Alzheimer's / Dementia

8/17/2020 | By Annie Tobey

Communication issues that arise as a person develops Alzheimer’s disease and other dementias can be uncomfortable for patients and for their loved ones. The methods of Validation therapy for dementia can help.

My grandmother had dementia for several years, and our communications reflected that. She would repeat stories, making conversations a loop of the same tales. She would tell us that she was leaving her nursing home later that day, though that was not the case. And she would tell us that Granddaddy was coming, although he had died several years earlier.

Once when I was visiting Grandmother, my aunts – her daughters – came to visit. Both women corrected Grandmother’s misstatements, reminding her that she was not leaving the nursing home and that Granddaddy had died. Naturally, the corrections confused and disturbed my grandmother. I couldn’t help but wonder, what was the point of the corrections? Didn’t they do more harm than good? Isn’t there a better way?

Enter Validation Therapy for Dementia

Naomi Feil had similar questions. She grew up in a home for the elderly, where both her parents worked. As an adult, Feil studied social work and began her own career with the elderly. Dissatisfied with traditional methods of working with severely disoriented people, she developed a system she called Validation. Feil wrote her first book on the subject in 1982, Validation: The Feil Method.

“Validation is a method of communicating and being with disoriented very old people,” explains the Validation Training Institute. The institute was founded by Naomi Weil to educate caregivers, both professional and personal, in working with disoriented older adults. “It is a practical way of working that helps reduce stress, enhance dignity and increase happiness. Validation is built on an empathetic attitude and a holistic view of individuals.”

But it’s more than just a kind and gentle way to ease communication and improve satisfaction for people on both sides of the conversation. The method emphasizes empathy and understanding, to help caregivers see the meaning beneath the person’s behavior, thus to help them heal. It embraces the idea that the person may be dealing with ghosts from the past, reconciling unresolved issues.

Such an approach is helpful for caregivers and patients alike. As the VTI website explains,

When disoriented elderly can express the things that have often been suppressed for many years, the intensity of the feelings lessen, people communicate more and are less likely to withdraw into further stages of disorientation. Validation practitioners are less stressed and frustrated, interactions are more rewarding and the everyday becomes easier.

Those who can benefit from learning techniques of validation for dementia include caregivers, family members, home health aides, nurses, physicians, and social workers, says

7 Tips for Applying the Validation Method

In interacting with a disoriented older adult:

1. Center yourself. Breathe and slow down before you act.

2. Listen. Don’t be anxious to respond. Try to understand the feelings or needs behind the words. Use eye contact and, if appropriate, physical contact.

3. Enter their world. Don’t force them into reality.

4. Rephrase and reflect. Without judgment or argument, rephrase their words to aid understanding.

5. Ask questions. Avoid questions like “Do you remember?” and “Why?” that might put them on the defensive.

6. Reminisce. Discuss memories and ask questions about meaningful people, events, and life stages. Acknowledge the feelings that arise. Use sensory descriptions: what someone looked like, how a favorite food tasted, and so on.

7. Speak clearly and calmly. A soothing voice can calm tense situations. If needed, go back to step 1, center yourself.

The Validation Method at Work

The VTI website cites a situation that an adult child of a person with dementia could encounter, and then examines the options.

Your mother hides picture albums and jewelry, then accuses you of taking them. When you find the missing items, she accuses you of pulling them out of the garbage where you threw them.

Do you:

Tell her the truth, that she hid the items?

No, she will argue that she didn’t. In actuality, she may have deeper reasons for her actions: the pictures and jewelry symbolize those things she’s lost – her youth, her husband, and so on. She may accuse other people so she doesn’t have to take responsibility for the losses herself.

Agree with her?

You could assure her that although you took those items, you won’t do it again.

No, then she won’t be able to trust you. “Deep down, she knows you are lying, patronizing her to keep her quiet,” the VTI example notes. “She needs to vent her feelings at being robbed, but no one hears.”

Help her express her anger?

Yes, you can realize that those possessions are symbols of her youth and empathize with her fears.

  • Rephrase: “Your wedding ring is gone, and you say I have stolen it?”
  • Use sensory descriptions: “That was that beautiful gold wedding ring with the date of your marriage engraved inside.”
  • Reminisce: “How did you and Dad meet?”

If you listen and empathize, your mother will have the opportunity to express how much she has lost. After time, her grief will lessen.

It’s comforting to know that methods have improved for communicating with our elders facing dementia. After all, they deserve our love and our respect.

Annie Tobey

Annie Tobey has been a professional writer and editor for more than 30 years. As editor of BOOMER magazine, she explored a diversity of topics of particular interest to adult children of seniors. When she’s not writing, she can be found running the trails or enjoying a beer with friends.

Annie Tobey