Basics
Validation is a
method of interacting with the dementia of people in the late stages of
Alzheimer's. People with Alzheimer's, especially on the late stages, frequently
exhibit abnormal, sometimes even incomprehensible, behavior. For example, they
may think they are living in a different time or place or they may continuously
repeat a physical gesture. Many people - including professionals - feel that
caregivers should handle this behavior by stopping it, ignoring it or
correcting it.
According to
validation method developer Naomi Feil, this unconventional behavior, while
illogical, is an attempt by the Alzheimer’s sufferer to communicate and express
their needs. The aim of the validation method is to understand and empathize
with the needs the person is trying to express. So, the theory behind
validation is the belief that people with dementia do and say things for a
reason, and validating their words and actions is a way of encouraging them to
keep communication open with the rest of the world. Another foundational
principle of validation states, that older people are to be valued as is, and
those with dementia should not be changed.
Principles
Here are the key
tenets of the Validation Method:
- Validation is a method of communicating
with and helping disoriented very old people. It is a practical approach
that helps reduce stress, enhance dignity and increase happiness.
Validation is built on an empathetic attitude and a holistic view of
individuals. By stepping into the shoes of another human being and seeing
the world through their eyes, caregivers can step into their world and
better understand the meaning of their sometimes bizarre behavior.
- Validation theory understands that these
patients are often in the final stage of life and trying to resolve
unfinished issues in order to die in peace. Validation techniques allow
patients to have the opportunity to express what they wish to express
verbally or non-verbally.
- Validation practitioners are taught to
be caring, non-judgmental and open to the feelings that patients
expressed, believing that when patients can express the things that have
often been suppressed for many years, the intensity of the feelings
lessen, they communicate more and are less likely to withdraw into further
stages of disorientation.
Effects
The way to validate a person that is suffering from dementia is to figure
out why they do and say what they do in details, and to accept this behavior.
Using validation methods of interaction is thought to prevent late stage
Alzheimer's patients from shutting down further mentally, keeping their
cognitive function active as much as possible. Validation encourages
Alzheimer's patients to forge a trust with their caregivers as a means to
encouraging communication between the two.
By lending an understanding ear to someone with Alzheimer's to verbalize their frustrations, worries and fears, the negative emotions can diminish. This will contribute to better cognitive functioning and behavior.
In her article “Communicating with the Confused Elderly Patient,” Naomi Feil
gives practical examples of the how the validation method works to help
communication between patient and caregiver. The following material is an
excerpt from this article:
The following scenario, based on actual case experience, depicts a less
effective way of responding to disorientation.
Mrs. K: “Doctor,
I have to go home now to feed my children.”
Physician: “Mrs.
K, you can’t go home. Your children are not there. You are 96 years old. Your
children are grown and live far away.”
Mrs. K.: “Oh,
Doctor I know all that. That’s why I have to get out of here, right now. I have
to feed them. They’re coming home for lunch, and the door is locked. Get me out
of here!”
The following response may be more appropriate, because it focuses
instead on the objective here and now and avoids asking why - a concept that
disoriented older people may not wish or be able to deal with.
Mrs. K.: “Doctor,
I have to go home now to feed my children.”
Physician: “What
will you feed them?”
Mrs. K.: “Oh,
Doctor, I am a good mother.” (The patient here confuses present and past time.)
“They love tuna. Do you think that’s good for them?”
Physician: “It
has a lot of protein. Is that what you fed your children? Do your grandchildren
eat tuna?”
Mrs. K.: “They
love it. I brought them all up right!” (The patient now moves between past
fantasy and present reality. When her need to be a good mother is expressed,
she can place herself in present time.)
Express the emotional need of the person aloud, thereby affirming the
person’s right to feel and to express feelings. Example:
Mrs. K.: “Doctor,
I have to feed my children.”
Physician: “You
must have been a good mother. You must miss your children.”
Mrs. K.: “You know
it. I always cared for them. Whatever they wanted, I gave them. You guessed it.
But I get along all right now without them.”
Dimensions
As a caregiver, you
have been introduced to a new and different world - the world of dementia.
People who inhabit the world of dementia are in a very different place than
those of us who live in "Reality" (whatever that is).
- Time. The first dimension in the Alzheimer’s
Universe is Time. Time in the world of dementia operates completely
differently than time does for the rest of us. First, time is not
sequential in the dementia universe. Time can be present at one moment,
past at another and future at another. Time has absolutely no continuity.
- Memory. Memory is very different in the
world of dementia. Past may be confused with present. Memory may be there
one moment and gone the next. The mind plays hurtful tricks in the world
of dementia - making a known and loved child or spouse into a stranger to
be feared. Family may no longer be family. As much as we in the "Real"
world know that this is our mother or wife or husband, the person in the
dementia world does not know these "Realities". S/he only knows
what they know at any given moment. It is so hard to accept their dementia
world.
It is so different from what we know in the "Real" world. Yet,
there is no successful alternative but to accept whatever the dementia person
claims as their reality - no matter how untrue it is to us. There is no
successful way to "force" a person with dementia to join the
"Real" world. Usually, the most frustrated caregivers are the ones
who have not accepted this simple fact: the world of dementia is defined by the
dementia victim. We in the "Real" world do not define it. We can only
hope to live in it somewhat peacefully IF AND ONLY IF we accept this dementia
world on the terms of the person with dementia. If they "see" a
rabbit on the couch, they see it. If you are not their spouse, you are not. If
it is breakfast time, it is breakfast time (even at 6 p.m.).
Telling the dementia person that "I am too your wife" or
"No, John, it IS NOT Friday. It is Sunday." Or saying, "Sally,
you don't have any little babies. You are 85. Your babies are all grown
up" - these kinds of statements from the "Real" world almost
always serve only to upset and distress the dementia person. However, if you
say something like, "If you say so, but I'd like to be your friend. .
." or "It's your Friday, huh? What do you do on Fridays?" or
"Sally, tell me about your babies."
- Emotions. Emotions are also very different in
the dementia universe. First, consider that the dementia person's
reasoning abilities are very limited or perhaps gone completely. There are
actual changes in the brain that affect a dementia person's ability to
think. So, they are somewhat like a pre-schooler in their ability to
assess, judge, make decisions, etc. Most dementia folks have some
difficulty in understanding the spoken language. However, almost all
dementia folks can easily pick up on the FEELINGS being expressed. It is
very true that in the dementia universe, it is NOT so much what you say,
but HOW you say it. When frustration, anger, and loudness creep into your
voice, the dementia person is going to feel that much more strongly than
the actual words being said.
Types
There are physical,
mental and social aspects of validation. Some Alzheimer's validation techniques
include:
- Centering. Centering is necessary in order to
feel empathy for someone with dementia. To become centered, one must
disregard personal feelings and thoughts in the mind.
- Mirroring. Mirroring is adopting similar actions,
tone, and volume of voice of someone. This technique is based on the human
behavior theory that people like, trust and feel comfortable with people
that are similar to them. Mirroring is not imitating or mocking. For
example, if someone is leaning in close to speak to you with a calm and
low voice, then you would also lean in close and use a low tone of voice.
- Physical Touch. Physical touch is used to foster a
relationship and trust with someone with Alzheimer's. This technique can
be used in subtle ways over time to foster communication with someone that
tends to withdraw.
Features
Alzheimer's
validation is comprised of four parts:
- The behavior of people with dementia is specific to their age. They
are trying to tie up the loose ends of their life's issues before they die.
- Validation puts the behavior of people with Alzheimer's into four
stages:
- Malorientation involves minimal forgetfulness and confusion;
- Time confusion involves losing the ability to distinguish
chronological time;
- Repetitive motion--when Alzheimer's patients can't use their words,
they resort to repetitive motion to solve problems;
- Vegetation, or blocking out the rest of the world and ceasing to
try to resolve their life issues.
- Validation should employ techniques related to the mental, physical,
emotional and social aspects of Alzheimer's.
- Five to 10 people should make up the validation group
with the goal of providing stimulation and communication with the person
suffering from Alzheimer's.
Benefits
Employing validation
techniques has the following benefits for Alzheimer's patients:
- Fewer incidents of lashing out physically;
- Less of a need to be physically restrained;
- Less of a need to be calmed down with medication or tranquilizers;
- Improved communication;
- The speed of Alzheimer's disease progression is slowed;
- Increased self-esteem and value of self.
History
Naomi Feil, an
expert on Alzheimer's disease, is credited with founding validation therapy.
She was born in Germany in 1932 and raised in a Cleveland, Ohio, home for
the elderly. Her mother worked in social services and her father was the
director of the elderly home. She developed validation as an alternative to
traditional methods of interaction with elderly people with dementia. The
Validation Method is a globally acclaimed protocol for care published in her
1982 book, Validation: The Feil Method. Feil’s philosophy for
dementia care is holistic and based in her understanding that unusual behaviors
expressed by dementia sufferers are often due to a combination of cognitive,
physical and social losses, and represent an attempt to express unresolved
feelings and emotions.
Sources and Additional Reading:
