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Rita Altman, R.N.

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Validating Feelings of Seniors with Memory Loss

Posted: 08/21/11 02:28 AM ET

Mr. Richards*, a slight man with thick, brown-rimmed glasses and a gait that revealed him to be every bit his age of 80, made himself quickly known to residents and staff alike in the assisted living community.

"Have you seen my mother?" he'd ask repeatedly, for hours, as he wandered up and down the hallways. It began shortly after his family moved him into our assisted living community's memory care neighborhood. When he wasn't asking for his mother, he was reciting fragments, and sometimes whole verses, of Poe, Frost and Emerson.

It's these behaviors that make memory loss and dementia the proverbial boogie man under the beds of everyone approaching their twilight years. There is nothing more frightening to us than losing our grip on reality, it seems.

With tears in his tired eyes and a tone of urgency in his voice, Mr. Richards stopped me in the hallway. "Please, have you seen my mother? I need to find her!"

To the inexperienced, these moments can freeze you. Should you tell him the truth? Do you need to snap him out of it by saying, "Your mom passed away 20 years ago!" or maybe appease him with a little white lie -- "I just saw her, she wants you to go back to your room and lie down." The stress and anxiety of how to respond can be paralyzing for both professionals and family caregivers.

I answered Mr. Richards in a concerned tone. "You're looking for your mother. Would you like to tell me about her?"

"She is beautiful," he said with a hint of wonderment in his voice. "She is nice and she is always there for me."

I replied, "She takes care of you" -- careful to repeat his mother's most important trait. "What kinds of things does she do for you?"

"She cooks for me," he says with determination.

Digging deeper with open-ended questions, I ask, "Is she a good cook? What does she cook for you?"

He begins to cry. "Yes, but all she ever makes is oatmeal. My father is awful, and he drinks up all the money, and my mother has to make do with what we have."

I keep listening as I attempt to match his expression and tone of voice.

"She makes a lot of oatmeal. Sometimes it's sweet and buttery and sometimes it's salty, but it's always good. She is a good mother," he says as the determination returns in his voice.

I want to validate his feelings. "Your mother always took good care of you and loved you very much," I said.

"You must think I'm crazy," he says. "An 80-year-old man looking for his mother. I know she is gone. She is no longer here," he confides. "Thank you for talking to me."

Mr. Richards just wanted to express his loneliness and his anger towards his father. Dementia robs him of his ability to convey his emotions in more traditional ways. As those with memory loss age, they unconsciously begin to reflect on their lives and seek to resolve unsettled emotions.

Instead of lying or denying the reality that memory loss sufferers live in, we can help them feel valued and heard by validating their emotions. We have the opportunity to accompany them on their journey to resolve conflict in their lives through listening with empathy. We can help them communicate.

In 1982, Naomi Feil published a seminal book, "Validation: The Feil Method." In this book, she articulated the framework for the Validation Method, a now widely-accepted but under-publicized approach to caring for those with dementia. My approach is rooted in the teaching of Ms. Feil, who was raised in a home for the aged. No doubt her childhood led her to explore new methods and challenge conventional wisdom about how to care for those with dementia.

Many of the validation principles and communication techniques that were developed by Naomi Feil are taught to professional caregivers, and some eventually make their way to family caregivers as well. There is no data on how many of the estimated 5.4 million people with Alzheimer's or other forms of dementia receive care rooted in the Validation Method. But it's difficult to imagine that a large proportion of the 11 million family caregivers have had the benefit of formal training.

According to the Alzheimer's Association, nearly half of all family and other unpaid caregivers rate the emotional stress of caring for loved ones with some form of dementia as "high" or "very high." While providing such care will always be a monumental task, much of the frustration and anxiety of trying to care for those with dementia can be eliminated once caregivers understand how to reestablish the lines of communication.

Shortly after Mr. Richards and I spoke, I found him in his room. I watched as he began having a long conversation with his father, who he imagined was there with him. Continuing on his journey toward resolution, he said all the things he was afraid to say to his father when he was a young boy.

As Mr. Richards progressed peacefully in the days and weeks ahead, he cried less. He looked for his mother less frequently. He had a trusted listener -- in me and in other caregivers trained in validation -- who spent time with him, talked about his childhood and accompanied him on his journey.

Today, there is no magic solution -- or pill -- that will make someone with dementia better again. However, we can understand that repetitive statements or unexplainable actions for these individuals are often their way of expressing an unmet basic human need and a substitute for saying, "I want to start a conversation about my life." Validating that desire by truly engaging with them will not only help them to feel valued and heard but also give caregivers the connection they may feel has been lost.

*The name of the resident has been changed to protect privacy.

 

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