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I am a nurse looking after
a 62 year old lady with AD who is living in a facility. The
lady is convinced that she is in someone else's home and
staff and family attempts to reorient her have been futile.
How can I assist the family in coping with this problem?
What strategies would assist the staff to alleviate her
anxiety?
It is almost impossible to
"re-orient" someone with dementia. Their own reality is what
is important. If it isn't upsetting her, it is perfectly
fine for your client to believe she is "visiting." If her
memory of the recent past is poor, then she may be
remembering another home from long ago. The place she is
living now certainly isn't that home, and so it isn't "home"
to her.
If she is distressed by being in a strange place, then it is
the job of her caregivers to help her with this distress.
Trying to convince her that her own reality is false will
just distress her more. Imagine how you would feel if people
tried to convince you that things you absolutely know to be
true are really not true. You would be upset, too.
In situations such as this, dementia experts recommend using
a technique called "validation." Statements that acknowledge
her reality, without actually agreeing with it, are the best
place to start.
"This place doesn't look like your house, does it? Tell me
about your house..." When you respond in this way you are
not agreeing with her delusional thought, but you are
validating that she doesn't recognize where she is as
"home." You are inviting her to talk about the home she
remembers. This kind of "validation" allows her to talk
about things she is comfortable with. It doesn't confront
her with a reality she can't accept. Validation also accepts
the fact that she may be anxious about being in a place that
is strange to her. Accepting, or validating, her anxiety by
saying, "It can be uncomfortable being in a strange place,"
might help her by allowing her to talk about how she is
feeling.
Validation may not completely rid her of her anxiety, but it
certainly is more productive than arguing with her about
where she is. Re-direction can also often be helpful. If she
is waiting by the door to leave, ask her to "help" you with
something on the other side of the building for a minute
until her "ride" arrives. If she might be willing to stay
until "tomorrow," or until "later this afternoon" then use
that. In the meantime, try to find an activity she can
successfully do. Sorting often works. Ask her to help you
sort or fold flat laundry, buttons, colored index cards,
silverware into trays, etc.
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