One of the most difficult aspects of dementia is that in its later stages, it not only robs the person of their memory, it often causes the person to lose their sense of what is real and what is not real. This can be sad and frightening for the individual’s family and friends who don’t know how to react to their loved one’s hallucinations, delusions and odd flights of imagination. In this situation, it is common to ask, “Should I remind my loved one that they have dementia and that what they are imagining, seeing or hearing is not real?”
In Validation Therapy for Dementia: Calming or Condescending? on the AgingCare.com website, author Carol Bradley Bursack writes “Most people’s initial reactions to an off-the-wall remark are to refute or correct it. Years ago, this kind of “reorientation” was widely accepted, but the downfall is that it only works on individuals who are capable of rational thinking. Dementia patients lose this ability as the disease progresses and can become agitated or upset when their concept of reality is challenged.” Today we understand that the most kind and respectful way to respond to the person with dementia is with both validation and reassurance.
Validation Therapy
Developed by Naomi Feil MSW, who worked with seniors with dementia, Validation Therapy acknowledges and accepts the “irrational perceptions of reality” often experienced by those with dementia. Instead of trying to correct someone who is convinced of the rightness of their own perceptions, this approach acknowledges and validates the individual’s experience of reality. This can help the person with dementia feel normal and reduce or even eliminate confusion and agitation. Validation is also a powerful gift to the individual’s loved ones/caregivers. By accepting the person’s new reality, caregivers free themselves of the need to cure or change them. When reality as we know it can no longer be understood by the person living with dementia, it is an act of love to let go of the need to control their thinking and instead, just go along for the ride.
The technique of validation “is now accepted as a practical way of working with people who have dementia,” writes the author. “It helps reduce stress, improve communication, reinforce self-esteem and infuse dignity into dementia care. It increases patients’ happiness because they aren’t continually being told that they are wrong and confused by truths that they cannot understand.”
Reassurance
Even as we validate the new reality of our loved ones and clients with dementia, there are times when distraction and redirection are necessary. This is particularly true when the person with dementia develops a belief that they or someone they love is in danger. In such cases, it is not wise to agree with the delusion that someone is out to harm them. A better approach is to validate their feelings and reassure them that they are safe and cared for. If, for example, a person with dementia believes that someone is trying to break into their home, a loved one/caregiver might walk them around the house checking the locks on the doors and windows. After that, they can be distracted with a fun activity.
Isn’t Validation Simply Lying to Our Elders?
Some people may feel that “validating” a person’s delusions is lying to them and treating them like a child. This is particularly true for spouses who may feel that it is being disrespectful. But as hard as it is to see that the person you love has changed, it creates a greater problem when “we as dementia caregivers, continually “correct” their thinking, thus chipping away at any self-esteem they have managed to retain throughout the course of this disease… The disease changes how the brain works and processes information, creating warped perceptions that they cannot differentiate from “true” reality. A caregiver’s commitment to honesty and accuracy may come from a good place, but it can be demeaning, even cruel, for a client or family member to endure.”
It’s natural to mourn the loss of a parent, friend, spouse or partner when dementia causes them to lose the ability to interact with us the way they once could. But as imagination takes the place of functional thought, caregivers can lock themselves out of their loved one’s world or they can learn to accept and even participate in their new reality. By going along for the ride, it may even create an opportunity to discover a new way of relating and bring back value to a relationship that once felt lost.
photo credit: A Health Blog Exercise Plays Vital Role Maintaining Brain Health via photopin (license)
