Eventually he’ll come down the stairs and peer out every accessible window, checking to see if the rain has stopped so he can go out for a walk. I have to be on guard until it does.  His need to follow his daily routine is so strong that if the rain doesn’t stop he’ll convince himself it’s not that bad and head out anyway. Despite all the reports that people don’t get sick from being chilled and wet I worry that he’ll get pneumonia. He can’t afford another bout. It nearly killed him the last time.  We’re in for a long day.

I shouldn’t complain.  I have it easier than many caregivers. Dad can still walk and talk. He dresses himself and feeds himself.  And, although he needs to be reminded often and needs the aid of a shower seat and sturdy hand rails, he is able to take a shower on his own. I’m grateful for those things every day even as I prepare for the time when all that will change.

At 81 he’s frail and his list of aliments is long. The major ones are Parkinson’s disease, emphysema, heart trouble, hypertension, short term memory loss, the on-set of age related dementia and the one that has caused the most turmol, the paranoid schizophrenia that has defined his life since his diagnosis at the age of twenty –three.  The more minor ones, (the ones he likes to pretend don’t exist), include intermittent swallowing problems, chronic toenail infections, diminished hearing and poor eyesight.  And just to spice things up we have stubborn Italian disease to deal with.  It’s a mix of ailments that requires a team of doctors, a busy schedule of office visits and strict monitoring of his medication.

He’s seen regularly at the following clinics at the VA hospital in Martinsburg, W.V.: Primary care, cardiology, psychiatry, neurology, urology, geriatric care, podiatry, dentistry, and eye care. He is seen occasionally by the ear, nose and throat specialist, the respiratory therapist and the dermatologist. He is monitored by an in-home tele-health program that allows me to send readings of his blood pressure, weight, blood sugar level, and blood oxygen level to the hospital daily so his medications can be adjusted as needed without an added visit to the doctor.  As a 100% disabled veteran all his care is covered by the Veteran’s Administration. It’s a blessing we thank God for every day.

“It’s still raining,” he says, popping his head in the door to my office. “It don’t make sense. It rained yesterday.”

I don’t bother to tell him that yesterday it was bright and sunny. If in his mind, it rained yesterday, that’s his reality and I go with it. Otherwise, his agitation will continue to grow until it reaches the point where he will reject everything I say and become convinced I’m trying to trick him. From there it’s a short hop to full blown paranoia and the need for a sedative. Taking one leaves him so listless and out of it I try to avoid them as much as possible.

“Well, the flowers and the grass need rain. Rain is good sometimes, isn’t it?”

“Yes, rain is good for the flowers … good for the grass… I can’t go for a walk. It don’t make sense. It rained yesterday,” he whisperes, his shoulders slumping as he turns and heads for the door.

“Dad, it’s not time for your walk yet,” I call to him, easing my body between him and the front door. “You took a walk after breakfast, remember? We can go out this afternoon when sun comes out again.”

He pauses for a moment, his head tilted as he tries to decipher what I just said.   

“Yeah, I took a walk after breakfast. I remember now.” He attempts a smile and nods at me before slowly walking toward back toward the staris to his room.”

It doesn’t matter that the walk he took after breakfast occurred yesterday. At this moment, he remembers the warmth of the sun on his face and the pleasure of following a familiar routine. He’s content and his world makes sense. And for a while… until he comes back down and tries again … that’s enough for both of us.

While many health professionals agree that “therapeutic lying” is a reasonable approach to dealing with delusions and dementia others believe it to be unethical. They believe it is the duty of caregivers to orient the patient to actual time and place.

How do you feel about this issue and what methods have you found successful and/or inadequate in dealing with a confused loved one? Please post your comments on this site. They could be helpful to others.