Should You Present Reality or Use Validation When Caring for Patients with Advanced Dementia?


Article Categories: Diseases & Basic Skills

Caring for patients with dementia causes you to wonder how the changes in your patient's brain can make them forget what has just happened or live in the past like they were their younger self.



In the advanced stages of dementia, the amount of time a patient believes has passed varies. Their present reality could be 5, 10, or 50 years ago, and the shift could happen at any moment.

For example, patients often insist on going home even if they are home, or they may be hurrying to go out and drive because their son, who is an adult in reality, needs to be picked up from the childcare center.

As a certified nursing assistant, you may have been in a similar situation. Did you present your patient with reality, by telling them that Jack is grown and that the patient has not been driving for years?

If you told the patient, “No, that is not true,” and pointed them back to reality, chances are your patient burst into tears, became angry or hostile, or withdrew from human connection altogether. If you are wondering why the patient reacted as negatively as they did, here’s a simple explanation:

The patient has no control over the changes happening to them, and they are not aware of this fact. They are trying to resolve unfinished issues of the past while finding meaning in life at the same time. They also want to restore balance and compensate for a lost bodily function or a loved one. Sometimes, it is their way of preserving their dignity and self-worth. Whatever the reason is, the patient's feelings must be acknowledged, and this is where validation helps.

What is validation, and how can it help confused patients in the advanced stages of dementia?

Validation is agreeing with a patient’s “reality” to reduce their anxiety and prevent stressing them unnecessarily. It focuses on empathy and listening, and also provides them with a means to express themselves as well as reminisce. It works with the idea that people are unique and valuable, and as such must be treated and respected as individuals.

A patient who says, “I want to go home,” may be feeling scared or tired, so they look for the comfort and safety of their home of 60 years ago. To use the validation technique, a CNA can ask:

“Are you uncomfortable?”
“Are you cold?”
“Do you miss home?”
“Tell me about Des Moines.”

If they insist on picking up little Jack from daycare, the nursing assistant can use validation by saying, "Ok, I’ll go with you, but let’s wait for a few minutes because I have to finish making the bed in the other room. Can you tell me about your son, Jack?”

Using validation is avoiding confronting the patient and arguing with them. It lessens their pain instead of adding to it.

So, does validation always work? Most of the time it will, but there will be moments when the plea to go home or meet with a relative from afar persists. But remember that you have still empathized with your patient and gave them worth as a person.

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