Example Of How We Can Provide Reassurance Bu Using Reality Orientation


Asked by suhana

Example Of How We Can Provide Reassurance Bu Using Reality Orientation


One of the hallmarks of Alzheimer's disease is the loss of short term memory (i.e. forgetting what they ate for breakfast or repeating the same conversation or question every five minutes). When a person is no longer able to access short term memories, often their long term memories come into greater focus. A person may recall in detail the events of the childhood, teenage years and early adulthood. And as the disease progresses a person may become disoriented to time, thinking that they are living in the past. In this confused state, a person may believe that they have to go to work (even if they have been retired for 25 years), may talk about wanting to go home to their childhood home, or more disturbingly, mistake a grown child for a spouse or parent.

If you find an individual in this state of confusion about reality or time, it is important to note that for the individual, their experience feels real. Additionally, because Alzheimer's disease impacts a person's thinking and judgment, the individual may no longer be able to rationalize. Therefore attempting to orient a person will likely prove a futile, frustrating experience. Trying to rationalize, convince or reorient the person will not only be frustrating, it can also bring up feelings of shame, embarrassment or even humiliation for the individual. Furthermore, given the progressive nature of Alzheimer's disease over time an individual will increasingly need to rely upon you for support and to meet their care needs. Therefore, it would be important to try to preserve a positive relationship between yourself and the individual with Alzheimer's disease, as they will become increasingly dependent on you for support. Attempts to reorient will likely cause tension or even rifts in the relationship.

Instead, try following the three step approach:

  1. Validate
  2. Reassure
  3. Redirect

Validate -; You want to start off by acknowledging the individual's feelings. Try saying, "I hear that you want to go home, and can see that you are upset about not being able to go. I would also be upset if I were in your situation". In validating the person's feelings, you show them that you understand and respect where they coming from, which will in turn reduce their anxiety level and resistance. It is important to note, that even though you are validating their feelings, you are not confirming or denying their false beliefs.

Reassure -; Individuals with Alzheimer's disease experience multiple losses -; loss of memory, loss of thinking abilities, loss of independence. These losses often lead to pervasive feelings of fear and anxiety that underlie even the most routine daily activities. The common desire to "go home" can be understood on a psychological level as a desire to feel the safety, security and comfort that home represents, rather than a desire to go to a physical place. The impact of these feelings of fear and anxiety is compounded by the fact that Alzheimer's disease interferes with an individual's ability to communicate verbally. This combination of factors often leads to difficult, aggressive or even violent behaviors, which can be understood as a person's best attempt to communicate their needs. By attending to and responding to these underlying feelings of fear and anxiety, you will be able to diffuse and deescalate this individual's resistance and agitation. Try saying, "I know you're upset about wanting to go home, but I want to reassure you that I will be with you every step the way to help you in any way that I can to make sure you are safe and comfortable".

Redirect - Once you have validated the individual's feelings and reassured them, try redirecting them towards something positive. For example offer a favorite snack or a magazine to look at. It is important not to skip the first two steps of validation and reassurance. Often, caregivers jump to redirecting, and in the process alienate their loved one by inadvertently denying the person's feelings or needs.

-The AFA Social Services Team