Caregivers of people suffering from Dementia often face the dilemma of whether they should agree with something the person says that they know is not true or disagree and correct the person. There have always been concerns about what is the best way to respond to an individual with dementia when he/she is confused about people, places, times, or situations.
The answer to this corresponds to two different approaches we have been practicing, reality orientation therapy and validation therapy. Selecting one of these two when responding to a person with dementia mostly depends on what stage of disorder the person is in, how much distress he/she is experiencing, and which practice you think can bring the most comfort to the sufferer.
The goal of the caregiver is, after all, to try and make the loved one feel good and happy and the practice that seems to be more effective at achieving this should be used. In this article, we consider the basic principles for the two types of approaches and some examples of implementation to help you decide which works better for you as a caregiver of a dementia patient.
Reality Orientation Therapy
The procedures used for this therapy were developed in 1958 and focus on reinforcing information about the current place, time, and people. This is essentially a behavior modification approach aimed at minimizing feelings of confusion, memory loss, and mental disorientation while improving one’s self-esteem.
This therapy involves frequently reminding the person of the reality to benefit his/her cognitive function. This approach to dementia care is more effective in the early stages of the disorder as orienting them to the present moment and surroundings keeps them grounded in the reality that they are also a part of it and hence, slows the cognitive decline.
Some of the most useful techniques to implement reality orientation therapy include having big clocks with dates and times in the home and labeling the drawers and doors about current events. You can direct conversations with the person to mention events that are currently occurring. Helping an individual with dementia by reorienting forms lasting relationships and encourages social interactions while reassuring the person.
This therapy is ideal in case the person with dementia often becomes disorientated as it offers reassurance and keeps them grounded in reality. Conversations about what just happened allow such people to maintain their dignity while helping them work out what is happening around them so that they can remain less agitated and anxious.
Validation Therapy
This therapy emphasizes the feelings and thoughts of the person with dementia and rather than trying to correct the person and forcing him/her to be in the real situation, it suggests that caregivers join with the person in his/her reality. Validation therapy consists of accepting the individual’s own world and thoughts to understand the person better.
This therapy is more useful for people in the mid to late stages of dementia where feelings are more important than orientation in reality. A person with dementia may have a personal reality based on the past as they relive the past experiences with loved ones who are no longer present. Validation therapy involves asking questions about the people or events involved in the person’s reality rather than correcting the person and reinforcing the original reality.
Tools to implement validation therapy often include personalized items like reminiscence and memory boxes that help the individual feel validated and safe while promoting a sense of assurance. When people are in later stages of dementia, it is better not to correct what they say because doing so could cause distress and confusion. The best way is to talk to them about their lives and show them pictures from their past.
Having a memory box near the person is a great way to use the validation approach. Items with visual cues of the individual’s life like old photographs of his/her family and holidays, a name badge from their old workplace, their favorite flower, or anything else they may find familiar are helpful.
Which is Better?
The question is which is the most effective and helpful approach and what the research says. Recently, the preference has shifted from reality to validation therapy and then a little back towards a more gentle form of reality orientation.
However, there is no one-size-fits-all solution to respond to people with dementia. Reality orientation and validation therapy are two of the most effective tools to help caregivers respond to confusion in positive ways to induce happy emotions and minimize anxiety and distress. We need a lot of tools when working with people suffering from dementia symptoms. What works today might not work tomorrow.
There can never be an absolute best way to handle a situation at a moment. It is always a matter of trial and error. But you can be sure that if you have a strong relationship with the person and you try to understand their needs and feelings, responding with care and concern, you are likely to get it right most of the time.
Reality Orientation and Validation therapy are two different approaches aimed at helping caregivers reinforce the sense of belonging and assurance in individuals with dementia. These techniques prove to be ideal in specific situations and stages of the disorder and help boost self-esteem while making the loved ones feel understood and loved.
