Validate the feelings of the person with dementia.
To validate: to recognize or affirm the validity of a person, their feelings or opinions.
Oxford English Dictionary
It is important for the caregiver to acknowledge and accept the feelings and beliefs of the person with dementia. Whether they are caused by delusions or misinterpretation of the situation or environment, acknowledging them and putting yourself in that person’s place often helps to prevent or resolve problems.
Henry, who had stage 5 Alzheimer’s disease, was admitted to a memory care unit because Grace, his wife of 55 years, and the person who had been his caregiver, died suddenly of a heart attack. After the funeral, his daughter Catherine brought Henry home with her to live, but she found she could not provide the supervision he needed. Catherine was also upset because Henry could not remember that Grace had died. He kept asking where she was.
Over and over again, Catherine explained that Grace had died, but each time Henry heard this was like the first time. Each time he would cry and grieve most of the day. However, when Henry went to his room at night Catherine knew he would forget that his wife had died, and in the morning would once again ask for Grace. This was so upsetting to her that she finally took the obituary notice that had run in the local paper and hung it on the refrigerator door. Each of them was suffering the loss of Grace. . . over and over again.
Before he was admitted, Catherine had told Henry he would be going to a large facility in the country. Henry was under the impression he was at a hotel for an extended vacation. Surprisingly, he was anxious to meet the other “guests” and easily fit in with the others on the unit. Since this delusion made it easier for Henry to accept his new home, the staff did not challenge his beliefs.
Once he was admitted, however, the staff had to decide how to handle Henry’s question “Where is Grace?” Everyone knew they all had to have the same answer, but they were not going to tell Henry his wife had died. They felt this was cruel and unnecessary. He obviously missed her, however, and the staff could not ignore his feelings. They decided instead to acknowledge his concern and love for Grace. They would simply say “She isn’t here right now, Henry, but I don’t know her, why don’t you tell me a little about her and the things you like to do together?”
After a few minutes spent talking about Grace, the staff would spin the conversation off to something else or follow it with some type of distraction like an offer to take him for a short walk or get him a cup of tea. This plan would certainly not work for someone who did not have dementia, but Henry, whose cognition and memory were failing, loved to talk about Grace and it was the kindest thing to do. It also helped him to relive some of the wonderful times he and his wife had together.
Henry never stopped believing he was in a hotel, and his caregivers did their best to treat him like a guest. Catherine was happy to do the same. They never challenged his belief or caused him grief with the news that he had lost his wife. Henry asked frequently about Grace in the beginning, but as his dementia progressed, Henry stopped asking about her.
Henry’s belief that he was living in a hotel was a delusion. Delusions are not uncommon in people with dementia and it is important to recognize the person’s feelings or beliefs are real to them. If delusions fill a need and are not upsetting or harmful, there is no reason to treat them.
Henry’s care plan encouraged his caregivers to imagine themselves in Henry’s place and work within his reality. The goal was to get Henry to openly express his feelings about Grace by allowing him time to talk about her and remember their life together. This helped Henry to cope with her absence and encouraged a feeling of warmth and understanding between Henry and the staff.
If Henry’s delusion about living in a hotel had been troublesome and caused agitation, the staff would have intervened and assessed whether Henry needed psychiatric help. Because of their insights and ability to validate Henry’s feelings, his quality of life was good despite his dementia.
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Naomi Feil developed validation therapy as a method of working with patients she described as severely disoriented (Feil, 2002, 1963). Her work over the years has led to the increasing use of validation in dementia care as a way of demonstrating to the patient that their feelings, thoughts, and opinions are acknowledged and respected by the caregiver. A combination of validation and reminiscence is often useful in helping confused patients experience the joy of earlier life experiences and contributes to their quality of life. A demonstration of Fiel’s work can be viewed in the following video.