Key Dimensions of Therapeutic Lies in Dementia Care: A New Taxonomy

Abstract

Background: Research suggests that the use of lies and deception is prevalent within dementia care settings, despite ongoing debates raised about the ethics of this approach. There has been increasing exploration of when and why deceptive practices should be used, but the lack of clarity as to what constitutes a lie has caused difficulty in ensuring that lies are used ethically. The aim of this study was to widen our understanding of the key dimensions that underpin the use of lies, and further to use this information to develop a taxonomy of lies within dementia care settings. Methods: A mixed methods approach was used for the study, which consisted of three phases: (1) obtaining examples of lies from experienced clinicians, (2) using expert advisors to standardise the examples, (3) asking independent participants to sort the examples into similarly themed groups. Hierarchical cluster analysis was used to produce clusters which led to the development of the taxonomy. Results: The results indicated that lies are mainly used in the best interests of people with dementia, often to reduce distress or manage difficult behaviour. From the developed taxonomy, there were two overarching clusters: the larger cluster was concerned with the welfare or activity of a family member/friend, and the second cluster was concerned with the welfare or activity of the person themselves. Conclusions: These results highlighted that in order to use lies appropriately it was important for caregivers to have a good understanding of the person with dementia and their life experiences. An awareness of the potential problems in using deception is key, and it is recommended that communication training should be employed to support carers in the use of therapeutic lying as a person-centred and beneficial approach. The study also shows that lies are often used to deal with the needs of PWD who are expressing concerns about the wellbeing of others. This notion of the importance of ‘other-directed’ needs in PWD is a new and relevant finding.