Original Manuscript

Nursing Ethics
1–9
Lying to patients with dementia: ª The Author(s) 2017
Reprints and permission:
sagepub.co.uk/journalsPermissions.nav
Attitudes versus behaviours 10.1177/0969733017739782
journals.sagepub.com/home/nej
in nurses

Daniela Cantone, Francesco Attena, Sabrina Cerrone,

Antonio Fabozzi, Riccardo Rossiello, Laura Spagnoli
and Concetta Paola Pelullo
University of Campania Luigi Vanvitelli, Italy

Abstract
Background: Using lies, in dementia care, reveals a common practice far beyond the diagnosis and
prognosis, extending to the entire care process.
Objectives: In this article, we report results about the attitude and the behaviour of nurses towards the
use of lies to patients with dementia.
Research design: An epidemiological cross-sectional study was conducted between September 2016 and
February 2017 in 12 elderly residential facilities and in the geriatric, psychiatric and neurological wards of six
specialised hospitals of Italy’s Campania Region.
Participants: In all, 106 nurses compiled an attitude questionnaire (A) where the main question was ‘Do
you think it is ethically acceptable to use lies to patients with dementia?’, instead 106 nurses compiled a
behaviour questionnaire (B), where the main question was ‘Have you ever used lies to patients with
dementia?’
Ethical considerations: Using lies in dementia care, although topic ethically still controversial, reveals a
common practice far beyond the diagnosis and prognosis, extending to the entire care process.
Findings: Only a small percentage of the interviewed nurses stated that they never used lies/that it is never
acceptable to use lies (behaviour 10.4% and attitude 12.3%; p ¼ 0.66). The situation in which nurses were
more oriented to use lies was ‘to prevent or reduce aggressive behaviors’. Indeed, only the 6.7% in the
attitude group and 3.8% in the behaviour group were against using lies. On the contrary, the case in which
the nurses were less oriented to use lies was ‘to avoid wasting time giving explanations’, in this situation
were against using lies the 51.0% of the behaviour group and the 44.6% of the attitude group.
Conclusion: Our results, according to other studies, support the hypothesis of a low propensity of nurses
to ethical reflection about use of lies. In our country, the implementation of guidelines about a correct use of
lie in the relationship between health operators and patients would be desirable.

Keywords
Attitude, behaviour, dementia, ethics, lie

Corresponding author: Concetta Paola Pelullo, Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Via
Luciano Armanni, 5, 80138 Naples, Italy.
Email: concettapaola.pelullo@unicampania.it
2 Nursing Ethics XX(X)

Introduction
Using lies, in the context of dementia care, reveals a common practice that finds application far beyond the
diagnosis and prognosis, extending to the entire support process. This is because with dementia, especially
as the disease progresses, the problems related to communication difficulties occur frequently, and truthful
communication is unlikely to be established in a stable and continuous way.1
Authors who favour the use of the lie consider it a useful instrument to attenuate the patient’s pain, to
improve his well-being, to ensure he abides by the pharmacological therapies and to reduce his agitation as
well as his aggressive and dangerous behaviours. Such authors justify lying because the patient progres-
sively loses the ability to understand and perceive the logic of communication and is thus unable to
distinguish between truth and lies. In addition, the authors underline that from the operator’s point of view,
using lies simplifies the relationship.2–8
Authors against the use of the lie define it as an unethical and immoral communicative modality
used to avoid difficult situations to manage the process of daily care. They also emphasise the
indispensability of the truth due to respect for the autonomy of the patient and for the basic trust
present in the relationship between the patient and his caregiver.9–11 This position belongs to British
organisations such as the General Medical Council,12 the Nursing and Midwifery Council13 and the
Alzheimer’s Society.14
To properly understand the central theme of the debate, we must distinguish between a non-
therapeutic lie and a therapeutic lie. The non-therapeutic lie is characterised by an intentional ambi-
guity. Its end is persuasion and control, and it is used for the benefit of the health operator and not for
the benefit of the patient. In contrast, the therapeutic lie is used for the patient’s benefit. It is empathic,
person-centred and reflects a desire to negotiate, although it is not always adapted to the patient’s
cognitive level.2,4,15–18
In the literature, further distinctions of the concept of the lie can also be found: outright lies, subtle lies,19
little white lies,20 going along,20 lies of omission,20 tricks,15 environmental manipulations,21 simulated
presence15 and the use of dolls.22
Over time, studies have increasingly shown the need to properly define the concept of therapeutic
lies4,23–24 and have contributed to the debate regarding their ethical and moral implications, which has led
to guidelines4,25 and recommendations26 aimed at including this practice within an ethical framework that
takes into account the patient’s vulnerability.24 For example, recommend the use of lies as the latest in a
series of alternative strategies ranging from ‘meeting someone’s needs’ to ‘simulating the need’, ‘distract-
ing’ and the use of a ‘therapeutic lie’.26–28
In an effort to resolve the semantic ambiguity implicit in the term ‘therapeutic lie’, Caiazza and James29
introduced the concept of dementia-orientated reality (DOR), a person-centred communication structured with
clear intention based on the patient’s biography that also fits in his timeline. The concept was subsequently
reviewed and adapted in Italian.30
Italy is lagging behind with respect to this issue, and such cultural lag explains the fact that in clinical
practice, the lie is used when healthcare providers are not adequately prepared to assess their implications in
their relationship with the patient and family members. The single study conducted in Italy by Cimmino
et al.31 explored the views and attitudes of a sample of 74 physicians and psychologists regarding the use of
lies in dementia patient care. This study showed that 68.9% of Italian practitioners use lying essentially to
deal with risk situations for the safety and well-being of the patients. Then, a cross-cultural study explored
such attitudes among a sample of Italian and British doctors.32
In literature, there are few studies that explored attitudes of nurses about lying in dementia care.4,17,33
Therefore, in this article, the attitudes and behaviours of nurses towards the use of lies with patients with
dementia are evaluated.
Cantone et al. 3

Methods
Setting
An epidemiological cross-sectional study was conducted between September 2016 and February 2017 in 12
elderly residential facilities and in the geriatric, psychiatric and neurological wards of six specialised
hospitals of Italy’s Campania Region.
Campania Region’s residential facilities (residenze sanitarie assistenziali (RSA)) accommodate depen-
dent older people because of physical and/or mental disability. These people cannot be taken care of at
home, but hospital care is not necessary.

Participants
The study’s participants were nurses working in the selected hospitals/residential facilities for the elderly.
To collect data from all or most of the nurses, two expert operators went to each facility two or three
times during the shift change. Before questionnaire delivery, a brief meeting was held to explain the
meaning of the study.
The questionnaire was filled in anonymously after informed consent had been obtained.
As a nurse could have a different position about lies depending on the degree of dementia, the II and III
degrees of the Clinical Dementia Rating (CDR) scale were identified as the target population of patients.

Questionnaires
Two different types of questionnaires were delivered randomly to the nurses. Both questionnaires con-
tained the same questions, but one was submitted that related to attitude (A) and the other related to
behaviour (B). For the attitudinal questions, we referred to the attitudes towards lying to people with
dementia (ALPD) questionnaire.34 Then, the attitudinal questions were reformulated to behavioural
mode. Before study initiation, the questionnaire was reviewed for content and comprehensiveness by
10 nurses and no changes have been made from the original version.
Therefore, the main question for (A) was ‘Do you think it is ethically acceptable to use lies with patients
with dementia?’ For (B), the main question was ‘Have you ever used lies with patients with dementia?’
Then, six different situations in clinical practice were identified as a possible source of lies. These situations
were preceded by the following premises: (A) ‘For which of these situations do you consider ethically
acceptable to use lies to the patients suffering from dementia?’, which could be answered with a four-point
Likert scale: disagree, partially disagree, partially agree and agree; (B) ‘For which of these situations did
you happen to use lies to patients suffering from dementia?’, which could be answered with a four-point
Likert scale: never, rarely, sometimes and often. Moreover, each question showed between brackets a
practical example, with exception of the question no. 5. Listed below are the six different situations:
1. ‘To simplify drug ingestion’ (Nurse: ‘Open your mouth and I’ll give you a candy’);
2. ‘To permit the execution of an invasive procedure’ (surgery, endoscopy and blood tests) (Nurse:
‘Let’s go for a walk’);
3. ‘Not to deny a false statement of the patient’ (the patient asks about his/her deceased mother; Nurse:
‘She will come later’);
4. ‘To alleviate the stress of the patient’ (to a patient with serious illness; Nurse: ‘Don’t worry;
tomorrow we will discharge you’);
5. ‘To prevent or reduce aggressive behaviours’;
6. ‘To avoid wasting time giving explanations’ (Patient: ‘Can I have a beer?’ Nurse: ‘Yes, later . . . ’).
4 Nursing Ethics XX(X)

Table 1. Sociodemographic characteristics of the study population.

Sociodemographic characteristics N %

Age (years)
20–30 27 12.9
31–40 30 14.3
41–50 75 35.7
51–60 58 27.6
>60 20 9.5
210 100
Sex
Male 97 46.6
Female 111 53.4
208 100
Position
Head nurse 21 10.8
Nurse 173 89.2
194 100
Length of service (years)
<2 19 9.4
2–10 66 32.5
11–20 61 30.0
>21 57 28.1
203 100

The next section contained more theoretical questions, with dichotomous answers, in order to get more
comparability between A and B: for (A) ‘Should the use of lies be adapted to the cognitive abilities of the
patient?’ (yes/no) and ‘Do you think it would be useful to introduce a discussion between health providers
on the use of lies to define more precise rules regarding the behaviour to be implemented towards patients
with dementia?’ (yes/no); for (B) ‘Has the use of lies been adapted to the cognitive abilities of the patient?’
(yes/no) and ‘Have you ever spoken with other health providers about a shared mode of the use of lies?’ (no;
yes, with other nurses; yes, with the physicians; yes, with the relatives). Finally, there is one question that
appears on both questionnaires: ‘Have you ever thought about the possible negative consequences of using
lies?’ (yes/no).
The Ethics Committee of the University of Campania ‘Luigi Vanvitelli’ approved this study.

Data analysis
Descriptive analysis was performed on all the variables. Comparison of proportions was performed to
compare, in attitude and behaviour, similar variables. A p value <0.05 was considered the level of statistical
significance. Analyses were carried out using SPSS Version 11.0 statistic software package.

Results
Of 235 nurses who submitted the questionnaire, 23 refused consent, meaning that the overall response rate
was 90%. In total, 212 nurses answered the questionnaire: 106 answered the ‘attitude’ form and 106
answered the ‘behaviour’ form. Of the 212 nurses, 53.4% were women, 72.8% were more than 41 years
old and 58.1% had been working for over 10 years. Only 10.8% of the nurses studied were head nurses of the
ward (Table 1).
Cantone et al. 5

Table 2. Nurses’ attitude (A) and behaviour (B) about using lies with patients with
dementia.

A. Do you think it is ethically acceptable to lie to patients with dementia?

N %

No 11 10.4*
Yes 16 15.1
Depend 79 74.5
Total 106 100

B. Have you ever used lies with patients with dementia?

No 13 12.3*
Yes Rarely 28 26.4
Sometimes 55 51.9
Often 10 9.4
Total 106 100

*Comparison of two proportions – results: w2 ¼ 0.189; 95% CI ¼ –7.4þ11.2; p ¼ 0.66.

The two groups were comparable for these socio-demographic characteristics. The main question of the
two questionnaires was aimed at evaluating whether and how often the nurses used lies (behaviour) and
whether they think it is acceptable to use lies (attitude). Table 2 shows that in both cases, only a small
percentage of the interviewed nurses stated that they had never used lies/that it is never acceptable to use lies
(behaviour 12.3% and attitude 10.4%; p ¼ 0.66).
Starting from the ‘disagree’ and ‘never’ columns of Table 3, the situation in which the nurses were more
oriented to use lies was to prevent or reduce aggressive behaviours. Indeed, only 6.7% (A) and 3.8% (B)
were against using lies. However, the case in which the nurses were less oriented to use lies was to avoid
wasting time giving explanations. In this situation, 51.0% (A) and 44.6% (B) of the respondents were
against using lies.
The majority of nurses believed ‘the use of lies should be adapted (77.1%)/has been adapted (71.8%) to
the cognitive abilities of the patient’. The majority of nurses also reported that ‘They thought it was useful to
discuss (79.6%)/have discussed (77.1%) about a shared mode of the use of lies’. Finally, 86.7% (A) and
77.9% (B) said ‘They had thought about the potential negative consequences of telling a lie’. In all answers,
we observed a consistency between attitudes and behaviours (p > 0.05; Table 4).

Discussion and conclusion

The debate on the use of lying as a communication strategy is still open and highlights the need to further
clarify risks and benefits of lying in the contexts of care, in the best interest of the patients with dementia and
in order to allow operators to respect ethical principles. Indeed nurses, daily involved in practical patient
care, appear more exposed to the ethical and moral implications of using lies.
In our study, the first conducted in Italy on nurses, only 12.3% said that they had never used lies and only
10.4% said that using lies is never acceptable. Therefore, our results are in line with the literature, especially
when referring to samples formed of nurses.4 We found a slightly higher rejection of lies in physicians.25,31
This discrepancy could be explained by the fact that healthcare providers who most readily supported the
use of lies were those professionals providing the most intensive face-to-face care.
6 Nursing Ethics XX(X)

Table 3. Nurses’ attitudes (A) and behaviour (B) about using lies during patient care.

A. For which of these situations do you B. For which of these situations did
consider ethically acceptable to use lies you happen to use lies to the patients
to the patients suffering from dementia? suffering from dementia?

Partially Partially
Disagree disagree agree Agree Total Never Rarely Sometimes Often Totalb

Propensity to lie Propensity to lie

p value

1. ‘To simplify drug N 16 10 38 42 106 24 26 33 19 102 p ¼ 0.12a

ingestion’ % 15.1a 9.4 35.9 39.6 100 23.5a 25.5 32.4 18.6 100
2. ‘To permit the N 27 21 33 25 106 38 34 18 8 98 p ¼ 0.04a
execution of an % 25.5a 19.8 31.1 23.6 100 38.8a 34.7 18.4 8.1 100
invasive procedure’
3. ‘To not deny a false N 15 29 29 33 106 20 24 27 26 97 p ¼ 0.23a
statement of the patient’ % 14.2a 27.3 27.4 31.1 100 20.6a 24.8 27.8 26.8 100
4. ‘To alleviate the stress N 18 25 36 26 105 19 24 30 27 100 p ¼ 0.72a
of the patient’ % 17.1a 23.8 34.3 24.8 100 19.0a 24.0 30.0 27 100
5. ‘To prevent or reduce N 7 1 34 62 104 4 24 36 40 104 p ¼ 0.35a
aggressive behaviours’ % 6.7a 1.0 32.7 59.6 100 3.8a 23.1 34.6 38.5 100
6. ‘To avoid wasting time N 53 14 16 21 104 45 30 18 8 101 p ¼ 0.36a
giving explanations’ % 51.0a 13.5 15.4 20.1 100 44.6a 29.7 17.8 7.9 100
Mean % 21.6c 25.05c
a
Comparison of two proportions.
b
The item ‘not applicable’ has been excluded.
c
Comparison of two means: results: t ¼ þ1.866; 95% CI ¼ –0.19 þ 6.99; p ¼ 0.06.

Table 4. Nurses’ opinions about adapting lies to patients’ cognitive abilities, about discussion, about use of lie and about
potential negative consequences of lying.

Attitudes Behaviours Total

N % N % N % p

A. The use of lies should be adapted to the cognitive abilities Yes 81 77.1* – – 0.38*
of the patient? No 24 22.9 –
B. The use of lies has been adapted to the cognitive abilities Yes – 74 71.8*
of the patient? No – 27 28.2
A. Do you think it is useful to discuss a shared mode of the Yes 82 79.6* – – 0.66*
use of lies? No 21 20.4 –
B. Have you ever discussed a shared mode of the use of lies? Yes – 81 77.1*
No – 24 22.9
Have you ever thought about the potential negative Yes 91 86.7* 81 77.9* 172 82.3 0.09*
consequences of a lie? No 14 13.3 23 22.1 37 17.7
*Comparison of two proportions
Cantone et al. 7

Faced with a very high percentage of nurses who lie (87.7%), only 9.4% said they do it often. This finding
leads to the assumption that in our sample, using lies is considered a strategy to use in moderation.
As for the typical situations of daily clinical practice, also in our study, the lie appears to be used mainly
in the interest of the patient: to relieve stress; not to contradict a false statement and to convince the patient
to adhere to drug therapies. All behaviours mentioned are in line with the idea of the therapeutic lie justified
on the grounds that one is dealing with a patient who is gradually losing the ability to decide on his own care
and adequately assess the risks to his safety.3–4,6,7,17.25,34 Confirming this is the high percentage of respon-
dents opposed to the use of lies in the case of to avoid giving explanations that waste time, which is a
situation where the interest is greater in the provider than in the patient (non-therapeutic lie). Therefore, in
accordance with other studies,4,17,33 in our sample, the lie more ethically accepted and the most used seems
to be the one that corresponds to the interest of the patient and not the care provider. Moreover, we would
like to comment the question ‘to prevent the patient’s aggressive behavior’. We have supposed this situation
in the interest both of the patient and of the nurses and we have considered in the border between therapeutic
and non-therapeutic lie. Thus, lying in these situations is a common interest of patient and nurse. Therefore,
it is not a coincidence that nurses, in this specific situation, have expressed the greatest agreement on lying
(93.3%). The subjects of our sample stated that they believe a lie must be tailored to the cognitive level of
the patient and declared that in most cases, they apply this principle in clinical practice. Additionally, not
only have they discussed this principle with colleagues, but they think it is useful to do so. Finally, they
claimed that they reflect about the potential negative consequences of lying in their daily practice.
Our study is the first that has been conducted for the purposes of comparing and evaluating, through two
separate questionnaires, attitudes and behaviour towards the use of lies. There were two initial hypotheses.
With the first, we were expecting a higher number of people who use lies and a lower number of subjects
who believe they are ethically acceptable. This was based on the fact that it is unacceptable to use lies, but
some do it anyway for convenience, to simplify procedures. With the second, we hypothesised that there
would be a substantial consistency in the responses to the attitudinal and behavioural questions and con-
sequently, as opposed to the first hypothesis, a lower attitudinal propensity towards ethical reflection on the
part of healthcare providers. Our study’s findings support the second hypothesis, as indicated by the high
percentage of individuals who failed to express a clear position about the ethical acceptability of lies (based
on the prevalence of the answer ‘it depends’).
In Britain, to meet the demand of trained healthcare providers in the use of deceptive practices, guide-
lines for lies were developed in 2016.4,28 They were further refined in 201325and changed significantly by
the Newcastle group, taking into account features associated with memory and relationship-centred care
practices.35
In our country, it would be desirable to implement guidelines aimed at ensuring the use of lies within an
established ethical framework that respects the four common bioethical principles: autonomy, beneficence,
non-maleficence and justice.14 On the basis of this study, it is necessary to reinforce how important it is for
healthcare providers to receive adequate training in the use of lies because it increases the awareness of this
practice and its ethical implications.

Limitations
Considering the difficulties associated with finding an adequate number of nurses and the fact that we did
not do a correct sampling of them, we believe that the modalities of the samples did not bias the results of the
study. The comparison between attitudes and behaviours must be interpreted with caution for two reasons:
respondents of the two questionnaires belong to different populations and the two four-point Likert scales
were not entirely overlapping. Therefore, we preferred to compare only the items to which the respondents
answered ‘no’ on both questionnaires. The topics of this study were particularly exposed to an information
8 Nursing Ethics XX(X)

bias because the respondents could have hidden their use of lies to please the interviewer and because the
use of lie is considered a socially reprehensive act, even though the study was anonymous. We assumed that
this effect was particularly strong in the last two questions presented in Table 4, when most of the nurses
stated they had engaged in discussions with other healthcare providers about a shared mode of the use of lies
and that they reflected on the possible negative consequences of a lie.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or
publication of this article.

Funding
The author(s) received no financial support for the research, authorship and/or publication of this article.

References
1. Seaman AT and Stone AM. Little white lies: interrogating the (un)acceptability of deception in the context of
dementia. Qual Health Res 2017; 27: 60–73.
2. James IA, Powell I, Smith T, et al. Lying to residents: can the truth sometimes be unhelpful for people with
dementia? PSIGE Newsl 2003; 82: 26–28.
3. Zeltzer BB. To lie or not to lie: that is the question. Am J Alzheimers Dis Other Demen 2003; 18: 325–326.
4. James IA, et al. Lying to people with dementia: developing ethical guidelines for care settings. Int J Geriatr
Psychiatry 2006; 21: 800–801.
5. Wood-Michell A, Waterworth A, Stphenson M, et al. Lying to people with dementia: sparking the debate. J Dem
Care 2006; 14: 30–31.
6. Wood-Mitchell A, James IA, Waterworth A, et al. Factors influencing the prescribing of medications by old age
psychiatrists for behavioural and psychological symptoms of dementia: a qualitative study. Age Ageing 2008; 37:
547–552.
7. Butkus MA. Compassionate deception: lying to patients with dementia. J APPA 2014; 9: 1388–1396.
8. Mitchell G. Therapeutic lying to assist people with dementia in maintaining medication adherence. Nurs Ethics
2014; 21: 844–845.
9. Sprinks J. Therapeutic lying should be avoided. Nurs Older People 2013; 25: 7.
10. Stubbs B. ‘White lies’ can sometimes be kinder for people with dementia. Nurs Stand 2013; 28: 30–31.
11. Walker B. Communication: building up a toolkit of helpful responses. J Dem Care 2007; 15: 28–31.
12. General Medical Council. Good medical practice, http://www.gmc-uk.org/static/documents/content/GMP_.pdf
(2013, accessed 5 June 2017).
13. Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses and mid-
wives, https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf (2008, accessed 3
June 2017).
14. Alzheimer Europe. Ethics – definitions and approaches – the four common bioethical principles. Beneficence and
non-maleficence, http://www.alzheimer-europe.org/Ethics/Definitions-and-approaches/The-four-common-
bioethical-principles/Beneficence-and-non-maleficence.
15. Schermer M. Nothing but the truth? On truth and deception in dementia care. Bioethics 2007; 21: 13–22.
16. Wood-Mitchell A, Mackenzie L, Cunningham J, et al. Can a lie ever be therapeutic? The debate continues. J Dem
Care 2007; 15: 24–28.
17. Tuckett AG. The experience of lying in dementia care: a qualitative study. Nurs Ethics 2012; 19: 7–20.
18. Caiazza R and James IA. Untruths in dementia care: ethical decision making process. Signpost 2016; 22: 6–9.
19. Vrij A. Detecting lies and deceit: the psychology of lying and the implications for professional practice. Chichester:
John Wiley & Sons, 2000, pp. 1–17.
Cantone et al. 9

20. Blum NS. Deceptive practices in managing a family member with Alzheimer’s disease. Symb Interact 1994; 17:
21–36.
21. Remington R, Abdallah L, Melillo KD, et al. Managing problem behaviors associated with dementia. Rehabil Nurs
2006; 31: 186–192.
22. Ehrenfeld M and Bergman R. The therapeutic use of dolls. Perspect Psychiatr C 1995; 31: 21–22.
23. Day AM, James IA, Meyer TD, et al. Do people with dementia find lies and deception in dementia care acceptable?
Aging Ment Health 2011; 15: 822–829.
24. Tuckett AG. The care encounter: pondering caring, honest communication and control. Int J Nurs Pract 2005; 11:
77–84.
25. Culley H, Barber R, Hope A, et al. Therapeutic lying in dementia care. Nurs Stand 2013; 28: 35–39.
26. Mackenzie CS, Wiprzycka UJ, Khatri N, et al. Clinically significant effects of group cognitive behavioral therapy
on spouse caregivers’ mental health and cognitive functioning: a pilot study. J Gerontol Soc Work 2013; 56:
675–692.
27. NHS Education for Scotland (NES). Promoting excellence in Dementia Care, http://www.nes.scot.nhs.uk/media/
2376191/dementia_newsletter_october_2013_final.pdf (2013, accessed 5 Jun 2017).
28. O’Connor E, James IA and Caiazza R. A response framework with untruths as last resort. J Dem Care 2017; 25:
22–25.
29. Caiazza R and James IA. Re-defining the notion of the therapeutic lie: person-centered lying. FPOP Newsl 2015;
130: 23–29.
30. Caiazza R, James IA and Cantone D. Realtà orientata alla demenza (DOR): strategie comunicative nel trattamento
del paziente affetto da demenza [Dementia orientated reality (DOR): communication strategies in the treatment of
people with dementia]. Ricerche di Psicologia 2015; 3: 447–458.
31. Cimmino A, Canonico V, Grossi D, et al. Mentire ai pazienti affetti da demenza tra esigenze di cura e questioni
etiche: uno studio pilota italiano [Lying to patients with dementia between needs of care and ethical issues: an
Italian pilot study]. Psicogeriatria 2015; 3: 8–16.
32. Caiazza R, James IA, Rippon R, et al. Should we tell lies to the people with dementia in their best interest? The
views of Italian and English medical doctors. Psychol Spec Interes Gr Older People Newsl 2016; 134: 35–40.
33. Hertogh CM, The BA, Miesen BM, et al. Truth telling and truthfulness in the care for patients with advanced
dementia: an ethnographic study in Dutch nursing homes. Soc Sci Med 2004; 59: 1685–1693.
34. Elvish R, James IA and Milne D. Lying in dementia care: an example of a culture that deceives in people’s best
interests. Aging Ment Health 2010; 14: 255–262.
35. Mackenzie L, Smith K and James I. How a time machine concept aids dementia care. Nurs Times 2015; 111: 18–19.