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Validating Without Lying: Validation Theory and Dementia

mother and daughter with flowers

Providing care for a spouse or family member who has dementia can be frustrating and challenging. Repeated questions, distortions of reality, agitation and anxiety are common. You may have heard of Validation Theory and dementia. Understanding Validation Theory can guide your communication and help to keep your family member calm. It is not necessary to be trained in this technique. Simply becoming familiar with the strategies may be all that you need to improve communication in dementia.

Disorientation and Confusion in Dementia

Dementia can be stressful and anxiety provoking for both the caregiver and the person who has it. Symptoms such as memory loss, confusion and disorientation are common. Although the cause of dementia is complicated, the result is damage to brain cells. Unfortunately, there is no cure for dementia nor is there a viable treatment to reverse the disease.

Read: Five Ways to Help a Parent with Dementia who Refuses Care

What Is Validation Theory?

Naomi Feil developed Validation Theory as a way to convey empathy for persons with dementia. As a person becomes more and more confused and disoriented, Validation techniques can help to reduce anxiety.

There is a reason behind the feelings of disoriented people. Confronting a person or correcting what they say can increase anxiety and agitation. The behavior of people with dementia can result due to one or more of the following basic human needs:

  1. Need to resolve unfinished issues, in order to die in peace.
  2. Need to live in peace.
  3. Need to restore a sense of equilibrium when eyesight, hearing, mobility and memory fail.
  4. Need to make sense out of an unbearable reality, to find a place that feels comfortable, where one feels in order or in harmony and where relationships are familiar.
  5. Need for recognition, status, identity and self-worth.
  6. Need to be useful and productive.
  7. Need to be listened to and respected.
  8. Need to express feelings and be heard.
  9. Need to be loved, to belong, and to have human contact.
  10. Need to be nurtured, feel safe and secure, rather than immobilized and restrained.
  11. Need for sensory stimulation: tactile, visual, auditory, olfactory, gustatory, as well as sexual expression.
  12. Need to reduce pain and discomfort.

Read: How Vision Changes with Dementia

How to Use Validation Theory with a Senior with Dementia

How are these principles applied in real life situations? People with dementia can become very agitated, confused and angry. Using the techniques of Validation Theory can help.

It is common for people with dementia to forget that they have lost a spouse, or want to go home. These beliefs or needs are often repeated over and over again. It can be tempting to lie or deceive by telling the person that their spouse is still alive or that they are home. But, this is not an approach that honors the person’s pain and needs.  It is like putting a band-aid on a wound that needs stitches!

A different approach would be the following:

1. Acknowledge what the person is expressing. A parent may repeatedly ask where their spouse is when in reality the spouse has died. Rather than saying: “Mom, Dad has died!” try a response that opens communication. For example: “Mom, what are your favorite things about Dad?”

2. Ease anxiety by honoring the feeling behind the request. A spouse who is in memory care may state over and over again that they want to go home. It can be tempting in these situations to say “But you are home now.” Or, “You moved here over a year ago. Your home is gone.” A much better approach gets to the heart of what the person needs. Are they cold, hungry, fearful or in pain? Agree and validate. Say, “That is a good idea. Being at home would be nice.” Then distract with another activity. You may also ask questions such as, “Your home sounds wonderful. Tell me more about it.”

Other Tips to Keep in Mind when Communicating through Dementia

If you are trying to calm agitation in an older adult with dementia, avoid confrontation. Confrontation is likely to escalate the situation. Instead, try changing the subject. Or, engage in a distracting activity.

Avoid reasoning and explanations. Your loved one will not be able to process the information and may become even more insistent and distressed. We can’t know what people with dementia are feeling inside. Anger may be completely unrelated to the stated subject. Try your best to honor and respect whatever the feeling is. Your parent or spouse may be in pain or some other discomfort. Perhaps they are tired, or bored.

Caregiving for a person with dementia can be incredibly stressful. There is a fine line between lying and distracting or redirecting. According to Validation Theory, it is never acceptable to lie. Rather, try and get to the heart of the matter. Realize that people with dementia are trying to regain some sense of control. Be as calm as possible to create a sense of security and comfort. Both of you will benefit.

Read: 24 Ways to Deal with Sundowners Syndrome (12 for Tonight)

Resources
Using Validation Therapy for People with Dementia
“What is Validation?”

About The Author

Amanda Lambert is the owner and president of Lambert Care Management, LLC which provides care management for older and disabled adults. She is the co-author of, Aging with Care: Your Guide to Hiring and Managing Caregivers at Home (Rowman and Littlefield, 2018). She has worked for over 20 years in the senior-related industry including mental health, marketing and guardianship. She has a passion for topics related to health, wellness and resilience as we age.