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The Royal College of Psychiatrists Improving the lives of people with mental illness

Lying to people with dementia: treacherous act or beneficial therapy?

Tony McElveen, ST5 Old Age Psychiatry, NHS Greater Glasgow and Clyde anthony.mcelveen@ggc.scot.nhs.uk

‘For what a tangled web we weave when first we practice to deceive.’
from Marmion by Sir Walter Scott.

Introduction
We may like to convince ourselves otherwise, but lies and deception are commonplace in
‘caring’  for  people  with  dementia.1   This  moral  dilemma  is  an  area  of  considerable difficulty for many clinicians and caregivers. It needs to be addressed and brought out into the open for a frank and ‘honest’ examination. It is clear that a culture of lies and deception is rife in many residential and nursing home settings and in NHS older people’s mental  health  wards.  Members  of  the  public  may  be  surprised  that  this  culture  of deception and lies is essentially unregulated in relation to people with dementia.  Little or no guidance or training is given to staff in relation to the acceptability and use of therapeutic lies or other techniques to deceive vulnerable adults. There is the potential for abuse of vulnerable people which could start out as a therapeutic lie, but there is also the case that it may alleviate distress and hurt for a person with dementia.

Before we plunge deeper into this quagmire, let me first make clear what we are considering to be a therapeutic lie. Some may think this is obvious and requires little clarification. However, there is much debate and disagreement around the definition of lies, deception and withholding the truth. We have probably all lied at some point in our lives and may justify it as a little white lie, bending the truth or being economical with the truth. Cunningham2 has shown that professionals often use euphemisms for lying such as ‘bending the truth’ to ease their conscience and rationalise their actions. For the purposes of our discussion we shall consider any lie or deception to be grouped together. The term ‘therapeutic lie’ is a false statement or deception with the best interests of the patient at heart. Backhurst3 stated that ‘all of these concepts are morally equivalent as they infringe a person's right to autonomy’.

This essay intends to explore some of the situations which may arise in caring for a person with dementia where a lie or deception is used in the person's best interests as deemed by the caregiver. The clinical and ethical arguments for and against therapeutic lies, as presented from a review of the literature, are then examined. It should be noted that patients who are assessed not to have mental capacity to make decisions related to the situations in question are those to whom we are referring in this discourse and who are referred to in the literature reviewed generally. This will be primarily patients with relatively advanced dementia. There is no suggestion that lies in any form are acceptable practice for a clinician to use in dealing with a person who has capacity to make a decision about the issue in question. The issue of determining capacity can however be extremely complex in some cases.

Literature Search

The following resources were searched as part of the literature review on therapeutic lies in dementia  care: CINAHL,  Psychology  & Behavioral  Sciences  Collection,  PsycInfo, Medline, Embase, Cochrane Library, ProQuest, NICE, SIGN. The search terms dementia, Alzheimer’s disease, senile dementia, vascular dementia, semantic dementia, dementia with Lewy bodies, and dementia complex, were used. The search terms were combined using  the  Boolean  term  ‘or’.  Another  search  included  the  terms,  lies,  lie,  lying, therapeutic  lies,  deception,  faking,  fraud,  cheating,  malingering,  and  untruths.  Again these terms were combined using the Boolean term ‘or’.

The search results were combined using the Boolean term ‘and’. Only English language articles were included and a time period of 1994 to 2014 was set.

The 335 articles were then reviewed by hand to remove those where the search terms were only subtext and not the subject of the main article. Articles out-with the time period set which frequently were referenced in the review articles were then sought and examined. Thirty-eight articles were then fully reviewed. The search found the articles to be mainly expert and non-expert  opinion  and some qualitative studies. This was not meant to be an exhaustive critique of all literature on this subject. The aim was to assess what   has   been   examined   and   commented   upon   within   the   last   two   decades.

Clinical scenarios: ethics and concerns

Picture, if you will, a demented widow frantically hammering on the locked ward door trying to go to meet her husband Charles, believing that he will be worried about her. She has been informed that Charles is dead on many occasions and this has caused her severe distress and upset. A nursing assistant tells her 'Charles is at the shop and will be here soon. Let's get a cup of tea just now while we're waiting'.

Or imagine an elderly man with moderately advanced Alzheimer's type dementia asking his wife if she has seen the car keys. She has hidden them as she knows he is a danger to himself and others on the road. The doctor and DVLA have informed him he is not safe to drive. She now tells him she hasn't seen them because he became angry and slapped her for the first time in their 58 year marriage when she previously told him he was unsafe to drive.

Anyone who has experience of working with people with dementia will recognise these scenarios and the hundreds of variations of them which are a challenging reality for caregivers across the country. If we take the view that lying is prima facie wrong, then justification is required to support the use of therapeutic lies in the scenarios above and in similar situations. The arguments in support of therapeutic lies are that they can prevent distress  and  agitation,  can  prevent  harm  and  keep  individuals  safe,  and  may indeed enhance the overall well-being of the person with dementia. This may arise from being spared hurt, shock and sadness from a truth which adds nothing but emotional pain and confusion. The patient's self respect and dignity may also in part be protected. There can also be a beneficial effect to carers, helping them to cope with challenging behaviour.  An approach to care involving the use of therapeutic lies may potentially maintain the person with dementia in their home and maximise their quality of life, commonly a goal for patients, carers and society alike.

Beneficence, actions performed for the benefit of others, is thus a key ethical principle and the common justification invoked in the use of therapeutic lies is that it is in the 'best interests' of the person being lied to. Closely linked with beneficence in this debate is paternalism, where the person who overrides justifies the action (namely the lie) by the goal of benefiting or avoiding harm to the person whose preferences are overridden.4   It is paramount therefore that the lie is being used in the best interests of the person with dementia and that it is not becoming a form of social control and a technique purely to make the life of the caregiver easier without clear benefit for the person who is being lied to.5, 6

Understandably some hold the view that any form of lying to patients with dementia who lack the relevant capacity is an abuse of that person and a path which exposes the person with  dementia  to  be  seen  as  a  non-person.  Their person-hood  and  human  dignity  is disrespected and demeaned9-11.    Kitwood10,11  commented on a 'malignant social psychology' which can arise from the practice of lying leading to the erosion of person- hood for the person with dementia. Kitwood discusses the ethics related to interacting with  dementia  sufferers  and  describes  a  variety  of  different  interactions  such  as infantilisation    and disempowerment which    can    result    in    loss    of personhood. Jones12 points out that with the erosion of person-hood there is the possibility that people with  dementia  may no  longer  be given  the consideration  and  dignity  given  to other humans. As a consequence, significant neglect and ill-treatment become more likely.

Proponents of therapeutic lies may state that dementia slowly diminishes the mental capacities    required    to    differentiate    between    what    is    truth    and    falsehood. Schermer9 comments that ‘once patients reach a state in which concepts such as true and false, reality and illusion, or fact and fantasy do not mean anything to them anymore it becomes logically impossible to deceive them or to lie to them’. He likens it to lying to a baby or a comatose person. The issue of delineating when the capacity to be lied to is lost is no easy matter. However, this argument does negate the autonomy principle trumping all others if, as Jones12  states, the person ‘is incapable of making a valid choice and that the duty of care suggests deception as a reasonable means of relieving suffering in the least restrictive way.’

The moral arguments that lying is wrong, invariably lead to reference to Kantian moral philosophy. Immanuel Kant, the German philosopher19, viewed lying, alongside coercion, as the root of evil and fundamentally wrong. Lying violates the autonomy of the person being lied to. If you make choices based on the facts or information you have available to you and it is false, then your autonomy and ability to self determine is eroded. In our society, and in particular in the field of medical practice, respect for autonomy is a pillar of good ethical behaviour.  Schermer9  argues that once we come to know a painful truth, we can start dealing with it – mourning it, accepting it, struggling with it, ‘giving it a place in our lives’.  For the person with advanced dementia a painful truth, such as the fact that their spouse has died, is new every time and hence ‘they cannot even start to 'deal  with  it'  since  they  do  not  remember’.  This  suggests  that  those  with  advanced dementia are not able to utilize, and so are not affected by, new information in terms of their future plans or goals. In turn Schermer, like Jones, highlights the view that the autonomy debate loses some of its relevance against therapeutic lying in moderate to advanced dementia.

Lies in practice

Treolar13-14   examined the use of covert  medication;  at the time of the study 79% of patients in long stay care settings for older people had medication administered via deception. This study highlights the lack of transparency and inadequate documentation around this practice13-17. This situation is arguably a breach of a person's human rights and Treolar recommends that capacity is assessed, and if absent, that a transparent procedure and locally agreed policy is followed, including discussion with all relevant parties. This view is echoed by James1 in a 12 item guideline for use when considering therapeutic lies (Table 1).

Table 1:  Guidelines  on therapeutic lies (James et al, 2006)

1) Lies should only be told if they are in the best interests of the resident, e.g. to ease distress.

2) Specific areas, such as covert medication and aggressive behaviour, require individualised policies that are documented in the care plan.

3) A clear definition of what constitutes a lie should be agreed within each setting.

4) Mental capacity assessments should be performed on each patient prior to use of therapeutic lies.

5) Communication with family should be required and family consent gained if a lie is to be told to the patient.

6) Once a lie has been agreed it must be used consistently across people and settings.

7) All lies told should be documented to ensure lies are being told in patients' best interests.

8) An individualised approach  should  be adopted  towards  each  case  – the  relative  costs  and benefits established relating to the lie.

9) Staff should feel supported by their manager and the patient’s family. They should not feel at risk  of  being  accused  of  misconduct  by  telling  lies  if  they  have  been  agreed  using  these guidelines.

10) Circumstances in which lies should not be told need to be outlined and documented.

11) The act of telling lies should not lead to staff disrespecting the patient. The lies should be seen as a strategy to enhance the patient’s well being, rather than an infringement of their basic rights.

12) Staff should receive training and supervision on the potential problems of lying, and taught alternative strategies to use when lies are not appropriate.

In a study by Culley18, old age psychiatrists' views on the use of these guidelines and their views on therapeutic lies were surveyed. Point 5 (Table 1) was widely considered unhelpful in terms of the family needing to consent to the use of a therapeutic lie. Whilst it would be good practice to consult and involve all relevant stakeholders it is not a legal requirement that family members with no powers as legal proxy consent to lying to a patient, or that they have a veto over such a decision.

Interestingly, there was a marked discrepancy between the psychiatrists’ views on key issues. When asked if they had ever lied to a patient who lacked capacity when judged to be in the patient's best interests, 69% answered yes. Moreover, when asked if they had sanctioned the use of lies by carers when judged to be in the patient's best interests, 66% answered yes. Yet when asked if lying to a person with dementia could be therapeutic, 65% disagreed. The majority of respondents also stated that the guidelines from James et al1,18 would be unhelpful to carers.    They stated the guidance would not improve communication, and would not make therapeutic lies ethical practice.

One approach advocated by several papers in this literature review is validation therapy. Proponents of validation methods would state they do not believe that any form of lying can be therapeutic20.  The rudiments of this approach are that one would acknowledge the dementing person's reality in order to enter their world with empathy. ‘The validation worker does not agree that the 90 year old woman's mother is alive and say, 'She will be here soon'. The validation worker does not divert or redirect the woman, nor does he argue or admonish her.’ 20

Using a validation technique, a person would try to gather the facts and background to what the person with dementia is saying, speak back in the same tense and take the conversation in the direction in which the person is going. Speaking to the person with dementia in the present tense about an event or person from their past as if it is current reality is perceived by some as a form of lying or deception. Feil20 and other advocates of validation  therapy  would  rebuke  such  an  assertion:  ‘This  is  not  lying;  rather  it  is accepting that the person has returned to the past and sees his or her mother/spouse/etc clearly in the mind's eye’.20

However, by this logic the carer is colluding with the person in a false reality which the carer is aware is not true. It could be likened to colluding with a psychotic patient in their delusional  beliefs.  Furthermore,  a  Cochrane  review  21   showed  there  is  insufficient evidence at present to support this approach as being effective.

Walker and Dale22  describe ‘fancy footwork’ as a technique to skirt around the issue of lies, distraction, ignoring the person's question, and truth telling. They suggest ‘talking with care and sensitivity in the past tense about someone who has died. Being very vague – the aim is to allow two differing realities to co-exist without contradiction’. In essence this appears to be closely related to validation therapy.   These techniques undoubtedly have their merits but they also highlight communication techniques in which family members and care home staff often have no training. It is learning on the job for most family carers in the UK. Often they will look to healthcare professional to validate their actions.

Most caregivers are initially uncomfortable about lying to their loved one with dementia. The relationship is built on trust, love and respect over many years. Caregivers of people with dementia struggle with the dilemma of how to treat the person with respect and dignity  as well  as being able to continue  to care  for them  in the home23,24.  Blum25 concludes that caregivers typically come to accept and justify that their use of deceptive practices is ultimately in everyone's best interest. Most people with dementia live at home and are supported by family members, who are at the coalface of dementia care. With the number of people in the UK with dementia set to double within the next 30 years there will be increasing numbers of carers dealing with distressed behaviour26. As clinicians diagnosing and managing patients with dementia, we need to give clear practical advice to our patients and their carers on all aspects of managing distressed behaviour. As distressed behaviour – also referred to as behavioural and psychological  symptoms of dementia (BPSD) – increases in frequency, so does the likelihood of the person with dementia moving from home into a nursing home 27.

Whilst lying is often used in daily life as a way of controlling flow of information, in the dementia situation it is utilized as an informal social control mechanism. Zarit et al28 describe the families of people with dementia as ‘the hidden victims’ of the disease. In this analysis  of the pros and cons of therapeutic  lies, we must not lose sight of the millions of family members worldwide who endeavour to care for relatives with dementia at home in the face of significant resistance and distress from the person with dementia who  lacks  insight.  Blum25    articulates  the  challenges  carers  face  in  maintaining  a semblance  of  normal  life  and  order  in  the  household.  The  article  focuses  on  the experiences of caregivers and the deceptive strategies employed by them. Blum illustrates that  as  dementia  progresses  and  strategies  such  as  negotiation  with  the  person  with dementia fail many careers resort to deception. One caregiver stated ‘I was working in the dark…I just came up with it out of the air [a therapeutic lie]…it was survival’.

Clinicians and academics can debate the ethics of lying to a person with dementia but we are often far removed from the situations caregivers endure and need to keep in mind that this condition is often managed by those who generally have a longstanding trusting relationship with the dementia sufferer. ‘Deception guilt’ is a phrase coined to describe the caregiver feeling guilt when the deception is not ‘authorized’23,29.   It is well documented23,25,28,29   that many caregivers experience increasing distress at having to lie and deceive those for whom they care. Justification for the use of lies is that it calms the person down, and therefore it has helped alleviate distress. Moreover, many carers use lies to successfully protect the dementia sufferer from potential risks such as wandering across town in the dark when the person lacks capacity to safeguard their own personal welfare.

The views of people with dementia have been canvassed by Day et al30  in regard to the use of lies in dementia care. This study had a small sample size, of people with early stage  Alzheimer’s,  but  it  highlighted  that  most  participants  considered  lies  to  be acceptable if they were perceived to be in the person's best interests. The best interest decision was determined by three key factors: the person being lied to, the carer and the nature of the lie (Figure 1).
 


Figure 1: Conceptual model depicting people with dementia's perspectives towards lies in dementia care. (Adapted from Day et al.)


Acceptability of lies
 

The ‘acceptability  of lies’ arrow is the entire large  circle.   The 3 smaller circles represent factors influencing the acceptability of lies.  The more overlap the more acceptable the lie.


This illustrates that each situation needs to be judged on a case by case basis. There was more  consensus  in  Day et  al’s  study that  lies  were  unacceptable  if  the person  with dementia   had   awareness   of   being   lied   to. They   ‘consistently   described   lying as patronising or demeaning.’ They expressed the view that being lied to reduced their autonomy and could impact negatively on their self worth and person-hood. Lies were considered more acceptable in the later stages of dementia when awareness of lies was less likely and lies were deemed more acceptable if no alternatives were available to the carer. There is clearly always an alternative to lying: to tell the truth regardless of the extreme distress which may ensue.  Interestingly, Day et al30 stated that people with mild dementia  in their study felt that:   ‘Overall,  there was a feeling that if the truth was explained in a kind way, it would not be as distressing for people with dementia’.  It raises the philosophical question of whether they are lying to themselves to protect themselves from the painful reality of the truth?

The Nursing and Midwifery Council (NMC, 2008)31  standards and code of practice state that all nurses  must be open and honest  and act with integrity.   Guidance  from the General Medical Council (GMC)32  espouses similar virtues. The Department of Health has said there are no plans to issue guidance on therapeutic lying, adding that healthcare professionals should decide whether to use it on a ‘case-by-case basis’33. The Alzheimer's Society has stated ‘Good quality care should be about identifying and addressing the causes  rather  than  encouraging  people  with  dementia  to  live  in  a  false  reality.  It’s important to give people with dementia choice and control over their life whenever possible’34.   In essence there is no clear guidance and the issue is open to personal interpretation.

Moreover,  training  for  caregivers  in  managing  challenging behaviour is  lacking22,35. Pool35  comments that people with dementia have ‘special needs and they deserve to be cared for by highly trained care workers who have been given the skills and support necessary for this demanding and rewarding work’. The situation is being addressed in part via post-diagnostic support, organisations such as Alzheimer's Scotland, and access to  information  more  widely  available  through  the  internet.  However,  with  limited financial resources and increasing demand being experienced in services for people with dementia across the UK, we must examine all potential therapeutic options we have available. The aim to decrease antipsychotic prescribing for distressed behaviour in dementia further encourages clinicians to explore all potentially beneficial therapies to alleviate distress and improve well-being.36

Conclusion

The topic of lying to patients does not sit easily with most healthcare professionals – and
rightly  so,  as  there  are  very  few  situations  in  which  it  should  ever  be  considered. However, the practice of lying is widespread in care settings for people with dementia. The  literature  in  this  area  is  still  sparse  and  there  is  a  dearth  of  high  quality research. Philosophers and ethicists have had much to say on the issue of truth telling and lies but this is often of little practical help to the person with dementia and those assisting in their care. That said, to merely conclude with the statement that more research needs to be conducted on the topic would be evading the issue. I believe we need to have a framework to help people with dementia and their caregivers, whether family or paid carers, to ensure best practice is adopted and care is tailored to suit each individual.

There has been a positive attempt by James et al1  to produce guidelines to aid clinicians and carers. Some psychiatrists have found this guidance bureaucratic and far from ideal but it is a good starting point for ensuring a consistent and considered approach to the use of therapeutic lies within a nursing home setting. It also provides a framework to ensure that lies and deception do not spiral out of control and become an abusive means of social control rather than a therapeutic intervention to alleviate distress.

Can a lie ever be considered therapeutic? I believe it can. I find that a difficult sentence to write because it does not fit with the deontological view that I would have espoused less than a year ago.  Yet if the function of truth in a situation is to bring nothing but pain and distress to a confused, demented fellow human being, then its utilisation in that instance is at best futile, at worst cruel. When we have exhausted all other possible therapeutic options – including truth-telling – and only when it is likely to enhance the person's well- being, should a ‘best interests lie’ be trialled and then benefit reassessed.

‘The unexamined life is not worth living’, said Socrates37. This is an issue that is worthy of proper examination and thought.  Pause and consider whether therapeutic lies are something you actively or passively condone.  If this issue affects your practice (and considering the evidence discussed, it is likely that it does), what checks and balances are in place firstly to assess whether it alleviates distress and secondly to prevent misuse and outright abuse of the vulnerable people to whom lies are told? Is this the time to adopt improved training, guidance and documentation in this area?

References

(1)  James,   I.  A.,   Wood-Mitchell,   A.,   Waterworth,   A.M.,   MacKenzie,   L.E.   and Cunningham, J. (2006) Lying to people with dementia: developing ethical guidelines for care settings. International Journal of Geriatric Psychiatry, 21, 800-801

(2) Cunningham, J. (2005) Care staff views about telling the absolute truth to people with dementia. Doctorate in Clinical Psychology, University of Newcastle, Newcastle upon Tyne

(3) Backhurst, D. (1992) On lying and deceiving. Journal of Medical Ethics, 18, 63-66

(4) Beauchamp, T., and Childress, J. (2001) Principles  of Biomedical Ethics. New York: Oxford University Press

(5) Tuckett, A. G. (2012) The experience of lying in dementia care: a qualitative study.
Nursing Ethics, 19(1), 7-20

(6) Anonymous (2008) The lying debate. Journal of Dementia Care, 16(2), 13-13

(7) AGE UK (2013) Guideline on Safeguarding Older People from Abuse

(8) Francis, R. (2013) Inquiry Report into Mid Staffordshire NHS Foundation Trust

(9) Schermer, M. (2007) Nothing but the truth? On truth and deception in dementia care.
Bioethics, 21(1), 13-22

(10) Kitwood, T. (1997) Dementia Reconsidered: The Person Comes First. Buckingham: Open University Press

(11) Kitwood, T. (1998) Toward a Theory of Dementia Care: ethics and interaction.
Journal of Clinical Ethics, 9: 23-34

(12)  Jones,  R.  (2001)  Ethical  and  legal  issues  in  the care  of  people  with  dementia.
Reviews in Clinical Gerontology, 11(3), 245-268

(13)  Treloar,  A.,  Beats,  B.  and  Philpot,  M.  (2000)  A  pill  in  the  sandwich:  covert medication in food and drink. Journal of the Royal Society of Medicine, 93(8), 408-411

(14) Treolar, A. Philpot, M. (2001) Concealing Medication in Patients' food. Lancet,
357: 62-64

(15)  Honkanen,  L.  (2001)  Point-Counterpoint:  is it ethical  to  give drugs  covertly to people  with  dementia?  No:  Covert  medication  is  paternalistic.  Western  Journal   of Medicine, 174(4), 229

(16) Kala, A., K. (2012) Covert medication; the last option: A case for taking it out of the closet and using it selectively. Indian Journal of Psychiatry, 54(3), 257-265

(17) Kirkevold, O. and Engedal, K. (2009) Is covert medication in Norwegian nursing homes still a problem? A cross-sectional study. Drugs and Aging, 26(4), 333-344

(18) Culley, H., Barber, R., Hope, A. and James, I. (2013) Therapeutic lying in dementia care. Nursing Standard, 28(1), 35-39

(19) Korsgaard, C. (2012). Kant: Groundwork of the Metaphysics of Morals. Cambridge: Cambridge University Press

(20) Feil, N. and Altman, R. (2004) Validation theory and the myth of the therapeutic lie.
American Journal of Alzheimer's Disease & Other Dementia, 19(2), 77-78

(21) Neal, M. and Barton Wright, P. (2003) Validation Therapy for dementia. Cochrane
Database of Systematic Reviews, 3

(22) Walker, B. and Dale, T. (2004) How Fancy Footwork can open up the language of dementia. Journal of Dementia Care, 12(6), 30-32

(23) Abel, E. (1990) Daughters caring for elderly parents. 189-206 in: The Home Care
Experience: Ethnography and Policy
, ed. Gubrium, J.    Newbury Park, CA: Sage

(24) Rubinstein, R. (1990) Culture and disorder. 37-57 in: The Home Care Experience: Ethnography and Policy, ed. Gubrium, J.   Newbury Park, CA: Sage

(25)  Blum,  N.  S.  (1994)  Deceptive  practices  in  managing  a  family  member  with
Alzheimer's disease. Symbolic Interaction, 17(1), 21-36 (26) Alzheimers.org.uk

(27) Balestreri, L. et al. (2000) Behavioural and psychological symptoms in dementia: A
clinical and research update.  International Psychogeriatrics 12; 59-62.

(28) Zarit, S. (1986) The Hidden Victims of Alzheimer's Disease: Families under stress. New York University Press

(29) Corbin, J. (1990). The key to home care. 59-73 in: The Home Care  Experience: Ethnography and Policy, ed. Gubrium, J.   Newbury Park, CA: Sage

(30) Day, A. M., James, I.A., Meyer, T.D. and Lee, D.R. (2011) Do people with dementia find lies and deception in dementia care acceptable? Aging & Mental Health, 15(7), 822-
829

(31)  Nursing  and  Midwifery  Council   (2008)   The  Code:   Standards   of  Conduct, Performance and Ethics for Nurses and Midwives. London: NMC

(32) General Medical Council (2013) Good Medical Practice Guide

(33) Department of Health spokesperson, Sept 2013

(34) McNamara, G. (2013) Head of Policy, Alzheimer's Society, UK

(35) Pool, J. (2007) Facts or feelings: do we need to choose? Journal  of Dementia Care,
15(2), 27-27

(36) Banerjee, S. (2009) The Use of Antipsychotic Medication for People with Dementia: Time for Action.  London: The Stationery Office

(37) Socrates; approx 430BC

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In September's newsletter

 

Editorial:  The newsletter and other matters

 

Old Age Regional Representatives Needed
 
Update from Alistair Burns

Update from James Warner


ESSAYS, POEMS AND PRIZES! 

 

Careers in old age psychiatry: senescent or vintage? My reflections on choosing a specialty

The judges for this competition were very impressed with all the entries.  To find out more, including the names of the winners and those short listed, and to read their work.

 

Bereavement in dementia

Lying to patients


WORKING ACROSS BOUNDARIES

 

Ever closer union?

 

Old Age Psychiatry on the cusp


PRACTICE

 

Mark Making: an experience of dementia and the arts

 

 

Reflections on teaching 12-13 year olds about dementia

 


CAREERS

 

My route to academic old age psychiatry - a good career choice


BOOK REVIEWS

 

Greg Spencer on Troublesome Disguises

 

Cate Bailey on Clinical Psychology in the Early Stage Dementia Care Pathway


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Next copy date:  31st October 2015