My grandmother, who is 92, recently reported that she’d seen three giraffes in her Midwest backyard. She is otherwise sharp (and also kind and funny), but the giraffe episode was further evidence of the mild cognitive impairment that has been slowly creeping into her life.
The question for my family has become: How should we respond? One of my sisters tried humor. (“Grandmom, I didn’t know you drank in the middle of the day!”) My father suggested that they were deer (to which she replied, “I’m 92 years old, and I know a giraffe when I see one.”) I tried to learn more about what, exactly, the giraffes were doing out there. (She didn’t seem to know, saying only that “the light shimmered.”)
Communicating with a family member who has cognitive impairment can be frustrating and disheartening, even downright depressing for patient and caregiver alike. And it’s a problem faced by a growing number of Americans.
According to a report published this month, about 4.1 million Americans have dementia. Alzheimer’s, one of the many forms of dementia, is the most expensive disease in the United States, costing $157 billion to $215 billion a year — more than heart disease and cancer, according to the study, which was sponsored by the National Institute on Aging. As baby boomers reach old age, these numbers are expected to increase dramatically.
A number of techniques can not only reduce the frustration but also create new ways of connecting. Among the most effective and popular among experts is the “validation method,” a practice pioneered by geriatric social worker and researcher Naomi Feil in the 1980s.
As its name suggests, the practice is based on the idea of validating a patient’s experience — to empathize, even if what the person is expressing doesn’t seem to make sense.
In my grandmother’s case, that might have been to ask how tall the giraffes were or how my grandmother felt upon seeing them.
“You match her emotions,” Feil said. You communicate that you “know that it’s real and meaningful for her, (that) she’s not psychotic or hallucinating.”
Feil, the daughter of a nursing home director and a social worker, studied psychiatric group work at Columbia University, then came home to work in her father’s facility in Ohio. There, her family established units for people experiencing memory loss. Today, Feil’s method is used around the world.
“Validation was one of the first approaches,” said Mary A. Corcoran, an associate dean at George Washington University School of Medicine and Health Sciences. There have been many since, she added, but “validation is one of the better known approaches to addressing the emotional needs of people with Alzheimer’s disease.”
Clinical study results on its effectiveness have been inconclusive, she said, but the technique has nonetheless become widely used.
Alice Bonner, director of the Division of Nursing Homes at the Centers for Medicare and Medicaid Services, said that validation “was the foundation for our teaching about person-centered, individualized care over the past year.” It is also the basis for a series of six training DVDs for health-care workers that CMS developed and distributed to each of the nation’s more than 15,000 nursing homes.
Sunrise Senior Living, which manages 300 communities nationwide, uses many of Feil’s validation strategies in its “Reminiscence” memory care units.
Rita Altman, a vice president of the McLean, Va.-based company, described a recent interaction with a Sunrise resident: A woman with advanced dementia was sitting alone, rocking her hands as if caressing a baby. Altman asked the woman if she loved to hold her baby. The woman, who was no longer able to communicate in full sentences, looked her in the eye and said yes. Altman set a doll in the resident’s arms as if it were her baby, and together they hummed a lullaby.
“By providing the resident with the doll and acknowledging how much she loved to take care of babies, I validated her feelings and helped to fulfill her basic human need to express love, and nurture or care for a child,” Altman explained in an email. “We know that deep down she knows it is a doll and that providing a doll is never enough. We also need to make that human connection. By using empathy along with some validation techniques, we can provide meaning and purpose to residents, even those in the later stages of memory loss.”
Helping others with dementia
Strategies for talking to people with dementia are not so different from effective listening techniques. Jo McCord, a family consultant for the Family Caregiver Alliance in San Francisco, suggested imagining yourself in your loved one’s position.
“Arguing with them is very damaging to their self-esteem,” she said. “Depending on where someone is in the disease, use a different vocabulary. Adapt your behavior to accommodate theirs.”
Families hoping to maintain or improve communication with those who have cognitive problems can use principles of the validation method on their own, Feil said.
These approaches can help with issues related to repetitive statements or questions, angry outbursts, false accusations or the longing to go home.
In each instance, Feil advised family members to “center,” by focusing on their breathing. Breathe in through the nose, she said, count to eight, and then exhale. Repeat this six times. It’s a different take on the adage about counting to 10.
If you are feeling frustrated with your loved one, take a minute, Feil said, and move. Just go up and down the stairs (if you can), or do something else physical to release your own tension.
In addition, she recommends finding someone to talk to, perhaps by joining an Alzheimer’s support group. Not talking about what is happening, Feil said, can lead caregivers to “blow up and not be able to use any of these techniques.”