Memory fails us all sometimes. (Quick, what did you have for dinner last night?) Over time, our memory lapses multiply, a medical fact of life we that we attribute to eroding brain cells and simple aging. Eventually, short-term memory may be all but lost, so we cling to that which was comfortable-the good old days.
But Alzheimer’s disease goes one horrible step further, submerging its victims’ minds into decades-old realities from which they can never emerge. It prevents them from thinking and reasoning. It robs them of their present and future.
The process begins with simple memory loss, but gradually, "Where are my car keys?" turns into "I’ve forgotten how to drive." It escalates to the point where victims no longer recognize their closest loved ones. A husband, for example, may come in from the yard to find his wife pointing a gun at him because she thinks he’s a burglar.
But if you think it’s frightening for the relatives of an Alzheimer’s patient, imagine what it must be like to have the disease. "I believe it’s close to being dropped off in a foreign country, where the language is foreign, the people are foreign, and everything around you is something you’ve never seen before," says Jeannette Smith, executive director of Arden Courts, a Sarasota assisted living facility for Alzheimer’s and dementia patients.
Traditional therapies for Alzheimer’s involved reminding-and often challenging-patients to return to their present surroundings. But a therapy called "validation" seeks instead to provide a comfortable existence for the patient within whatever reality they choose.
That means if an 84-year-old woman wants to dress every day for a job she no longer has, she should do so. If a man insists his son is always late to visit, it’s OK to tell him that his son just got caught up in traffic-even if his son died 20 years ago.
Validation therapy was pioneered by Naomi Feil, who developed an acute understanding of seniors while growing up in the nursing home her father managed. The technique, which grew out of her frustration with traditional treatments she considered ineffective, encourages caregivers to identify and empathize with the disorientation that causes so much of the anguish of Alzheimer’s.
According to Feil, patients under this treatment cry less, withdraw less, communicate more and are less aggressive. They need fewer chemical and physical restraints and seem to regain their sense of humor. But just as important, validation therapy has given caregivers higher morale and reduced burnout. It is now practiced in more than 10,000 agencies throughout the U.S., Canada, Europe and Australia.
Validation is based on the theory that victims who lose their recent memory revert to periods in their lives that gave them fulfillment or pleasure. Feil writes in one article that this "retreat into personal history [is] a survival strategy, not mental illness." She suggests that instead of viewing Alzheimer’s patients as diseased, we see them simply as very old people struggling to survive in whatever reality the condition has plunged them into.
To illustrate how validation works, Dr. Thomas Skoloda, a psychologist with the Alzheimer’s Association in Sarasota, uses the example of a patient who’s visited the same hairdresser for years, but suddenly insists the stylist is making her hair fall out. The hairdresser might counter that she’s doing the same thing she’s always done. But Skoloda says trying to re-orient someone with a cognitive impairment only exacerbates the conflict.
Instead, the hairdresser should ask the patient when she began noticing her hair falling out. "She can ask, ‘Where is it falling out? How often?’" he says. By accepting the patient’s reality, the hairdresser can alleviate her anxiety.
Skoloda, who has worked with geriatric patients for more than 35 years, says people afflicted with Alzheimer’s are merely trying to make sense of their world. They seem to understand that their reality is different from everyone else’s, and this frightens them.
Smith says this terror throws them into compulsive behaviors. "We have people who walk and walk and walk from morning until sundown, looking for something they call home," she says. Others deliberately rearrange items from one room to another in an apparent grasp at control. "We don’t see this in patients with later-stage Alzheimer’s. By then they seem content to ease into whatever world they’ve found."
But every stage of this disease is challenging because, although Alzheimer’s creates the same clinical havoc in each victim’s mind, every life experience is different. And therefore, so is every manifestation. Validation works best when caregivers take the time to listen to patients so they can link together the intricate rationale behind their incomprehensible behavior. Says Smith: "Dr. Skoloda once told me, ‘To know one Alzheimer’s patient is to know just one.’"
In the end, that’s what validation seeks to accomplish: to know and value these individuals as they are in the present and allow them to live with grace and dignity.