Thank you for this article. I'm still new to being a dementia caregiver. When my mom first started showing cognitive impairment, I vowed to always be honest with her. My motivation came from a good place - I wanted to commit to never lying to her about her condition or her prognosis or her finances or anything I do for her.
A few days ago, I found myself in the car heading to the store with her, squabbling about whether she needed kleenex. I had just days earlier been in her ALF apartment searching for her lost keys when I found at least 12 boxes of kleenex stashed in various places, but she was wanting to get kleenex at the store. Our "discussion" ended with her sulking on her side of the car, upset with me that I didn't think she would know if she had kleenex or not. I felt pretty rotten upsetting her like that over something silly like kleenex. I had to ask myself what I hoped to gain by denying her kleenex if she wanted kleenex and I realized - nothing at all. We bought kleenex. She now has fourteen boxes of kleenex. Next time I'm in her apartment, I'll tell her I need kleenex at home and ask her if I can borrow a box or two. She can feel like she's helping me and I can mitigate the kleenex overload I felt a little like a pushover, but she was happy and I had lost nothing for it. And then I read this article, and realized - my instinct to let it go was correct and I felt better because my response WAS better. I hope I can remember this lesson.
It's funny that as parents we work so hard to be firm with our children and hold our ground on certain things. Then - as grown children of parents with dementia - we work so hard to go with whatever flow they are following at the moment.
My parents were both nurses. For most of my pre-adult years my dad was a Director of Nursing in Long Term Care facilities. My mom had similar roles in the local hospital system. The rule both of them followed always was to make sure the patients were as happy as possible. As they started nursing in the 60’s I don’t know if the term “Validation” was used. My parents just called it compassion and humanity and what was right. Basically, don’t harm. I had the opportunity to actually watch my dad interact with the patients in his facilities (I was a patient and volunteer). I saw how he would enter their world and reassure them. I witnessed his redirection when the situation could not be validated (where the patient believed they were in danger or their beliefs were harmful to others). When my paternal grandma started into dementia my parents set the rules that the whole family were not to correct her. Don’t remind her that she’s told you that over and over. If she is saying or doing something dangerous or harmful than redirect her. Thankfully my grandma was very accepting of all this. When the time came for LTC my parents went and visited the ward to see how the staff interacted with the residents, to make sure these beliefs were used. She lived very happily for 15 years with dementia. But I know that’s not common. Now, my dad has entered into rapid onset and decline dementia. Perhaps around stage 5 or 6 from what I can gauge. It’s taken only around 2 months to reach this point. We are still awaiting doctors visits to see if there is an underlying cause that might be able to treated. I have the benefit of his example all these years to show me how he wants to be treated. For that I know I am very lucky that this was something my parents always made their views on clear. Still, to read it written up here so wonderfully really helped reassure me of this course. And, importantly, it brought back so many memories of how my dad treated those with dementia and how he would like to be treated. Thank you!
Could anyone suggest a better way? We cannot use validation therapy for my MIL because she is always telling us how she was raped by this person or that person when she was young. She claims her own husband raped her multiple times. This is hard for my husband to hear. We cannot validate these dementia delusions. It appears her dementia is taking her down a low road. How do we talk to her without making her feel like we don't believe her (which we don't) or without making her feel that this is acceptable?
My mom suffers from Lewy Body Dementia. With the help of Donepezal, many of the prior hallucinations have gone away. I understand the reasoning behind Validation, but if they are frightened, should we use realty to curb those fears? For example, although she lives on the second floor in an Assisted Living facility, she thinks someone is looking through her window. I've told her that no one has a ladder that tall to look in but wonder if that is not the right response?? Thanks!!
There is a book that I have found very helpful: 'A Loving Approach to Dementia Care' by Laura Wayman. I also had the opportunity to hear her speak and offer solutions. Laura writes to acknowledge the person's feelings, for instance if they are frustrated with their failing memory starting off with "I would be frustrated if I couldn't find my purse either, let's look in your closet!"...addressing their feelings and offering some sort of remedy to see if that calms them, then it's easier to re-direct. Her book has a great way describe how a person with dementia may experience their day..think of when you finish at a store and walk down the aisle where you thought you parked..but you don't see your car! There are those seconds of confusion (where IS my car?!) and then panic (Did my car get stolen?!)...those feelings could be experienced by a person with dementia several times a day or more! This has given me more empathy in caring for Mom and I think more patience, too!
Hi... LaTxKan... I can relate to your struggle with your dad. My mom was diagnosed with dementia by a doctor in a long term care unit that was treating her second case of pneumonia in 6 months. After the this diagnosis she simply continued care with her primary care physician as if it had never been said. Fast forward 2 and 1/2 years and we are to the point now where she has several days of seeing the police coming down the road to arrest her... People in her room.... Little kids running around messing with things... And this goes for 3 or 4 days and nights in a row with very little sleep. The last time it happened she went so far as yo actually call 911. Thankfully we have an appointment in a couple days with a neurologist and I'm hopeful that maybe there's a medication that can help because validating these particular hallucinations is becoming more and more difficult to say the least... Sorry for the rambling nature of this post... I guess I just needed to vent
My brother is in a nursing home. Has lewy bodies dementia. He lives in Florida, I live in VA. Visited recently. Made a memory book of our family. My brother loved it. First time he laughed since entering the home. Thank you for discussing the value of a memory book. I made this book before reading your article. Now I feel he knows we are here and we love home.
I wished that I had known this therapy before my mom passed. She was having delusions of her past life and I did not know what to say to her. For example, even we were home, she kept asking when can we go back home. I was so stunned and then told her that we were home. She thought she was at the hotel because my dad used to be a musician and they traveled a lot. It was so hard to watch her.
This is exactly what I do with my mom and other residents in Memory Care. When we call relatives in our home state so that mom can talk to them they never skip a beat and play right along. Reorientation may be more appropriate with people in psych facilities. Dementia/Alzheimer's is a different bag.
Reorienting them to truth only makes them sad. Why do that to them? I never tell mom when someone has passed away. When she asks if I've seen her parents or my dad I don't tell her they have passed on years ago when she was well. I just say "Oh, they're around here somewhere" and she accepts that. The main focus is that the rest of her days be happy, feeling loved, safe and secure.
When visiting her I make sure it is fun. We laugh and talk, I do her nails, lotion her down, brush her hair and put lipstick on her. I take a picture and send to my sisters and other relatives who live in other states and want to be kept up to date on how she is doing. She may throw an F bomb or two every now and then but we giggle about that too. Staff included!
On one visit mom was so comical that the staff and I laughed our heads off. I wiped tears from laughing so hard and laughed for several days every time just thinking about it. The residents enjoyed the laughter and it was good for them.
So, whatever your loved one says, no matter how far off the wall, play along and agree. It hurts nothing and loved one is happy. That's what's important.
I cannot say enough positive things about the harmony this approach has brought to my household. With my husband's increasing dementia, my natural inclination was to try & reorient him in reality and refute is confabulations. While the path isn't always smooth, there is definitely more peace of mind for both of us now that I better realize what's going on and how to best respond to him.
Carol, what a beautifully written article! Thank you for sharing. I am very fortunate at this moment in time that my 93 yr old mother does not have nor show any signs of dementia. Maybe she will be one of the lucky ones. I surely hope so. My heart goes out to everyone who suffers through this awful disease.
I believe the article perfectly describes a loving daughter trying to, as you mentioned, get inside her father’s world and tend for his needs. Validation means exactly what it means if you look it up: “recognition or affirmation that a person or their feelings or opinions are valid or worthwhile”.
I think it’s definitely the most caring and loving demonstration of a conscious and constant effort to help a loved one with dementia get through life at peace and feeling respected.
Otherwise, what would you get out of contradicting someone that simply firmly believes that today -for example-he or she will see a deceased parent? What exactly would you get out of making someone grieve again over and over?
That person believes that what they think is true at that point in time as much as you believe your name is Vickie.
Trying to invalidate what the article states because you want to stick to a narrow definition of “validation” doesn’t seem helpful for all the people that visit Agingcare, who are desperately trying to cope and find the best way to deal with a loved one that lives in a different reality.
I personally think that the way this article describes validation is the best human way to give your loved one reassurance that they are ok, cared for and loved.
My dad has Parkinsons and Parkinsons delusions. I found this article after a long night. I like this premise but is there a book on suggestions of what to say when? Last night he wanted to end it all and was going to take a bottle of aspirin because he so scared the authorities are going to come lock him up and put in jail. My dad has always had a fear of authority from minor to major. I had a wake up call since he actually got up and found a new box of aspirin b4 I woke up. (Fixed that issue) How do you redirect? He says then I would not have to take care of him. Is this really in the back of his mind? What do you say in the am when he asked how I slept when I was up 2 hours talking and hiding things? Article and responses gave me some ideas. Any suggestions on sucide (he would never consciously do) what be appreciated. Im not at my best at 2 am or now after little sleep. Sorry if I rambled.
Dear Carol, it's great that you found something that helped you but what you described was not really Validation. One of the most important Validation principles, created by my mother Naomi Feil, is that people live on various levels of consciousness and older adults know when you are playing, acting or lying. One should never lie to an older adult with cognitive decline. A Validation practitioner does indeed enter into the world of the other person but does not pretend that it's real nor correct. She explores the needs and feelings of the other person, accepting those as important and real. The other thing I'd like to mention is that the Validation method was created for building relationships and communication with very old people who have usually been diagnosed with late onset Alzheimer's. They are in the final life stage and are trying to resolve unfinished business from the past. Some elements of the method have been successfully used with others. I hope this helps. Come visit our website: www.vfvalidation.org for more information.
Some nursing homes get very creative with their validation therapy in order to reduce agitation. The best scenario I heard of was at the home where my father was placed.
There was a resident who always got very agitated around 10-11 pm and no sleeping pill could keep him in his bed. He would pace the halls and check the doorknobs of the others residents' rooms - and could not be dissuaded from this behavior, no matter which distraction technique was employed.
One day the daughter came to visit and happened to mention to the staff that her father had worked as a night watchman for 40 years - when they mentioned his being up all night! Clearly, the man was engaging in his "customary" behavior.
So, they bought him a huge ring of plastic door keys that resembled the ring of keys he used to carry. The staff allowed him to walk the halls during the night checking the locks with the "keys" - and allowed him to sleep during the daytime.
All of the behavior problems with this resident ended once they validated and accommodate his customary life routine.
I think it's just plain "mean" to validate their "delusion." But it's fine to validate their "feelings," which is a different matter.
Redirection is always a good technique to use with dementia patients, just as we often use redirection with toddlers.
For example, an RN colleague of mine said that one of her dementia residents asked where her daughter was. (The daughter had died 10 years earlier of cancer.) The RN said, "Well, it's Saturday, and a lot of people go shopping on Saturdays." The resident laughed and said, "Oh yes, my daughter really loves to shop at that new mall and will shop until she drops." She's likely shopping right now." The RN then changed the subject - and the resident never remembered that she asked about her daughter.
You will notice that the nurse did not validate the resident's delusion or outright lie to her - but she provided a distraction. It would have served no constructive purpose to blurt out, "Mrs. Jones, your daughter died 10 years ago." But the nurse did validate Mrs. Jones' feelings of being concerned that her daughter was not present.
I totaly agree with validation therapy and find it helpful. I am glad you pointed out that at times you it is not helpful and need to use distraction and redirection. My mother is living with me and at times has fixed false beliefs mostly in later in the day regarding that someone is out to harm her or me. I did not find it helpful and actually made her more frightened and difficult to care for when family members would reinforce to her that her beliefs were true that somone was out to harm us. She got to the point where she was so frightened she never wanted me to leave the house. How can you teach others how to validate her feelings without feeding the frightening fixed false beliefs?
I'm happy to see this article here. I'm glad there's authority validating the idea of validating the alternate reality of a demented loved one. As I posted on another thread, we adopted this approach when my critically ill sister developed delirium during an extended stay in the ICU. She was already terrified of her helplessness and severe illness, and it would have thrown her over the edge to make her feel that she was also going crazy and imagining things. The exception was when her delusions involved something threatening to her. In that case, we tried to validate her thinking, yet show her (if we could) that the threat had been /would be taken care of by those she still trusted, such as her husband. We just couldn't keep contradicting and correcting her - it would have taken away the last vestige of control she had, and might have added us, her loved ones, to the list of people she couldn't trust and who were threatening to her.
oceansong, you said it so well. There are creative responses to these things - often all you can do is say is offer comfort and say "we'll take care of you." Validation isn't always about agreeing with the person but it's never about arguing. Support and comfort and safety are what you are offering. Thanks for your excellent comment. Carol
I help my friend with her 92 year old mother. Emma's husband of 70 years died at age 91. At first we would try to tell Emma the truth - that her husband died. But then she would forget and ask all over again "Where is he?" Telling her again just re-traumatized her - because for her, she was just hearing it for the first time. We started telling her he was on a trip and would be back later. And then, occasionally she would have a lucid moment and state: He died, didn't he? At those moments, we would tell her she was right. When we moved Emma across the country, she was worried that her parents (who died decades ago) wouldn't know where she was, or would be mad at her for not being home. We started reassuring her that her mom and dad knew where she was and they were glad she was coming to live with us. When she refuses to take her meds, we will sometimes tell her that we just talked with her doctor, or with her mom and that person said she has to take her meds, or eat her dinner, or.... When she accuses one of us that we are trying to kill her (insisting that she wash her hands, or change clothes, or..) - we can't validate that reality. But we can reassure her that we love her and that her mom said it's OK for her to be there. You just have to be creative and adapt your response to what will work in the moment.
Maria, I checked the stats on mental illness and saw that 18% of people in the US have some form of mental illness each year. That surprised me. This included depression, bipolar, anxiety disorders, schizophrenia, and other major disorders. If a large number of people have mental illnesses, but are not diagnosed, the 18% could be a low estimate. If the estimate is right, it is no wonder that so many of us have such a trying time as caregivers. We're not only dealing with the elder-onset problems, e.g. dementia, but the long-term mental illness. You are definitely not alone.
My mother has been bipolar for most of her life. At 90, she is not a typical dementia case. Her mental illness colors everything and has always complicated our family life. My dad and brother are dead. It's just me and my mother in my house at this time and she's a real trip. May I quote my dear brother? - "Sis, she's gonna kill us all." That means I'm next lol
Matriarch60, you'd be surprised (or maybe you wouldn't but a lot of people would) how many letters I receive with such issues in mind. Lifelong depression, bi-polar disease and other mental illness is affecting our aging generations. This is a good idea for a future article. Thanks for mentioning it. Carol
I'm eager to see some articles about the struggles of aging mentally ill people--people who do NOT have Alzheimer's or dementia, but who've struggled with schizophrenia, mania, or other major mental illness their entire lives, and who are now living longer.
That's because you are human. We don't always have the time, presence of mind (as in when she's climbing over the rails), etc. to do exactly the right thing - whatever that may be at the moment. It's not possible. Validation makes day to day life easier and more pleasant for most caregivers as well as the people for whom they care. However, as you say, there are times...well, we all understand that! Take care, Carol
Sounds great in theory and it does work. But I know that I have my breaking points as well. You can only take so much and then you have to bring them into some kind of reality. There are times when my mom wants me to bring all the children to her to sleep in her bed, (There are no children). There are times when she wiggles out of her clothing and wants to have sex.(Obviously that is not happening). By the way she is 96 years old. It is very hard and sad to deal with all this. Wish I could be positive all the time but at 3 am when she is climbing over the rails on her bed and falling, I break down.
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Is Using Validation for Dementia Calming or Condescending?
A few days ago, I found myself in the car heading to the store with her, squabbling about whether she needed kleenex. I had just days earlier been in her ALF apartment searching for her lost keys when I found at least 12 boxes of kleenex stashed in various places, but she was wanting to get kleenex at the store. Our "discussion" ended with her sulking on her side of the car, upset with me that I didn't think she would know if she had kleenex or not. I felt pretty rotten upsetting her like that over something silly like kleenex. I had to ask myself what I hoped to gain by denying her kleenex if she wanted kleenex and I realized - nothing at all. We bought kleenex. She now has fourteen boxes of kleenex. Next time I'm in her apartment, I'll tell her I need kleenex at home and ask her if I can borrow a box or two. She can feel like she's helping me and I can mitigate the kleenex overload I felt a little like a pushover, but she was happy and I had lost nothing for it. And then I read this article, and realized - my instinct to let it go was correct and I felt better because my response WAS better. I hope I can remember this lesson.
It's funny that as parents we work so hard to be firm with our children and hold our ground on certain things. Then - as grown children of parents with dementia - we work so hard to go with whatever flow they are following at the moment.
I had the opportunity to actually watch my dad interact with the patients in his facilities (I was a patient and volunteer). I saw how he would enter their world and reassure them. I witnessed his redirection when the situation could not be validated (where the patient believed they were in danger or their beliefs were harmful to others).
When my paternal grandma started into dementia my parents set the rules that the whole family were not to correct her. Don’t remind her that she’s told you that over and over. If she is saying or doing something dangerous or harmful than redirect her. Thankfully my grandma was very accepting of all this. When the time came for LTC my parents went and visited the ward to see how the staff interacted with the residents, to make sure these beliefs were used. She lived very happily for 15 years with dementia. But I know that’s not common.
Now, my dad has entered into rapid onset and decline dementia. Perhaps around stage 5 or 6 from what I can gauge. It’s taken only around 2 months to reach this point. We are still awaiting doctors visits to see if there is an underlying cause that might be able to treated.
I have the benefit of his example all these years to show me how he wants to be treated. For that I know I am very lucky that this was something my parents always made their views on clear.
Still, to read it written up here so wonderfully really helped reassure me of this course. And, importantly, it brought back so many memories of how my dad treated those with dementia and how he would like to be treated. Thank you!
Her book has a great way describe how a person with dementia may experience their day..think of when you finish at a store and walk down the aisle where you thought you parked..but you don't see your car! There are those seconds of confusion (where IS my car?!) and then panic (Did my car get stolen?!)...those feelings could be experienced by a person with dementia several times a day or more! This has given me more empathy in caring for Mom and I think more patience, too!
I can relate to your struggle with your dad. My mom was diagnosed with dementia by a doctor in a long term care unit that was treating her second case of pneumonia in 6 months. After the this diagnosis she simply continued care with her primary care physician as if it had never been said. Fast forward 2 and 1/2 years and we are to the point now where she has several days of seeing the police coming down the road to arrest her... People in her room.... Little kids running around messing with things... And this goes for 3 or 4 days and nights in a row with very little sleep. The last time it happened she went so far as yo actually call 911. Thankfully we have an appointment in a couple days with a neurologist and I'm hopeful that maybe there's a medication that can help because validating these particular hallucinations is becoming more and more difficult to say the least... Sorry for the rambling nature of this post... I guess I just needed to vent
Reorienting them to truth only makes them sad. Why do that to them? I never tell mom when someone has passed away. When she asks if I've seen her parents or my dad I don't tell her they have passed on years ago when she was well. I just say "Oh, they're around here somewhere" and she accepts that. The main focus is that the rest of her days be happy, feeling loved, safe and secure.
When visiting her I make sure it is fun. We laugh and talk, I do her nails, lotion her down, brush her hair and put lipstick on her. I take a picture and send to my sisters and other relatives who live in other states and want to be kept up to date on how she is doing. She may throw an F bomb or two every now and then but we giggle about that too. Staff included!
On one visit mom was so comical that the staff and I laughed our heads off. I wiped tears from laughing so hard and laughed for several days every time just thinking about it. The residents enjoyed the laughter and it was good for them.
So, whatever your loved one says, no matter how far off the wall, play along and agree. It hurts nothing and loved one is happy. That's what's important.
I believe the article perfectly describes a loving daughter trying to, as you mentioned, get inside her father’s world and tend for his needs. Validation means exactly what it means if you look it up: “recognition or affirmation that a person or their feelings or opinions are valid or worthwhile”.
I think it’s definitely the most caring and loving demonstration of a conscious and constant effort to help a loved one with dementia get through life at peace and feeling respected.
Otherwise, what would you get out of contradicting someone that simply firmly believes that today -for example-he or she will see a deceased parent? What exactly would you get out of making someone grieve again over and over?
That person believes that what they think is true at that point in time as much as you believe your name is Vickie.
Trying to invalidate what the article states because you want to stick to a narrow definition of “validation” doesn’t seem helpful for all the people that visit Agingcare, who are desperately trying to cope and find the best way to deal with a loved one that lives in a different reality.
I personally think that the way this article describes validation is the best human way to give your loved one reassurance that they are ok, cared for and loved.
Last night he wanted to end it all and was going to take a bottle of aspirin because he so scared the authorities are going to come lock him up and put in jail. My dad has always had a fear of authority from minor to major. I had a wake up call since he actually got up and found a new box of aspirin b4 I woke up. (Fixed that issue) How do you redirect? He says then I would not have to take care of him. Is this really in the back of his mind? What do you say in the am when he asked how I slept when I was up 2 hours talking and hiding things?
Article and responses gave me some ideas. Any suggestions on sucide (he would never consciously do) what be appreciated. Im not at my best at 2 am or now after little sleep. Sorry if I rambled.
The other thing I'd like to mention is that the Validation method was created for building relationships and communication with very old people who have usually been diagnosed with late onset Alzheimer's. They are in the final life stage and are trying to resolve unfinished business from the past. Some elements of the method have been successfully used with others.
I hope this helps. Come visit our website: www.vfvalidation.org for more information.
There was a resident who always got very agitated around 10-11 pm and no sleeping pill could keep him in his bed. He would pace the halls and check the doorknobs of the others residents' rooms - and could not be dissuaded from this behavior, no matter which distraction technique was employed.
One day the daughter came to visit and happened to mention to the staff that her father had worked as a night watchman for 40 years - when they mentioned his being up all night! Clearly, the man was engaging in his "customary" behavior.
So, they bought him a huge ring of plastic door keys that resembled the ring of keys he used to carry. The staff allowed him to walk the halls during the night checking the locks with the "keys" - and allowed him to sleep during the daytime.
All of the behavior problems with this resident ended once they validated and accommodate his customary life routine.
Redirection is always a good technique to use with dementia patients, just as we often use redirection with toddlers.
For example, an RN colleague of mine said that one of her dementia residents asked where her daughter was. (The daughter had died 10 years earlier of cancer.) The RN said, "Well, it's Saturday, and a lot of people go shopping on Saturdays." The resident laughed and said, "Oh yes, my daughter really loves to shop at that new mall and will shop until she drops." She's likely shopping right now." The RN then changed the subject - and the resident never remembered that she asked about her daughter.
You will notice that the nurse did not validate the resident's delusion or outright lie to her - but she provided a distraction. It would have served no constructive purpose to blurt out, "Mrs. Jones, your daughter died 10 years ago." But the nurse did validate Mrs. Jones' feelings of being concerned that her daughter was not present.
Oh, Mom, I'm sorry you're so scared that someone is out to harm you. That must be a terrible feeling. What would make you feel more safe right now?
NOT, oh mom, yes you're right, there is someone out to get you.
Carol
When we moved Emma across the country, she was worried that her parents (who died decades ago) wouldn't know where she was, or would be mad at her for not being home. We started reassuring her that her mom and dad knew where she was and they were glad she was coming to live with us.
When she refuses to take her meds, we will sometimes tell her that we just talked with her doctor, or with her mom and that person said she has to take her meds, or eat her dinner, or....
When she accuses one of us that we are trying to kill her (insisting that she wash her hands, or change clothes, or..) - we can't validate that reality. But we can reassure her that we love her and that her mom said it's OK for her to be there.
You just have to be creative and adapt your response to what will work in the moment.
dementia case. Her mental illness colors everything and has always complicated our family life. My dad and brother are dead. It's just me and my mother in my house at this time and she's a real trip. May I quote my dear brother? - "Sis, she's gonna kill us all." That means I'm next lol
Carol
Take care,
Carol