Coping with denial and lack of insight with dementia

Coping with denial and lack of insight

It can be upsetting when a person does not acknowledge or accept their condition. This can be especially difficult if they seem not to be open and honest with other people about the problems they’ve been having.

It’s very common for people with dementia to do this with their GP or social care professionals. However, if you can empathise and try to support the person, it might make it easier to manage the situation.

Ways to help a person with denial or lack of insight

Even though a person may not acknowledge their diagnosis, there may still be ways to help them.

For example, they may be able to talk about any general concerns or worries they have, such as memory problems. This can be a useful way to find out about any difficulties that they accept they’re having, which may give you ideas about how you might be able to approach these.

Talking and sharing

Even if someone is in denial, they might still react emotionally to not being able to do some things they’ve always been able to.

For example, they might feel upset, angry or anxious because they can no longer follow conversations as they used to. Ask them how they feel and talk to them sensitively about the changes they’re going through. This may help you both to work out what they would find helpful.

Tips for supporting a person with denial or lack of insight

• Try to understand that the person may be in denial because they are afraid or anxious. Remember that denial and lack of insight are not deliberate.
• Give the person time to adapt to their condition and sensitively check every so often to see if they seem ready to talk about it. Think about whether it matters that the person isn’t acknowledging their diagnosis. Are you reminding them about it for a reason, such as to encourage them to accept help? If not, it may be better not to keep reminding them.
• Listen carefully to what the person says without interrupting or correcting them, and try not to directly contradict their account of what is happening. This can help you to find out more about how they’re feeling and what they need, and how to approach these conversations in future.
• Always try to be supportive, gentle and calm when you’re talking to the person. If you’re angry or stressed it will make things worse.
• If the person does not want to use the words ‘dementia’ or ‘Alzheimer’s’ it is important to respect this. Instead, talk to them about changes they’ve noticed in themselves or specific problems they’re having. This might lead them to talk about their feelings and you can then give them reassurance or suggest support to help with these.
• Try not to confront the person or attempt to convince them of their diagnosis. It isn’t possible to persuade someone to suddenly accept their condition if they are in denial or experiencing lack of insight, and it will likely be upsetting for you both.
• Look for services that can help people with dementia come to terms with their condition, such as support groups, talking therapies and creative therapies.
• If a person does not realise they are having problems with some activities, it may help to point out the benefits of doing things differently. For example, if a person is no longer able to drive safely, it may help to talk about the benefits of not driving. You could focus on the money they will save on petrol, road tax and insurance. If someone else drives, the person may also enjoy being a passenger without the pressures of driving.
• Think about the person as an individual and what might persuade them to accept support if they need it. Some people who think they don’t need help might accept visits from a professional carer if they feel it would benefit someone else in their home, such as a family member.
• If a person has stopped taking their medication because they don’t think they need it, it’s especially important to talk to them about any problems that they do feel they’re having, even if they don’t believe they are dementia-related. This can help you to know how much insight they have into their condition, as well as to encourage them to take their medication. You can also talk to their GP about this, either by telephone, letter or email, or by going to an appointment with the person.
• Some people find it helps to give the person information about the difficulties they’re having. For example, if they need help with remembering things, you could show them The memory handbook. Introducing information that refers to dementia in a gentle way might help them to understand that the problems they are having could be due to the condition.

Support for family and carers when a person is in denial or has lack of insight

If you’re feeling exhausted and worried about someone not acknowledging their diagnosis, this can lead you to feel irritated too. You may want the person to accept their diagnosis and the problems they’re facing so that you can address these.

Perhaps you’ve got ideas about how to help them with specific activities or tasks. You might also want them to be able to go to specific care services such as support groups.

Think about it from the point of view of the person with dementia

It can help to look at the situation from the person’s perspective. If they are in denial or experiencing lack of insight then, as far as they are aware, they don’t have any problems. Think about how it might feel if their family and health professionals keep insisting that they do and that they need help.

Looking at the situation from this perspective can help you understand the emotions they may be feeling, which might help you find ways to help them.

Talking to others

It is also very important to look after yourself and talk to other people about how you are feeling, as well as the impact on you. You could talk to a friend or family member you trust, or to a professional such as a counsellor or dementia adviser.

You can call our support line on 0333 150 3456 or talk to other carers in our online community Talking Point.

Looking after yourself

As well as talking to others about the impact that a person’s denial or lack of insight has on you, there are other ways you can look after your own health and wellbeing. These include making sure you take regular breaks, maintaining a healthy lifestyle and relaxing to help reduce stress.

For more information see Carers – looking after yourself, or for general information on all aspects of caring, including looking after yourself, see Caring for a person with dementia: A practical guide