Deciding whether to tell someone who is cognitively impaired that their spouse has died is a serious and often recurring struggle. Dementia and death are sad and challenging enough on their own, but when they coincide, the result can be truly heartbreaking. For someone who has never experienced the challenges of caring for someone with dementia, decisions about telling the truth may seem like a no-brainer. However, as with many dementia-related quandaries, the question and answer are far more complex for those facing this reality.

There is no one-size-fits-all solution to this painful situation. In all my years of caring for seniors and interacting with other family caregivers, I’ve learned a great deal from my own experiences and others’ caregiving journeys. Keep in mind that the “right” approach depends on a few different factors and will often vary from day to day.

My Experience With Dementia and Grief

My struggle with this dilemma began when my father started receiving hospice care. At this point in my caregiving journey, both my parents had dementia and shared a room in a nursing home. For many years, they had lived in their own private rooms on the same floor, but the end was near for both of them. We felt they needed to be together during this time, and their money was nearly gone from the expense of two nursing home rooms.

At first, I did not want Mom to know that Dad was going on hospice care since I knew she’d immediately think “death.” This correlation is what most people focus on, even though hospice services are a blessing for ailing loved ones and their families. However, I knew this news would be traumatic for Mom, who was already suffering from a great deal of physical pain and the effects of dementia. I wanted to spare her even more anguish.

The hospice staff kindly but firmly rejected my plan. Their chaplain handled informing Mom of the change to Dad’s care plan, and she was included in the services they offered. Of course, they were right to do this. It was painful for everyone involved, but these wonderful people walked us through each step.

I continued to talk Mom through it daily, since she kept forgetting that Dad was on hospice. Eventually, though, it did not matter. She just couldn’t retain the information. Fortunately, she didn’t dwell on the connotation with death, and she loved the extra attention she and Dad received from the hospice care team.

Should You Tell a Person With Dementia That Their Spouse Has Died?

Upon his passing, I remember thinking, “Dad died, Mom has dementia. How in the world are we supposed to handle this?” Obviously, she had to know. It was only fair, and there was no avoiding it. I cleaned out his side of their room the following day, and Mom got a new roommate. Yet, every day she had to be told that Dad had died. In her mind, he was back in his private room down the hall where he had lived for so many years.

It was excruciating to have to tell her on a daily basis that her husband was dead. She experienced the same degree of shock and heartbreak over and over again. Eventually, though, she began asking me, “Is he really gone?” I would confirm the news and she would just shake her head and say, “I can’t believe it.” She passed away five months after Dad.

I believe a surviving spouse should be informed of the death at least once no matter what. Every person, with or without dementia, should have the opportunity to mourn the loss of their significant other. In some cases, the news will sink in over time, whether you realize it or not, and it can have a surprising effect.

For example, there was a man with late-stage Alzheimer’s disease who lived in my parents’ nursing home. His devoted wife visited daily until she died from cancer. The man attended his wife’s funeral, but he seemed, as always, totally unaffected by anything around him. Shortly after, for no particular reason, he died peacefully in his sleep.

In many cases, I believe that one spouse is waiting for the other to go first, so they no longer feel the need to look after them, even if, in all practicality, they haven’t been able to do so for years. It is their right to know that their life-long partner is gone.

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Memory Loss Complicates the Grieving Process

Another difficult decision arises when the surviving spouse cannot retain the news. Grief is natural and normal following the loss of a loved one, but dementia complicates this process. Whether you continue to remind a dementia patient that their significant other has passed away is entirely up to you.

Different approaches work better for different people, depending on their cognitive abilities. For a parent who is in the beginning stages of the disease, it will likely sink in that their spouse is gone. Moderate impairment is more of a gray area. Perhaps reminding them for a few weeks afterward is a good place to start. If the person reacts intensely to this news each time and it affects their mood, behavior and health over the long term, then it may be wise to reconsider this approach after a certain trial period. Remember, you can’t make a dementia patient remember something no matter how hard you try.

As many dementia caregivers come to learn, little white lies are often necessary to simplify life and calm anxious or agitated loved ones. Refraining from bringing up their spouse’s death isn’t going to harm anyone. The challenge comes when they notice the absence and ask where their late spouse is. For loved ones in the advanced stages of the disease, explaining that their significant other is busy running errands or doing something they enjoyed in life may satisfy their curiosity and avoid what is sure to be a prolonged, painful reaction. This approach may be necessary if they cycle through this process quickly and frequently. Dealing with the fallout of telling the truth on a weekly basis is far more reasonable than several times each day.

In the end, you know your loved one best and the choice is yours. I encourage caregivers to tell their family members the truth as much as possible. But if the loss of a spouse affects a dementia patient’s health and quality of life and hinders your ability to care for them, there should be no shame in trying everything you can to minimize their pain.