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Ever wonder if you are just wasting your breath when it comes to trying to tell your loved one that they are mistaken about the date, the place or what they think is happening? You're not alone. As your loved one progresses through the stages of dementia, their memory and perception of time and situation becomes drastically skewed. So the question becomes should we try to use reality orientation to correct their mistakes, or should we "buy-in" to their way of thinking? The answer to that question lies in what stage your loved one is in their progression of dementia. So let's explore both options.
Reality Orientation vs. Validation Therapy
Reality Orientation
Reality orientation is a program designed to improve cognitive and psychomotor function in persons who are confused or disoriented. This technique originated with disabled veterans to help them engage, and connect, with their surroundings. The process involves caregivers actively and repetitively presenting functional information needed to orient patients, including dates, locations, times, environment and people. These "reminders" are often incorporated into normal conversations with the dementia person.
Several studies have demonstrated that the use of reality orientation has improved the cognitive function of people with dementia when compared to control groups who did not receive the approach. It has also been shown to improve cognitive function when combined with medication, such as Aricept. One study found that the use of reality orientation may delay the need for nursing home placement by slowing cognitive decline and may even have some benefit on challenging behaviors, which can reduce the quality of life and can expedite nursing home placement.
Strategies for Reality Orientation
Some great methods for reinforcing a person's sense of reality is by:
Having conversations about orientation, including the time of day, date, season or other environmental information as often as possible
Buying daily newspapers (and throwing the old ones out for recycling)
Discussing current events
Frequently using the person's name while speaking with them
Displaying a board with the day, date, meal time, weather, etc. (just make sure you update daily)
Mounting large wall clocks and/or calendars in each room with frequent use and referencing from caregiver
Making sure everyone wears a name badge, particularly if dementia person is in a facility
Placing labels or signs on doors and cabinets to identify purpose, location or contents
Talking about and asking questions about personal photos or other decor
This process is most helpful for the person in the early stage of dementia. While sensory stimulation is helpful in the later stages, attempts to orient the person to date and place only serve to confuse and agitate them. Reality orientation has experienced a decline in more recent years when compared to validation therapy. This is primarily due to caregivers and professionals using the reality orientation method without taking into account the person's emotions and mental health. For example, if a person with dementia asks, "Why don't you take me to my mother's house?", use of a strict reality orientation response may be, "You are 88 years old and your mother has passed." Although this may serve to be a reminder for them, it may also cause your loved one emotional distress since some dementia person's may be inappropriate for this approach. If you find that reality orientation seems to upset more than calm, then it is best to take a step back and move into their reality with a different approach.
Validation Therapy
Therefore, when your loved one becomes more agitated when attempting to orient them, it may be necessary to move into using validation therapy. This method emphasizes the feelings behind the behaviors or statements of the dementia person. In this approach, caregivers talk about the reality that their loved one is in (rather than what we know to be true) in order to help them process what they are feeling and, ultimately, help them to feel comforted and more at peace. Validation therapy was developed by Naomi Feil to help elderly patients connect through listening and dignified care in the final stages of life. It provides insight into behaviors and thoughts for those who suffer from Alzheimer's, and provides caregivers a way to interact with their loved ones, even if they may be experiencing disorientation or hallucinations.
Strategies for Validation Therapy
Some of the methods used during validation therapy include
Treating people as unique individuals
Focusing on their feelings, rather than your own reality
Building trust and a sense of security to ease fears
Not judging their actions
Showing empathy and respect so the person feels valued
Allowing your loved one extra time and multiple attempts at expression to work through their unresolved conflicts
This strategy is used by many professionals and caregivers to facilitate a feeling of comfort and safety. This strategy should be implemented for all dementia patients who have progressed to the mid- to late-stages of dementia. Using our previous example about the demented person asking "Why don't you take me to my mother's house?", the use of validation therapy would have a response something like, "You miss your mom?...Tell me about her..." In this example we acknowledge and discern that perhaps the reason they are asking to go to their mother's house is because they miss her or are thinking about her. Offering them an opportunity to talk about it can help to relieve the stress they are feeling. Using this method often results in decreased behaviors, increased communication, and increased physical interaction within their environment, which ultimately results in a better quality of life.
Have you ever had a moment when you can't find your car in a large parking garage and you start to panic? Was it stolen? Do I remember where I parked? Imagine going through the day with the same kind of fear and doubt. This is similar to what happens when a person develops dementia.
To ensure that our loved ones remain happy and healthy, we must continue to assess both their verbal and non-verbal communication. Using the above methods can keep your loved one feeling safe and valued by their caregiver and help to develop a trust that eases the stress experienced by both patients and caregiver.
No one knows your loved one better than you, so watch their behaviors as you attempt each approach. If your loved one is still in the early stage of dementia and seems to catch on to your conversational cues about orientation, then continue to provide them to help stave off further deterioration or possible nursing home placement. However, if your loved one becomes more agitated with your gentle reminders, it is best to transition to talking about their feelings rather than the reality.
Have you tried either of these methods with your loved ones? How did they work? We would love to hear your stories. Please share your experiences below or post to our forum to create a discussion.
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