vailidation of demenia
Explain the difference between a reality orientation approach to interactions & a validation approach
A reality orientation approach is about avoiding disorientation by keeping the individual grounded in the moment ie who and where they are, the date, and the time. This is done by making references such as "Good morning Mary", "What a lovely warm summer day", "Its almost time for lunch. Can you take me to the dining room?" etc. It brings them into our world.
A validation approach respects the individual's reality ie how they view the world. You enter their world and acknowledge what they believe. For example the individual may refer to people and events from the distant past as if they are still true. They may believe that their parents are still alive and want to know when they will see them. With this approach you would acknowledge their concern and suggest an activity while they wait to distract them. You would not make them face your reality.
From page 2.13 http://www.accreditation.org.au/site/learning_packages/Dementia-communicating.pdf http://en.wikipedia.org/wiki/Cognitive_therapies_for_dementia
http://www.ncbi.nlm.nih.gov/pubmed/17038105
Abstract
BACKGROUND:
Validation therapy was developed by Naomi Feil between 1963 and 1980 for older people with cognitive impairments. Initially, this did not include those with organically-based dementia, but the approach has subsequently been applied in work with people who have a dementia diagnosis. Feil's own approach classifies individuals with cognitive impairment as having one of four stages in a continuum of dementia: these stages are Mal orientation, Time Confusion, Repetitive Motion and Vegetation. The therapy is based on the general principle of validation, the acceptance of the reality and personal truth of another's experience, and incorporates a range of specific techniques. Validation therapy has attracted a good deal of criticism from researchers who dispute the evidence for some of the beliefs and values of validation therapy, and the appropriateness of the techniques. Feil, however, argues strongly for the effectiveness of validation therapy.
OBJECTIVES:
To evaluate the effectiveness of validation therapy for people diagnosed as having dementia of any type, or cognitive impairment
SEARCH STRATEGY:
The trials were identified from the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG) on 8 January 2003 using the terms validation therapy, VTD and emotion-oriented care. The Specialized Register at that time contained records from the following databases: MEDLINE, EMBASE, CINAHL, PSYCLIT, and SIGLE and many trials databases.
SELECTION CRITERIA:
All randomized controlled trials (RCTs) examining validation therapy as an intervention for dementia were considered for inclusion in the review. The criteria for inclusion comprised systematic assessment of the quality of study design and the risk of bias.
DATA COLLECTION AND ANALYSIS:
Data were extracted independently by both reviewers. Authors were contacted for data not provided in the papers. Psychological scales measuring cognition, behaviour, emotional state and activities of daily living were examined.
MAIN RESULTS:
Three studies were identified that met the inclusion criteria (Peoples 1982; Robb 1986; Toseland 1997) incorporating data on a total of 116 patients (42 in experimental groups, and 74 in the control groups (usual care 43 and social contact 21, 10 in reality orientation). It was not possible to pool the data from the 3 included studies, either because of the different lengths of treatment or choice of different control treatments, or because the outcome measures were not comparable. Two significant results were found:Peoples 1982 - Validation versus usual care. Behaviour at 6 weeks [MD --5.97, 95% CI (-9.43 to -2.51) P=0.0007, completers analysis] favours validation therapy. Toseland 1997 - Validation versus social contact. Depression at 12 months (MOSES) [MD -4.01, 95% CI (-7.74 to - 0.28) P=0.04, completers analysis], favours validation. There were no statistically significant differences between validation and social contact or between validation and usual therapy. There were no assessments of carers.
REVIEWER'S CONCLUSIONS:
There is insufficient evidence from randomized trials to allow any conclusion about the efficacy of validation therapy for people with dementia or cognitive impairment
agree” with them, but to also use conversation to get them to do something else without them realizing they are actually being redirected. So, if an 87 year old woman says that she needs a phone to call her grandmother, validation therapy says, “OK.” Here is an example for a caregiver working with someone with dementia in an adult day care: Older adult: “I have to find my car keys.” Caregiver: “Your car keys…” ( Don’t mention he doesn’t have a car and he hasn’t driven for years) Older adult: “Yes, I need to go home – lot’s of work to do!” Caregiver: “You are busy today?” (Don’t mention he is at adult day care and isn’t going home for hours) Older adult: “Hell, yes! I’m busy every day.” Caregiver: “You like being busy?” (Trying to find a topic of conversation that they might accept discussing) Older adult: “Are your kidding? I didn’t say I LIKED it. I just have to work like the rest of the world.” (He’s getting a little frustrated, but seems to have forgotten about the keys.) Caregiver: “I know about work. I do some of that myself. In fact, I’m getting ready to fix some lunch for us. Care to join me?” Older adult: “Lunch, huh? What are you having?”
Why Validation Therapy Works: The Pros
The number one reason why validation therapy works well is because it is not confrontational. Never is a person belittled, yelled at, or told “no.” Remember dementia is a group of symptoms, not a disease. It is easy to misdiagnose. For example, people suffering from UTIs (urinary tract infections) are said to demonstrate characteristics of dementia if the infection goes undetected. Criticisms of Validation Therapy: The Cons
The biggest criticism of validation therapy is that it promotes lying. These lies weigh heavy on the consciouses of caregivers and family members. For example, validation therapy says that a family member should just accept their aging parent calling them someone else’s name, not correct them. When family stories are switched around, the family is suppose to just listen to the stories as they are told. While there seems to be significant emotional harm to caregivers and family members, very little harm is done to the person with dementia; but isn’t it the well-being of the person with dementia that is most important.
A reality orientation approach is about avoiding disorientation by keeping the individual grounded in the moment ie who and where they are, the date, and the time. This is done by making references such as "Good morning Mary", "What a lovely warm summer day", "Its almost time for lunch. Can you take me to the dining room?" etc. It brings them into our world.
A validation approach respects the individual's reality ie how they view the world. You enter their world and acknowledge what they believe. For example the individual may refer to people and events from the distant past as if they are still true. They may believe that their parents are still alive and want to know when they will see them. With this approach you would acknowledge their concern and suggest an activity while they wait to distract them. You would not make them face your reality.
From page 2.13 http://www.accreditation.org.au/site/learning_packages/Dementia-communicating.pdf http://en.wikipedia.org/wiki/Cognitive_therapies_for_dementia
http://www.ncbi.nlm.nih.gov/pubmed/17038105
Abstract
BACKGROUND:
Validation therapy was developed by Naomi Feil between 1963 and 1980 for older people with cognitive impairments. Initially, this did not include those with organically-based dementia, but the approach has subsequently been applied in work with people who have a dementia diagnosis. Feil's own approach classifies individuals with cognitive impairment as having one of four stages in a continuum of dementia: these stages are Mal orientation, Time Confusion, Repetitive Motion and Vegetation. The therapy is based on the general principle of validation, the acceptance of the reality and personal truth of another's experience, and incorporates a range of specific techniques. Validation therapy has attracted a good deal of criticism from researchers who dispute the evidence for some of the beliefs and values of validation therapy, and the appropriateness of the techniques. Feil, however, argues strongly for the effectiveness of validation therapy.
OBJECTIVES:
To evaluate the effectiveness of validation therapy for people diagnosed as having dementia of any type, or cognitive impairment
SEARCH STRATEGY:
The trials were identified from the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG) on 8 January 2003 using the terms validation therapy, VTD and emotion-oriented care. The Specialized Register at that time contained records from the following databases: MEDLINE, EMBASE, CINAHL, PSYCLIT, and SIGLE and many trials databases.
SELECTION CRITERIA:
All randomized controlled trials (RCTs) examining validation therapy as an intervention for dementia were considered for inclusion in the review. The criteria for inclusion comprised systematic assessment of the quality of study design and the risk of bias.
DATA COLLECTION AND ANALYSIS:
Data were extracted independently by both reviewers. Authors were contacted for data not provided in the papers. Psychological scales measuring cognition, behaviour, emotional state and activities of daily living were examined.
MAIN RESULTS:
Three studies were identified that met the inclusion criteria (Peoples 1982; Robb 1986; Toseland 1997) incorporating data on a total of 116 patients (42 in experimental groups, and 74 in the control groups (usual care 43 and social contact 21, 10 in reality orientation). It was not possible to pool the data from the 3 included studies, either because of the different lengths of treatment or choice of different control treatments, or because the outcome measures were not comparable. Two significant results were found:Peoples 1982 - Validation versus usual care. Behaviour at 6 weeks [MD --5.97, 95% CI (-9.43 to -2.51) P=0.0007, completers analysis] favours validation therapy. Toseland 1997 - Validation versus social contact. Depression at 12 months (MOSES) [MD -4.01, 95% CI (-7.74 to - 0.28) P=0.04, completers analysis], favours validation. There were no statistically significant differences between validation and social contact or between validation and usual therapy. There were no assessments of carers.
REVIEWER'S CONCLUSIONS:
There is insufficient evidence from randomized trials to allow any conclusion about the efficacy of validation therapy for people with dementia or cognitive impairment
agree” with them, but to also use conversation to get them to do something else without them realizing they are actually being redirected. So, if an 87 year old woman says that she needs a phone to call her grandmother, validation therapy says, “OK.” Here is an example for a caregiver working with someone with dementia in an adult day care: Older adult: “I have to find my car keys.” Caregiver: “Your car keys…” ( Don’t mention he doesn’t have a car and he hasn’t driven for years) Older adult: “Yes, I need to go home – lot’s of work to do!” Caregiver: “You are busy today?” (Don’t mention he is at adult day care and isn’t going home for hours) Older adult: “Hell, yes! I’m busy every day.” Caregiver: “You like being busy?” (Trying to find a topic of conversation that they might accept discussing) Older adult: “Are your kidding? I didn’t say I LIKED it. I just have to work like the rest of the world.” (He’s getting a little frustrated, but seems to have forgotten about the keys.) Caregiver: “I know about work. I do some of that myself. In fact, I’m getting ready to fix some lunch for us. Care to join me?” Older adult: “Lunch, huh? What are you having?”
Why Validation Therapy Works: The Pros
The number one reason why validation therapy works well is because it is not confrontational. Never is a person belittled, yelled at, or told “no.” Remember dementia is a group of symptoms, not a disease. It is easy to misdiagnose. For example, people suffering from UTIs (urinary tract infections) are said to demonstrate characteristics of dementia if the infection goes undetected. Criticisms of Validation Therapy: The Cons
The biggest criticism of validation therapy is that it promotes lying. These lies weigh heavy on the consciouses of caregivers and family members. For example, validation therapy says that a family member should just accept their aging parent calling them someone else’s name, not correct them. When family stories are switched around, the family is suppose to just listen to the stories as they are told. While there seems to be significant emotional harm to caregivers and family members, very little harm is done to the person with dementia; but isn’t it the well-being of the person with dementia that is most important.