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Wednesday, April 17, 2013
Dementia makes communication difficult, but some steps can make it easier
From The Washington Post:
My grandmother, who is 92, recently reported that she’d seen three giraffes in her Midwest back yard. 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 last week, 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 says. 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,” says Mary A. Corcoran, an associate dean at George Washington University School of Medicine and Health Sciences. There have been many since, she adds, 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 says, 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, says 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.
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