By: Linda Roehrenbeck
There have been years of trial and error as we look retrospectively at the practice of caring for an individual with Dementia. Reality orientation, redirection, and restraint are no longer the most effective methods of caregiving for people with Dementia.
Research is still in its infancy. Evidence-based, best practices of care are being identified, providing support for families and caregivers. One such practice is Validation, developed by Naomi Feil, M.S.W., A.C.S.W. Validation theory explains that many very old disoriented people, who are often diagnosed as having Alzheimer type dementia, are in the final stage of life trying to resolve unfinished issues in order to die in peace. Their final struggle is important and we, as caregivers and family, can help them.
Validation is built on an empathetic attitude and a holistic view of individuals. When one can “step into the shoes” of another human being and “see through their eyes,” one can step into the world of disoriented very old people and understand the meaning of their sometimes bizarre behavior.
Validation is a theory that very old people struggle to resolve unfinished life issues before death. Their behavior is age-specific.
Validation techniques offer disoriented elderly an opportunity to express what they wish to express whether it is verbal or non-verbal communication. Validation practitioners are caring, non-judgmental and open to the feelings that are expressed. When unresolved feelings are suppressed for many years, they grow more powerful. When we listen with empathy for these expressions, the intensity of emotion lessens and the person with dementia communicates more freely and is less likely to withdraw further.
Based on the collaboration with health care providers and with family members the resulting findings need to emphasized and translated into best practices for healthcare environments, home, hospital, adult day care, assisted living and long-term care.
Family caregivers of people with dementia carry the weight on their shoulders, and often developing stress, poor health, and financial strain as a result. While many caregivers want to “live in the moment” and hope that they will not have to face the challenges posed by the dementia progression, most ultimately will. Therefore, we believe that these family caregivers of persons with dementia deserve the same level of anticipatory guidance to ensure that they are prepared for each new transition. Using the Validation theory as a framework for the development and implementation of clinical and educational approaches, we can play a pivotal role in the health and well-being of persons with dementia and their family.
The Principles of Validation Therapy are that:
1. All people are unique and must be treated as individuals.
2. All people are valuable, no matter how disoriented they are.
3. There is a reason behind the behavior of disoriented old-old people.
4. Behavior in old-old age is not merely a function of anatomic changes in the brain but reflects a combination of physical, social and psychological changes that take place over the lifespan.
5. Old-old people cannot be forced to change their behaviors. Behaviors can be changed only if the person wants to change them.
6. Old-old people must be accepted nonjudgmentally.
7. Particular life tasks are associated with each stage of life. Failure to complete a task at the appropriate stage of life may lead to psychological problems.
8. When more recent memory fails, older adults try to restore balance, in their lives by retrieving earlier memories. When eyesight fails, they use the mind’s eye to see. When hearing goes, they listen to sounds from the past.
9. Painful feelings that are expressed, acknowledged, and Validated by a trusted listener will diminish. Painful feelings that are ignored or suppressed will gain strength.
10. Empathy builds trust, reduces anxiety, and restores dignity.
Linda Roehrenbeck, BSN MBA, is the executive director of National Church Residences Mill Run, and a Certified Validation Worker. Linda provides in-house guidance, support and small group presentations in the practice of Validation.