Do you find it difficult to know what to say when an individual with dementia is focused on "leaving" or doing things they did in the past, but can't do now (such as driving or heading out on their own)? The following points provide a few basics for you to consider when the person with dementia is in need of having his/her feelings validated and discussed.
It is important to address feelings first. It is generally a good practice to validate the feelings of those around you -- wherever and whenever these feelings and needs arise. In fact, when you think about it, you too need your feelings validated. Caregivers need to be validated, too.
Families need someone to acknowledge that it is tough watching a loved one decline (and they need to be validated at each step throughout the journey -- including times when tough decisions need to be reached -- such as those related to nursing home placement) and staff need someone to acknowledge the great work they are doing as they devote their time and energy to provide good care.
We need to consider what it must feel like to live in a world where things don't make sense.
This blog will discuss the need to validate feelings.
Setting the stage: When needed, validate feelings!
There are times when some people with dementia just want to talk about the frustrations they are experiencing in the moment. These people are in need of chatting about the circumstances related to where they believe they are now (which could be a situation or place from the past or a feeling/thought they need to act on immediately).
For example, they may want to go home (their childhood or family home). This is a common situation for those living in long-term care environments. These people need someone to validate how they are feeling. These people may want to leave because they don't know where they are -- this place is unfamiliar -- and/or they are looking for a place where they feel they belong, with people to love and to care for. There are many reasons for the behaviour. All behaviour has meaning. We need to find out what the behaviour is telling us. Then we need to validate the feelings behind the behaviour.
We, as family and professional providers of care, need to consider what it must feel like to live in a world where things don't make sense. Imagine what it must be like to focus on memories from the past -- as if they exist in the moment. Imagine what you would do if no one was meeting your needs in the present.
What would it be like to think you are heading home to look after a husband or children, or heading to work, or simply looking for the place you call home. Would you want someone to say, "You can't leave. You live here." When this happens, don't argue with facts. Would you not get frustrated? Agitated? Mad?
If a person is simply looking for his/her room, then provide the directions needed. If the behaviour relates to something related to memories from the past and/or needs in the present, focus on validating feelings. The experience that presents itself may have arisen because the person is lonely and/or bored and/or can't find his/her way (such as the place his/she calls home).
Do your best to acknowledge and support the person, sending clear messages that you care, you are so glad to see him/her and you want to know more about the situation that presents itself at this moment. Explore the thoughts and needs of the person by re-phrasing what they are saying (e.g. -- "You want to go home?") Ask about the what, where and why of the situation. (To learn more about Validation Techniques refer to the work of Naomi Feil or visit our website to learn about our DementiAbility Validation Communication Workshop.)
Living with dementia is a tough journey. Feelings and needs must be acknowledged, and addressed, before these individuals can move onto any other conversations or activities. Once you have asked questions about "home" or family or love or whatever the question "in the moment" may be, and you have validated how they are feeling, ask if they would like to join you in completing tasks or doing something with you that would provide companionship and joy. Consider whether it was boredom, loneliness or the inability to do things independently that lead to the behaviour. Always think about addressing the needs that arise in the moment.
The takeaway point is that all of us have feelings that need to be validated and that these techniques can help to create stronger relationships between the person with dementia and providers of care.
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At times everyone can become tired of housework, business activities, or social obligations. However a person with dementia may become very passive, sitting in front of the television for hours, sleeping more than usual, or appear to lose interest in hobbies.
A person with dementia may seem different from his or her usual self in ways that are difficult to pinpoint. A person may become suspicious, irritable, depressed, apathetic or anxious and agitated especially in situations where memory problems are causing difficulties.
Everyone can become sad or moody from time to time. A person with dementia may become unusually emotional and experience rapid mood swings for no apparent reason. Alternatively a person with dementia may show less emotion than was usual previously.
Anyone can temporarily misplace his or her wallet or keys. A person with dementia may put things in unusual places such as an iron in the fridge or a wristwatch in the sugar bowl.
A person with dementia may find it difficult to follow a conversation or keep up with paying their bills.
People with dementia may dress inappropriately, wearing several layers of clothes on a warm day or very few on a cold day.
We sometimes forget the day of the week or where we are going but people with dementia can become lost in familiar places such as the road they live in, forget where they are or how they got there, and not know how to get back home. A person with dementia may also confuse night and day.
Occasionally everyone has trouble finding the right word but a person with dementia often forgets simple words or substitutes unusual words, making speech or writing hard to understand.
People with dementia often find it hard to complete everyday tasks that are so familiar we usually do not think about how to do them. A person with dementia may not know in what order to put clothes on or the steps for preparing a meal.
Declining memory, especially short-term memory, is the most common early symptom of dementia. People with ordinary forgetfulness can still remember other facts associated with the thing they have forgotten. For example, they may briefly forget their next-door neighbour's name but they still know the person they are talking to is their next-door neighbour. A person with dementia will not only forget their neighbour's name but also the context.
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