Post by norbert1 on Feb 8, 2005 15:17:51 GMT -5
Twenty years ago, the standard procedure was to reorient the dementia patient to reality by explaining where they were, etc. When a person was asking for a dead parent, because they had lost memory back to a point where they were younger, they would be told how old they were and that the parent they were asking for was no longer living. For a person living in the past, this was not comforting.
The current practice is to reorient to reality WHEN the person is confused but UNDERSTANDS the explanation. Eventually, the person is unable to process this information. The person who has delusions (firmly fixed false beliefs) is also unable to accept these explanations. Attempts to explain reality and reorient will only produce anger. After all, you are contradicting their reality, and you become a liar, or someone not to be trusted. At this point in dementia you must switch to validation.
This does not mean that you encourage this false viewpoint or reinforce it. It means you buy into it, and go along with it. For the person asking for their mother, you ask about her mother, what she was like, etc. You validate the feelings associated with her mother. Reminiscing about the home they want to go to allow a discussion of the emotions associated with the home.
The expression that sums all this up is "you have to go into their world, you cannot expect them to come into ours."
Validation is not to be confused with Validation Therapy that was developed by Naomi Feil. Her theory goes beyond simple validation and talks about resolving old conflicts in earlier life. Since the persons memory does not process and remember new information, this portion of her theory is really a stretch IMO. The more basic parts of her theory are good. She has written several books on this. I believe the latest is "The Validation Breakthrough"
Dementia sayings that sum it up...
-Pick your battles -
unless the delusion creates a danger, arguing about a delusion is just not worth the effort.
Dealing with behaviors-
join in, distract, and redirect
Norbert
--------------
New Techniques to Handle Loved Ones With Dementia
By Sue Shellenbarger
From The Wall Street Journal Online
If caring for an aged family member with dementia is making you lose your grip, caregiving experts have some advice:
Go ahead and lose it.
People with dementia can be unreasonable, agitated or aggressive, making caring for them a challenge. Trying to reorient them to reality is exhausting and usually futile, a fact that is contributing to rising rates of depression and disability among family caregivers.
Now, some caregiving organizations are promoting therapies that teach the opposite: Join patients in their mental world, play along with their memories and even lie, if necessary, to calm them.
There's a method to the madness. Researchers and counselors believe these new therapies can ease the caregivers' stress and help people with dementia, too. Among the methods: "therapeutic lying," or going along with elders in their confusion to avoid conflict; Aikido, a way of empathizing named for a nonaggressive Japanese martial art; and "validation therapy," which entails joining patients in recalling buried memories and emotions.
The techniques aren't for everyone. Sometimes the tactics demand too much of caregivers, or they risk isolating or offending the patient. Nevertheless, a growing number of caregivers swear by the techniques.
All have one thing in common: They require the caregiver to give up trying to force the dementia patient to accept reality, and surrender instead to the fact that the patient is living in another mental and emotional world. They differ in the degree to which the caregiver tries to understand the feelings and needs that underlie the dementia patient's behavior.
With therapeutic lying, the caregiver briefly pretends the elder's illusions are true and tells a lie as a distraction. A caregiver might tell a relative who insists on seeing her dead sister: "She went to the store. She'll be back in a bit."
Therapeutic lying can be practical and effective in matters of no consequence. It's best used to smooth over a brief moment of confusion. It can help control and reassure a dementia patient when time is short. But there are risks; some patients will know subconsciously that the caregiver is lying. Remembering the truth later, they may confront and accuse the caregiver.
It can be painful for caregivers too: They're giving up on their loved one as they knew them, and relinquishing hope that their old relationship will ever be the same. Portia Stewart wept at the idea of misleading her mother, 81 years old, after learning about the technique in a caregiver class. "I don't usually lie to my mother," she says.
But Ms. Stewart was forced to admit that reasoning with her mother had become impossible. She no longer could endure the continual battles. When her mother kept insisting she still lived at her previous home in Oakland, Calif., instead of Berkeley, where she lives now, nothing could dissuade her. Giving up averted conflict hasn't had any adverse effects. "It really doesn't matter where she is. We have to go with her to where she is in her head," Ms. Stewart says.
Another method, drawn from Aikido, takes the caregiver a little deeper into the patient's mental world. Instead of correcting the old person or lying to them about factual matters, the caregiver using Aikido sidesteps the issue altogether and looks for a deeper truth: the underlying emotion that's causing the problem. The caregiver states the emotion, tries to relate to it, expresses concern using "I" sentences and enlists the old person's help in finding a solution.
In one example, a caregiver might be turning herself inside out to care for a person with dementia, only to be accused by the patient of not doing enough, says Dan Kuhn of Mather LifeWays Institute on Aging, an Evanston, Ill., nonprofit that provides caregiver-training programs.
Instead of angrily asserting the facts -- that the caregiver actually is working very hard -- "the savvy caregiver would say, Mom or Dad, this must be very hard for you to be on the receiving end. I share your frustration about your becoming so dependent. How can we make this easier for you?" Mr. Kuhn says.
A third method, validation therapy, takes caregivers even more deeply into an old person's memories, encouraging them to "join the patient's emotional journey," says its creator, Naomi Feil of the Validation Training Institute in Cleveland. It requires a caregiver to recognize when unreasonable behavior isn't really about the matter at hand, but rather a deeper emotional issue. By inviting the old person to reminisce and air feelings, this technique allows repressed emotions to dissipate.
Like Aikido, this technique avoids lying by sidestepping factual matters. But rather than finding an immediate solution, validation therapy aims for the healing effect of airing emotions to a caring listener.
Lita Kohn's aged mother was driving her crazy on a car trip one day by continually repeating, "Do we have enough gas?" After answering yes five times, Ms. Kohn, of Cleveland, realized her mother was hurting over her loss of control of her life, and said: "Mom, it must be so hard to be the passenger rather than the driver." Together, they reminisced about how her mother had once enjoyed driving well and chauffeuring the family around, and she immediately relaxed and became happier, Ms. Kohn says.
But don't try this at home if you lack the love, emotional closeness and time needed to delve into the world of past experience where your relative lives, mentally and emotionally.
----------------
From Harvard health Advisor
-- Enter her world. People with Alzheimer's disease sometimes have delusions; challenging these delusions may only make them feel threatened and insecure. Instead, you should acknowledge the underlying emotion and perhaps redirect their thinking. If someone with Alzheimer's talks about her dead mother as if she were still alive, rather than disagree with her, you might say, "Your mother sounds like a lovely person. Tell me about her." Sometimes entering this world means just playing along.
The current practice is to reorient to reality WHEN the person is confused but UNDERSTANDS the explanation. Eventually, the person is unable to process this information. The person who has delusions (firmly fixed false beliefs) is also unable to accept these explanations. Attempts to explain reality and reorient will only produce anger. After all, you are contradicting their reality, and you become a liar, or someone not to be trusted. At this point in dementia you must switch to validation.
This does not mean that you encourage this false viewpoint or reinforce it. It means you buy into it, and go along with it. For the person asking for their mother, you ask about her mother, what she was like, etc. You validate the feelings associated with her mother. Reminiscing about the home they want to go to allow a discussion of the emotions associated with the home.
The expression that sums all this up is "you have to go into their world, you cannot expect them to come into ours."
Validation is not to be confused with Validation Therapy that was developed by Naomi Feil. Her theory goes beyond simple validation and talks about resolving old conflicts in earlier life. Since the persons memory does not process and remember new information, this portion of her theory is really a stretch IMO. The more basic parts of her theory are good. She has written several books on this. I believe the latest is "The Validation Breakthrough"
Dementia sayings that sum it up...
-Pick your battles -
unless the delusion creates a danger, arguing about a delusion is just not worth the effort.
Dealing with behaviors-
join in, distract, and redirect
Norbert
--------------
New Techniques to Handle Loved Ones With Dementia
By Sue Shellenbarger
From The Wall Street Journal Online
If caring for an aged family member with dementia is making you lose your grip, caregiving experts have some advice:
Go ahead and lose it.
People with dementia can be unreasonable, agitated or aggressive, making caring for them a challenge. Trying to reorient them to reality is exhausting and usually futile, a fact that is contributing to rising rates of depression and disability among family caregivers.
Now, some caregiving organizations are promoting therapies that teach the opposite: Join patients in their mental world, play along with their memories and even lie, if necessary, to calm them.
There's a method to the madness. Researchers and counselors believe these new therapies can ease the caregivers' stress and help people with dementia, too. Among the methods: "therapeutic lying," or going along with elders in their confusion to avoid conflict; Aikido, a way of empathizing named for a nonaggressive Japanese martial art; and "validation therapy," which entails joining patients in recalling buried memories and emotions.
The techniques aren't for everyone. Sometimes the tactics demand too much of caregivers, or they risk isolating or offending the patient. Nevertheless, a growing number of caregivers swear by the techniques.
All have one thing in common: They require the caregiver to give up trying to force the dementia patient to accept reality, and surrender instead to the fact that the patient is living in another mental and emotional world. They differ in the degree to which the caregiver tries to understand the feelings and needs that underlie the dementia patient's behavior.
With therapeutic lying, the caregiver briefly pretends the elder's illusions are true and tells a lie as a distraction. A caregiver might tell a relative who insists on seeing her dead sister: "She went to the store. She'll be back in a bit."
Therapeutic lying can be practical and effective in matters of no consequence. It's best used to smooth over a brief moment of confusion. It can help control and reassure a dementia patient when time is short. But there are risks; some patients will know subconsciously that the caregiver is lying. Remembering the truth later, they may confront and accuse the caregiver.
It can be painful for caregivers too: They're giving up on their loved one as they knew them, and relinquishing hope that their old relationship will ever be the same. Portia Stewart wept at the idea of misleading her mother, 81 years old, after learning about the technique in a caregiver class. "I don't usually lie to my mother," she says.
But Ms. Stewart was forced to admit that reasoning with her mother had become impossible. She no longer could endure the continual battles. When her mother kept insisting she still lived at her previous home in Oakland, Calif., instead of Berkeley, where she lives now, nothing could dissuade her. Giving up averted conflict hasn't had any adverse effects. "It really doesn't matter where she is. We have to go with her to where she is in her head," Ms. Stewart says.
Another method, drawn from Aikido, takes the caregiver a little deeper into the patient's mental world. Instead of correcting the old person or lying to them about factual matters, the caregiver using Aikido sidesteps the issue altogether and looks for a deeper truth: the underlying emotion that's causing the problem. The caregiver states the emotion, tries to relate to it, expresses concern using "I" sentences and enlists the old person's help in finding a solution.
In one example, a caregiver might be turning herself inside out to care for a person with dementia, only to be accused by the patient of not doing enough, says Dan Kuhn of Mather LifeWays Institute on Aging, an Evanston, Ill., nonprofit that provides caregiver-training programs.
Instead of angrily asserting the facts -- that the caregiver actually is working very hard -- "the savvy caregiver would say, Mom or Dad, this must be very hard for you to be on the receiving end. I share your frustration about your becoming so dependent. How can we make this easier for you?" Mr. Kuhn says.
A third method, validation therapy, takes caregivers even more deeply into an old person's memories, encouraging them to "join the patient's emotional journey," says its creator, Naomi Feil of the Validation Training Institute in Cleveland. It requires a caregiver to recognize when unreasonable behavior isn't really about the matter at hand, but rather a deeper emotional issue. By inviting the old person to reminisce and air feelings, this technique allows repressed emotions to dissipate.
Like Aikido, this technique avoids lying by sidestepping factual matters. But rather than finding an immediate solution, validation therapy aims for the healing effect of airing emotions to a caring listener.
Lita Kohn's aged mother was driving her crazy on a car trip one day by continually repeating, "Do we have enough gas?" After answering yes five times, Ms. Kohn, of Cleveland, realized her mother was hurting over her loss of control of her life, and said: "Mom, it must be so hard to be the passenger rather than the driver." Together, they reminisced about how her mother had once enjoyed driving well and chauffeuring the family around, and she immediately relaxed and became happier, Ms. Kohn says.
But don't try this at home if you lack the love, emotional closeness and time needed to delve into the world of past experience where your relative lives, mentally and emotionally.
----------------
From Harvard health Advisor
-- Enter her world. People with Alzheimer's disease sometimes have delusions; challenging these delusions may only make them feel threatened and insecure. Instead, you should acknowledge the underlying emotion and perhaps redirect their thinking. If someone with Alzheimer's talks about her dead mother as if she were still alive, rather than disagree with her, you might say, "Your mother sounds like a lovely person. Tell me about her." Sometimes entering this world means just playing along.