Courtesy of Carol Bradley Bursack

Dear Carol: My grandparents had been married for 63 years.

Two years ago, my grandmother's general health started to decline and she has recently been diagnosed with moderate dementia. My grandfather seemed in excellent health considering his age, but a few weeks ago he died of a sudden heart attack.

He had been my grandmother's primary caregiver and her whole world had always revolved around him. She now feels that Grandpa abandoned her, maybe for another woman. Normally, when Grandma is caught up in her delusions or whatever her mind is telling her is real, my parents and I just agree with her. But her inability to understand the reality of Grandpa's death is breaking her heart - and ours. We have tried to remind her that Grandpa had a sudden heart attack and died, but she just says, “No, that can't be. He left me.” What do we tell her? - Roger

Dear Roger: This is one of the most heartbreaking realities so many adult children face. There's no one-size-fits-all answer.

My personal belief is that even if the surviving spouse is in the later stages of dementia, he or she should be told once, out of respect for the marriage and the dignity of the survivor, that his or her spouse has died. After that, it's perhaps best to say something like “you'll see him (or her) soon,” and then try to distract the person with something pleasant. It seems to me that to deliver the sad news repeatedly, under these circumstances, just causes unnecessary pain. This is, however, a unique decision for each family.

You have a tough situation in that your grandmother is in an earlier stage of dementia and therefore it's harder to distract her from the reality that her husband is gone for good. Also, she thinks her husband deserted her which, of course, makes matters even more painful. You have the right idea that while generally it's best to just meet her where she is, this one time when that approach obviously can't be used.

You may want to try reminding your grandmother about her husband's funeral. You could show her the memorial prayer card and guest book, and then say something about how wonderful it was they had each other for 63 years. Doing so will upset her, but not as badly as thinking her husband left her for someone else.

After talking with her, you could help her reminisce, unless that upsets her more. Old photos from when they were a young couple could help, as she may get comfort from remembering that happier time of their lives. If not, distraction of some sort is the probably the best you can do.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders.