Entering the Dementia Patient’s World

September 28, 2010

For many years, “Reality Orientation” was the recommended technique for dealing with dementia patients.  In other words, it’s the belief the caregiver can “reorient” the dementia patient to the real world.  The most extreme example I’ve heard of this technique involved an elderly woman who had dementia and was on hospice care.   When her nurse arrived at the patient’s home, the elderly woman said with a smile on her face, “I had breakfast with my mother this morning.”  The nurse’s reality orientation response?  “Ma’am, you know your mother is dead.”  At this point, the patient dissolved into tears, experiencing her mother’s death once again as if for the first time.

The current school of thought is much kinder and more affirming to the patient.  It goes by several names — “Validation therapy” from Naomi Feil, “Habilitation” from Joanne Koenig Coste,  and several others names.  The basic premise is this:  As time goes on, the dementia patient is less and less able to connect with the “real world.”  Trying harder and harder to “reorient” them will not be successful, because they have lost their capability to understand reality.  Given that, love them the way they are, validate them the way they are, interact with them in their world.

What would have been a better response from the nurse?  “You had breakfast with your mother?  How nice!  What did you talk about?” or “What did you have to eat?”  In this scenario, the patient is given the opportunity to relate their happy memory (which may have no basis in reality or may have its basis in a real event that occurred many years ago).  Even if the patient has lost the capability to relate that memory coherently, it leaves them with a pleasant feeling about the interaction, rather than a feeling of devastating loss.

Here is a less dramatic example of this technique:

Patient: “I want to go home.”

Caregiver: Instead of saying, “Surely you know that you are home,”  the caregiver could give an affirming response like, “Tell me about your home.  Do you remember when you and your father built the porch on the back of the house when you were a boy?”

Again, affirm where the patient is, who they are, and what they believe.  Their fears and beliefs may not be at all rooted in reality, but they are very real to the patient.  Distract them, affirm them, make the interaction pleasant.  This is most difficult for family caregivers who remember their loved one as a rational, capable human being.  With my loved ones with dementia, I always thought that if I tried hard enough, corrected them enough, “reoriented” them enough, I could reach that rational person.  The truth is that most times you can’t and the constant correction further contributes to the depression that so often goes hand in hand with dementia.

Suggestions:

  1. Don’t correct!  Redirect!
  2. Enter the patient’s world, as you would the play world of a child.
  3. Always treat the patient with the kindness and respect.

Copyright 2010, Dementia Dynamics, LLC – All rights reserved

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