in day-to-day routine.
‘I need to go home’ - this place I’m in doesn’t feel like home.
‘I need to see the dentist/optometrist/audiologist’ - my teeth/eyes/ears aren’t working properly.
ACKNOWLEDGE
What you might say in each of these scenarios is:
‘I’ve lost my car keys!’
I can’t find your keys at the moment, but is there somewhere you wanted to go?
‘I need to speak with my Mum’
I miss my Mum when she’s not around. Is there something in particular you wanted to talk to her about?
‘I’m late for work’
I don’t think you’re working today. Do you enjoy going to work?
‘I need to go home’
We can’t get home right now, but is there something you need from there?
‘I need to see the dentist/optometrist/audiologist’
We can look into an appointment. Is something in particular bothering you?
REDIRECT
Now when redirecting you can link it to the exact scenario or it can be more generalised. For example with the car keys, you could offer to take them out for a drive which fulfils the need to get out & have a sense of freedom without directly addressing the car. Alternatively you can try redirect with more general tasks like:
‘Can you tell me more about your Mum while we make a cup of coffee?’
‘Let’s go outside for a walk in the sun while you tell me about work’
‘I could really use your help folding this washing. What kind of towels do you like the best?’
You’re aiming to slowly get their focus away from the immediate distress. If you were to change the topic to something completely different, there’s a chance they’ll feel invalidated and misunderstood. However, by keeping a loose link between their concern and reality you help ease them away from their worries.
ASK QUESTIONS
While you’re doing the task together, ask plenty of questions. Get curious about their car, their job, their Mum etc.
‘If you could have any car in the world, what would you have?’
‘If you could change career, what else do you think you could have done?’
‘What do you love most about your Mum?’
‘What’s your favourite thing about your home?’
Again, this helps make the individual feel heard and validated, whilst not trying to correct their reality.
After doing the four steps above your loved one should be starting to de-escalate. If they’re not, try coming at it from a few different angles, but keep trying to come back to the core of why they’re upset and validate that concern.
CREATIVE CHANGE
This final step is one to do post-conversation and involves trying to find a creative way to help fill that unmet need.
‘I’ve lost my car keys!’
You could have a set of keys that your loved one can have in their pocket, that doesn’t actually go to a car. This may give them a sense of freedom feeling like they could access a car if needed, without actually doing it.
**Note - this won’t necessarily work for everyone. I’ve had some clients that feel more distressed by the keys because then they can’t get to the car.
All these interventions are trial and error to see what works best for that individual.
‘I need to speak with my Mum’
You could set up a photo album or digital frame with old photos of their Mum and family.
‘I’m late for work’
Some aged care facilities will set up a fake bus stop so that residents can sit by the bus stop to ‘go to work’ each morning. Depending on what they did for work you could create a task similar to what they previously would’ve done e.g. sorting books if they used to be a librarian or setting the tables at mealtimes if they used to work in hospitality or a bank balance book where they can record various transactions.
‘I need to go home’
Try to bring home to them. If you or they can identify items that feel especially like home for them, you can bring them into the facility. This could be duvet covers, picture frames, paintings, recliner chairs, books or special cups & saucers.
‘I need to see the dentist/optometrist/audiologist’
Either you or the staff at the facility could do regular checks on their dentures/glasses/hearing aids to make sure they’re fitting and comfortable. If it’s a problem you know cannot be resolved, perhaps finding other meaningful activities will help draw their attention away from issue.
I don’t proclaim that these interventions will magically resolve any tricky conversations, but in my experience they help ease some of frustration from family and the individual living with dementia.
When one person believes a cup is blue and another is adamant the cup is red, nobody wins. Both parties walk away feeling frustrated. By trying to step back and understand the meaning behind their words, we have a better chance at everyone feel more validated and understood.
As always, please feel free to pass this newsletter on to friends or family. If they want to subscribe, they can do so via my website. If you have any questions about the info above, please reply to this email. I’d be happy to discuss!
You can listen to previous episodes of ‘The Truth About Ageing’ in your favourite podcast app (Apple Podcasts, Spotify) or you can stream it at
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Thank you again for being part of the Navigate gang.
Big love,
Kate.
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