Palm Beach Florida Weekly

Respect the reality of dementia



We are all guilty from time to time – it is easy to become frustrated or annoyed with an elderly parent or senior spouse who is forgetful, repetitive, or confused. Even though we love them, and it is not their fault, we often slip and say something without thinking. Or we act in a way that only makes the situation worse. There’s a way to communicate better, react appropriately, and protect those we love and care for, it is called Validation Therapy.

Validation Therapy invites us to “step into their world.” Seniors often realize their brains and bodies are declining, they are often sad as well as scared. Nobody wants to hear, “…how can you not remember that…. I just told you a minute ago;” or, “…you could do that if you really tried.” Validation Therapy is a powerful method for communicating with people who have dementia, whether it is caused by Parkinson’s disease, Alzheimer’s disease or another medical condition. The idea behind Validation Therapy is to understand and respect the way reality seems to the person who has dementia. This means “stepping into their world”, and trying to help within that framework. Validation Therapy can reduce anxiety, enhance self-esteem and avoid confrontation. Don’t say, “…you already told me that ten times,” or, “…how could you not remember you retired years ago,” and attempt to correct the person, instead accept their reality in order to move forward. Here’s two excellent examples: ¦ Margaret is 97 years old. She is calling out for her mother and seems upset and sad. She wants to talk to her mother on the phone, but she passed away 30 years ago. Correcting Margaret by telling her that her mother is dead is not a good approach. In Margaret’s mind, Margaret is a young girl and her mother is still alive, and Margaret is missing her mother. Telling her that her mother died might be shocking to Margaret and she might experience the grief of losing her mother all over again.



Validation Therapy starts with empathy. Understand that Margaret is missing her mother and try to make Margaret feel better instead of challenging her belief that her mother is alive. Instead engage Margaret in a conversation about her mother: “Where did your mother grow up? Tell me some of your favorite things you did with your mother!” This validates Margaret’s feelings about missing her mother and helps her to express them. Once this occurs, it should be much easier to gently redirect Margaret toward taking a walk or sharing a meal. “Oh, I see it’s almost time for lunch. I’m starved. Would you like to join me?”

¦ George is in his mid-80s. He is pacing nervously around the house he has lived in for the past 20 years, and is repeating, “I want to go home,” with increasing urgency. It might seem natural to respond by saying “But, George. This IS your home” and try to convince George by pointing to his favorite easy chair, photos of him with his family on the coffee table, and other things that should be recognizable. But this approach is unlikely to convince George he is home, and might escalate into an argument. It might even cause him to wander away from the home, get lost and put himself in danger.

Using Validation Therapy, you would start by acknowledging George’s anxiety at not feeling like he is at home. In George’s reality, “home” could be the place where he lived as a child or as a young adult; the place he is now living is different from that. By exploring George’s feelings, we might be able to find the source of his discomfort. We can ask questions about George’s home. “Tell me about your home, what is your favorite room? Were you able to walk to school?” Once George expresses his feelings about his home, and we understand the underlying cause for his behavior, it should be easier to redirect George from his urgent need to leave. Alternatively, it might be that George needs to use the bathroom but can’t articulate that — “I want to go home,” could actually mean, “I want to find the bathroom.” We need to find the reason for George’s discomfort rather than correct him.

The Validation Therapy approach can make all the difference between a calm, successful resolution and an escalated confrontation. Not every situation is easy to solve, and it is important to be creative, flexible, and keep calm. The key is to accept the reality that the person with dementia is perceiving and find a solution within that framework. Validation Therapy was created in the 1960’s by Naomi Field, a social worker who worked extensively with dementia patients. Today, it enjoys wide acceptance by experts in the field. In fact, Alzheimer’s Community Care is currently working with the Palm Beach County Sherriff’s Department to help them utilize Validation Therapy when they encounter a person with dementia.

At Visiting Angels of the Palm Beaches, we train our caregivers in the principles of Validation Therapy. We pose various hypothetical situations to them and see if they can find the right approach. We ask them to role play so we can see how they would react, and then train them in the appropriate response. Only then do we allow them to work with clients who have dementia. In the same vein, our caregivers are trained to work with Holocaust survivors by understanding the special challenges they face. We are working with Alpert Jewish Family & Children’s Services on this initiative and our caregivers are attending their excellent Honoring Life training program. ¦

— Visiting Angels of the Palm Beaches has a refreshing and award- winning approach to homecare relationships. Let our “ Angels” help you or a loved one while recovering from illness, accident or surgery, or assist with the care and companionship needed to remain comfortably and safely at home while aging in place, or dealing with the daily demands of living with Alzheimer’s and Parkinson’s. Call us at 561- 328- 7611 or visit PalmBeaches.

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