People with dementia are emotionally more vulnerable, so it is especially important how we approach them and how we communicate with them so that they do not intensify their distress.
It is important that we affirm a person with a dementia in a conversation or in what he/she wants to communicate, although this is not always true. A person with dementia, for example, asks when he/she will lunch, but we know that he/she ate it half an hour ago, but he/she does not remember it anymore. Since we know that the memory for storing new information has fallen, it is right that we answer the question in a way that makes us feel accepted and satisfied. For example, lunch will be soon or in half an hour.
This does not mean that we lied to a person, but merely that we have entered into her world of perception. Facing the truth is inappropriate for a person with dementia, as it deepens her distress. We generally respond to each and every one of her questions, although for the third time in a row, and we do not comment on how many times we have done this in the same hour / day.
Naomi Feil developed a special method of communicating with people with dementia, which she called validation or empathic understanding. Validation means that a person with dementia is confirmed - validated in his/her experience.
Only one person at a time should talk to a dementia person. We always approach the person from the front, because he/she can use all the senses (and feel safe). Of extraordinary importance is also the eye contact, with which we establish interpersonal trust. The words we use should always be simple, the sentences should be brief and concise, the instructions should be simple, the speech should be slow and distinct, and the voice of the appropriate strength according to the situation. We should also encourage the person to speak, and we should not correct if there are any mistakes in the speech and we only use our touch if the person allows it. We avoid the words "you must", "you cannot" and do not quarrel with the person, although we know that we are right. In all this, we must also look at the various disturbances: the sounds of the radio, the TV in the room, we must be in the same room and not speak from somewhere far, etc.
Levels of communication/validations by Naomi Feil:
|Stage one|| Denying problems |
• Apologizing for memory loss
• Denial of the disturbance of loss of vision, hearing, flexibility, etc.
• Denial of feelings and feelings of loneliness, fear, joy, etc.
Contradiction to changes
• Agitation if things are not always in the same place (chair in the right place, the other person in the room ...)
Eye contact rejection
Eye contact rejection (da so jim kaj odtujili, podtaknili ipd.)
| Step 1: Focalising
• We pay full attention to the person, we do not burden ourselves with our own feelings, worries, prejudices;
• We do not directly address emotions: e.g. "I feel you are upset.";
• We pay attention to the fact that touches are only at will or as a return to touch;
• Do not draw attention to shortcomings, do not correct people;
• We avoid the question of why or how, as they demand a justification, which the patient with dementia cannot give;
• Questions about details (e.g. Who, What, Where?) are often too demanding and make people uncomfortable;
• It is better to ask a person so that he or she can answer with yes or no.
|Stage two||Time disorientation: |
a person loses a sense of time; confuses persons from the present with persons of the past;
• They may think they still live with their parents /they think they are small children;
• Wishes to return to their previous home (often to the period of childhood, youth, to the house of their parents);
• Occasionally does not recognize his/her apartment;
• The long-term memory is still preserved, and the short-term is occasionally lost;
• From time to time, a person also hears voices, sounds from the past, sees his/her images, perceives odors;
• The view is moving away and is not directed;
• Speaking can be quiet, unclear. A person can make new words because he/she cannot find the right words;
• Because of the misunderstanding of the circumstances, the person is often in conflict with it.
| Validation handling:
• We should be taking the person seriously, regardless of the reality of his / her claims;
• We take care of the height of our voice that remains at the same level as the height of the voice of a person with dementia;
• We allow and encourage a person to tell about his/her memories as long as he/she can.
|Stage three||Repeating movements:|
• Walking and then making various sounds, crying, calling, brushing, mumbling or singing.
• The person rarely recognizes familiar faces, e.g. relatives, neighbours, nursing staff and occasionally reacting to people and things from the past.
• The feeling of "self" is often lost.
• The person responds to touching and direct vision, but eyes quickly move away.
• A person can no longer perform certain tasks (or it is difficult) and often suffers from incontinence.
| Validation handling:
• Words with multiple meanings are used;
• Repetition of the spoken words of a person with dementia;
• We try to connect certain behaviour with a certain need;
• We use touches, music and mirroring (while we must be careful not to imitate the person, but only its actions, let's say we walk with it up and down the corridor, wipe the dust, etc.).
|Stage four|| Vegetation stage |
• No longer own initiative or it's just insignificant.
• The person does not recognize his/her relatives (even if they come to visit every day).
• Person does not show feelings (at least not so as to be visible to others).
• The eyes are often closed, no visible awareness of their own body.
• Person does not talk or hardly says anything.
| Validation handling:
• Focusing on touching;
• We use music, basal stimulation, we invite invigorating essences;
• We speak in whole sentences.