How do you know what part was real from what is made up? -

How do you know what part was real from what is made up?


I recently started volunteering at an assisted living community. They matched me up with someone they felt needed some extra time for interaction and told me he/she had beginning stages of dementia. I have been trying to hold conversations with this person but they seem to be having a hard time following conversation and will tell me the same story 3 or 4 times all with different details. I understand this is part of the disease but I'm worried, I may end up upsetting this person. How do I talk with someone with dementia? The staff told me to talk about past events she would know well but the individual cannot seem to express anything without changing huge parts of the story.
The staff provided me with some tips but seem to be really preoccupied with their daily tasks. I want to keep volunteering but I dont want to harm anyone.
Where can I get some good information how to talk with people with dementia? I dont have much background on the person and cannot tell what really happened over what did not. Or is that even important at this point?

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I like that you are matched up with an individual, rather than visiting different people each time. You'll soon learn which topics are most productive. For example, I've learned not to ask my mom what she had for lunch. Food is very important to her and she enjoys eating, but 10 minutes later she can't remember if she ate, let alone what. And it distresses her a bit to realize that she can't remember. It is safer for me to say what I am making for dinner and ask if she likes those foods and maybe talk about what foods she liked to cook. But it took me a while to figure this out, and she wasn't damaged by all my awkward attempts -- I just eventually realized that talking about a recent meal wasn't the best approach. You will learn about your assigned elder, too, and figure out topics or activities that make your assigned person happy.

You are going to be just fine!
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Agree with Maggie; You're not going to do any damage unless you start correcting her or pointing out inconsistencies, and even then, she'd probably just blow you off. The great thing is that you can have the same conversation several times! Ask her what life was like when she was young; where is she from, what what school like. Does she remember the first time she voted? Where did she go on her honeymoon. Does she have a particuarly wonderful vacations she'd like to tell you about? What does she remember about the second world war?
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I think you're thinking too hard about this. Why would you worry about upsetting this person? Lighten up, my friend! Make small talk. Ask a lot of open-ended questions. Offer to paint her fingernails. Comb her hair. Ask what she did that morning. What she had to eat. Ask if she's made any friends....what the last entertainment program was...if she ever owned any many children she has. What you ASK hardly matters. What she ANSWERS hardly matters. She's making a human connection. You're "touching" her in ways you cannot know.

Angel's work, I tell you. ;)
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Glad to see you want to educate yourself !! A quote from: Ethelle Lord, DM - "I found something worse than receiving a diagnosis of Alzheimer's. It is not getting the workforce trained in time to care for persons living with Alzheimer's whether at home or in a care center." Ethelle Lord is President based in Maine

Learning about and accepting Confabulating and Confabulations has been
essential and not easy to accept.

In psychology, confabulation (verb: confabulate) is a memory
disturbance, defined as the production of fabricated, distorted or
misinterpreted memories about oneself or the world, without the
conscious intention to deceive.

Key factors in confabulations are there is no intent to deceive,
second the person being unaware that the information is blatantly
false. Confabulating is distinct from lying because there is no intent
to deceive, and the person being unaware that the information is
blatantly false. Carers challenge: is what they say true?
Confabulations become a far greater concern in the later stages,
because confabulations are much more likely to be acted upon.

It is difficult for everyone to accept a mind is damaged by
Alzheimer's Disease. Not only is memory damaged their ability to
process thoughts and conversations is impaired.

Confabulations are a major annoyance and can be dangerous- when we the
take everything in a discussion at face value. Confabulating is very
frequently observed in people with Alzheimer's.

We all Confabulate when we make..verbal statements and/or actions that
inaccurately describe history, background and present situations
unintentionally. We must be aware of information that is blatantly
false yet are coherent, internally consistent, and appear relatively

Understand the similarities between confabulation and delusions; e.g.,
both involve the production of unintentional false statements, both
are resistant to contradictory evidence.

Recognize Sunrise Syndrome delusions that are frequently observed in
Alzheimer's patients include beliefs about theft, the patient's house
not being his home, a spouse, is an impostor, belief an intruder is in
the house,abandonment, spousal infidelity, and paranoia.

It seems that Alzheimer's world is fraught with confabulation speak.
The general public doesn't understand Alzheimer's they certainly need
to be educated regarding Confabulation.

{Quoting Nature Reviews Neuroscience }

"Most patients with spontaneous confabulation eventually stop

"Confabulators may occasionally act upon their confabulation."
("Occasionally"? Later-stage Alzheimer's patients persistently and
repeatedly act upon the belief their childhood memories are relevant
to their present circumstances.)

"Confabulations are usually limited in time; they relate to the recent
past, the present, and the future."

{End Quoting Nature Reviews Neuroscience }

An aide/caregiver must understand the individual has Alzheimer's
Disease, be aware of the danger, and treat the person with patience.
Also, Confabulation is common. Conversing with someone who has
Alzheimer's is often like talking with your cat.

Acknowledge, respond, be affectionate, develop boundless patience.
Forget about rational responses. Show respect, your therapeutic
fictional responses are allowed. ~{quoting}DLMifm}

To cope with spontaneous confabulation, and ease the confusion,
frustration, and fear for the loved one, use resources such as:

Jennifer Ghent-Fuller's paper "Understanding the Dementia Experience"

Jolene Brackey's book, Creating Moments of Joy

By far, the most serious danger posed by Alzheimer's disease is when
the individual may decide they want to go for a walk, go searching for
"home," or maybe just walk outside to get the paper. In a restaurant
they may go to a rest-room. When they turn around, the place they
expect to see is gone. Their assurance they are Ok and can go on their
own ?. may be a example of confabulation.


Alzheimer Society of Canada, Toronto,
Ontario, M4R 1K8

Hallucinations and delusions are symptoms of Alzheimer's disease and
other dementias. With hallucinations or delusions, people do not
experience things as they really are.

Delusions are false beliefs. Even if you give evidence about something
to the person with dementia, she will not change her belief. For
example, a person with dementia may have a delusion in which she
believes someone else is living in her house when she actually lives
alone. Delusions can also be experienced in the form of paranoid
beliefs, or accusing others for things that have not happened. For
example, the person with dementia may misplace an item and blame
others for stealing it. Some people with dementia may have the
delusion that others are "out to get them." For example, he
may believe that his food is being poisoned.

Hallucinations are incorrect perceptions of objects or events
involving the senses. They seem real to the person experiencing them
but cannot be verified by anyone else. Hallucinations are a false
perception that can result in either positive or negative experiences.
Hallucinations experienced by people with dementia can involve any of
the senses, but are most often either visual (seeing something that
isn't really there) or auditory (hearing noises or voices that do not
actually exist). For example, a visual hallucination could be seeing
bugs crawling over the bed that aren't actually there. Of course,
people also make “visual mistakes,� mistaking a housecoat hanging
up for a person, for example, because they can’t see the object
clearly. This can happen to anyone, and is not considered a


Definition of Alzheimer's Sunrise Syndrome

Internet description: cognitive instability on arising from sleep.

Sunrise Syndrome,(sun?riz) a condition in which a person with
Alzheimer's wakes up rising in the morning and their mind is filled
with delusions which include include beliefs about theft, the
patient's house not being their home, a spouse is an impostor, belief
an intruder is in the house, abandonment, spousal and paranoia, people
eavesdropping. Sometimes the person may carry over content of a dream.

One observation is that Sunrise Syndrome is different from Sundowning
because the person may wake up in a confabulation mind set. During a
Sunrise Syndrome conversation with the content may filled with
confabulations; verbal statements and/or actions that inaccurately
describe history, background and present situations.

Sundowning in contrast displays as confusion, disorientation,
wandering, searching, escape behaviors, tapping or banging,
vocalization, combativeness; the demons of anxiety, anger, fear,
hallucinations and paranoia come out.

When I became a caregiver for my wife with Alzheimer's I had no
clue to the tasks ahead. I started to read and search the Internet for

Now retired I enjoy blogging and networking. I am an Aggregator to
Ishmael's Knowledge Network, I frequently collect content from various
Internet sources and consolidate it on Ish's Knowledge Network
Knowledge networking is a pastime / hobby. BTW I have no
commercial ties to the linked information.
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Dang! I wish we could edit! People with dementia are NOT usually so fragile that a comment is going to set them off or damage them.
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It doesn't matter what is real and what is made up. What matters is someone is paying attention and being kind. Don't argue and don't correct. Yes, you know that story couldn't have happened in that year. They war was over by then. But so what? There are probably some kernels of truth in there somewhere.

(If the story is that the staff is abusing this person, then the truth matters. Otherwise, not so much.)

It is kind of you to be so concerned about saying and doing the right things. People with dementia are usually so fragile that a comment is going to set them off or damage them. Relax a bit. :)

My mom has 4 daughters and she gets 7 or 8 visits every week plus once in a while some from her sons. I am always so sorry for the residents who get almost no visitors. I know that the staff tries to give them extra attention, but it is wonderful when there are volunteers to provide some interaction! Thank you!

A book you might enjoy is "Creating Moments of Joy" by Jolene Brackey. And here are some articles on this site that may be helpful:

What you are doing is valuable!
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Enjoy the stories, listen as if you are hearing them for the first time. This is your chance to hear a lot of History from someone who lived it. Start with the Great Depression, WWII, all the Presidents, music, dance styles, hair, clothing, makeup from long ago. Ask her what school was like when she was a kid.
Older memories are usually very well preserved.
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i was hangin with edna yesterday while she got her nails done . theres an old gal there named jo - jo . she was fed up with her roommate and was telling staff and anyone else who happened to be in the rec room / makeshift nail salon about it . the colorful language she was using had me cracking up . i love me a straight talker . by dam i think ive made a new friend there . jo - jo is extremely intelligent and studious , just dont piss her off . if your being a b*tch , shes going to call you a b*tch ..
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My mother did this for a year or so. She would rewrite stories. I usually just listened, since it wasn't important to correct the story. I would just suggest listening as if it were the first time you had heard the story. It doesn't matter if things make sense. It does go against that logical part of our minds that tries to reason if one version is true, then another version is not. Realities change with dementia and the brain fills in details that are forgotten. Many times the details are wrong, but as long as they aren't malicious, then it doesn't matter.

You're wonderful for volunteering at the community, clearasday. I hope that it is enriching your own life. The only advice I would give about talking to someone with dementia is not to argue with them or try to correct. Complex questions that require reasoning might confuse them. Many people like to talk about their pasts, so all you can really do is listen and tell them about your own experiences. It really isn't too hard to talk to someone with dementia, though it can be confusing to listen to them when things don't fit. When they seem not to fit, just think to yourself that it isn't important.
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my aunt is late dementia and in nh . we cant go outside much now because of the cold weather . shes pretty deaf so our conversation is even limited somewhat . she goes over her little aches and pains with me and i check out each complaint like a concerned doc might . im always as upbeat as possible with her and tell her her leg is looking better all the time or that nh is doing a great job and shes being well cared for -- anything that calms her and gives her hope . she lies like a rug on valium but i would never correct her . her thought process isnt right and facts elude her . facts arent important . only our time together and her peace of mind matter . take your care recipient a piece of resteraunt pie and share it with them . family style resteraunts will sell a piece of pie to go and it comes with plastic ware that includes a spoon , fork , and knife . the container is styrofoam and clam shell in design . rip the lid off and presto -- a pie dish for each of you .
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