Kate, a 45-year-old working mother of three, has been providing care for her mother, Mary, who was diagnosed with Alzheimer's disease two years ago. With Kate's ongoing oversight, Mary has been able to remain in her own home. Then, late one night, Kate received a phone call from a neighbor, who noticed that Mary was several blocks from her home and appeared to be lost and confused. When he offered his assistance, she responded, "No thanks, I'm on my way to my mother's house because she is very sick and I must take care of her." Kate arrived on the scene and had a difficult time convincing her mother to return home. She finally succeeded after deploying the "therapeutic fib" -- "Your mother is waiting for you at your house." When they returned home, Mary became very angry because she could not find her mother there and frantically searched every room in the house, repeatedly pounding on the locked front door.
Since that evening, Kate has been spending every night at her mother's house to prevent Mary from wandering away again. At first, when Mary would tell her that she must go to her mother's home, Kate used reality-based responses, such as, "Mom, this is your home" or "Don't you remember that your mother passed away 20 years ago?" Another therapeutic fib, "She'll be here to visit you tomorrow," was also commonly used. Sometimes Kate offered distractions, like bringing Mary ice cream or tea, which sometimes helped to calm her for a moment. However, none of these distractions seem to completely help ease Mary's distress. Then Kate decided to try Validation.
Kate and Mary are not alone. These scenarios can be common occurrences in homes, assisted living communities, nursing homes and hospitals, or wherever people who are disoriented to time and place are living. Up to 60 percent of individuals with dementia will "wander" at some point during the course of their disease, according to the Alzheimer's Association.
By using the following techniques, some of which are from Feil's Validation Method, you might be able to improve communication and reduce the frustration that both you and your loved one with memory loss are experiencing.
1. Center yourself. Whenever you start to get upset or frustrated, stop and take some deep centering breaths while you think of something that makes you feel calm and collected. Centering clears the mind from distractions and helps one to be more calm, open, receptive and resourceful -- all important skill sets when caring for and communicating with a loved one experiencing memory loss.
2. Use empathy. Using empathy means that we try to step into the world of another person in order to better understand their feelings. Empathy helps us tune into the emotions of the person with memory loss. If he or she appears to be sad, instead of distracting them or ignoring their feelings, acknowledge their sadness with your words or expressions. Give the person your undivided attention, and they will feel respected and understood. Try not to interrupt or correct what they are saying.
3. Avoid using reality. Unless the person is in the very early stage of memory loss and wants to be reminded of a day, date or other reality based topics, it's best to avoid orienting them to reality. To some, it seems logical that pointing out reality would jar the memory of their loved one and bring them back to the present. However, to a disoriented person, it becomes frustrating and can lead to power struggles and arguments. Instead of trying to bring them to your reality, try to enter their reality. Even though the person with memory loss has poor short-term memory, they often retain long-term memories from the past and might be reliving emotional experiences that happened long ago.
4. Ask open questions. Asking open questions, such as the one that Kate learned to use with her mother, might help figure out the reason behind one's behavior. For example, instead of using reality or distraction, Kate began to say, "Tell me about your mother." Mary talked about how much she loved and missed her. She told Kate that she was not able to be there when her mother died because she had to be at work that day. Kate continued to ask open questions and included reminiscing with her mother by looking through one of her old picture albums. After a couple weeks of this, Kate noticed Mary wasn't searching for her mother as often.
5. Try asking the extreme. Asking the extreme means that you ask the person to tell you the best or worst thing about whatever they are expressing. When Kate followed up by asking, "What do you miss the most about your mother?" Mary replied, "Everything. She was the best mother a person could have and I should have been there for her the way she was always there for me." Validating a person's feelings helps them to express emotions and can sometimes even result in fewer behavioral expressions. It is not a magic wand that will automatically stop difficult or challenging behavioral expressions from reoccurring; however, it can yield powerful results because it helps to build a bond of trust. Even though people with Alzheimer's disease and related forms of memory loss may not remember your name or everything you said, something inside them will know that they can trust you because you have listened with empathy.
In addition to these communication techniques, consider looking into a residential memory care neighborhood where your loved one can receive specialized, person-centered memory care in a secure environment. The Alzheimer's Association and Alzheimer Society (Canada) are valuable resources, too.
A quote from the late Maya Angelou comes to mind: "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."