Jan 31, 2018

The Role of Confabulation and Rejection in Dementia Care

The stories that people with dementia confabulate can be funny, interesting, and sometimes ridiculous.

The Role of Rejection in Dementia Care | Alzheimer's Reading Room
By Rachael Wonderlin
Alzheimer's Reading Room

It is hard, for so many people, to just “go along” with what their loved one with dementia says.

Many caregivers struggle with the idea that they must embrace the reality of the person with dementia, so, instead, they reject it.

By saying things like, “Mom, that’s not true, your parents are dead,” or, “Dad, you aren’t going to work today, remember? You retired 15 years ago!” we reject a person’s story.
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Embracing that story —and enjoying it— are two incredibly important pieces to positive dementia care.

A few years ago I was caring for a woman in her own home. Marie was in her early 90s and had dementia. While she was able to recount the distant past quite well, her memory of the recent past was fuzzy —and sometimes altogether inaccurate.

“He visited me today,” Marie offered one morning, pointing at the television screen. I looked at the TV and saw President Obama giving a speech. “The President was here,” she explained happily.

Of course, this was just not true. The President had obviously not been to Marie’s house that morning, or ever, for that matter.

That was not the point, though. Even though I knew her story was not true in our reality, it was true to her. That is what mattered: it was true to Marie, and in her house, her reality was the one we lived in. Marie’s world was sometimes confusing, but it was always colorful. I like to think that she truly enjoyed each minute of it.

“Wow, that’s really interesting!” I smiled. “What did you guys talk about?” I asked, pushing the story forward. I wanted to know what happened.

“Oh, he loved the photos I have here on the wall. And you know what else? I told him that I didn’t like politics very much,” she went on. “He said, ‘Oh, I can understand why some people don’t like politics,’” Marie nodded.

“I bet it was great to see the President at your own house,” I said. “Was he nice?”

“Oh, yes! He also had very nice-looking hands,” she smiled. “He is very handsome in real life.”

I laughed when she told me about his hands. I still have no idea where Marie came up with this story, but I truly enjoyed listening to it.

The Importance of Nonverbal Communication in Dementia Care

The stories that people with dementia confabulate can be funny, interesting, and sometimes ridiculous.

If you can find a way to enjoy that crazy story, however, your caregiving experience can be made significantly richer.

*Confabulate - fabricate imaginary experiences as compensation for loss of memory. See the psychological definition at the bottom of this article.

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Persons living with dementia often get details mixed up and sometimes fabricate stories from fragmented memories. In Psychiatry there is a name for this mental process called "confabulation".

Confabulation is defined as: filling in memory gaps with a falsification that a person believes to be true. 

The person living with dementia believes without question, that this memory is complete and intact.  

Sometimes these "memories" are plausible explanations that sound reasonable; and at other times, they are absolutely preposterous.

Since the belief is absolute and sincere, it makes no difference that they are illogical, impractical, or even impossible.

Topic - When someone living with Alzheimer's believes something to be true

Rachael Wonderlin has a Master’s of Science in Gerontology from the University of North Carolina at Greensboro. She works as a Memory Care Program Coordinator and Manager at Clare Bridge of Burlington in Burlington, NC.

Rachael also writes on her own blog at Dementia By Day.