Dementia patients can be very unpredictable, and if you are not used to working with them all of the time, you may not be aware of the various techniques that we use to help to manage some of their challenging behaviours.

Validation therapy has a very simple theory at its core: “enter their reality”.

What does this mean? Well, instead of trying to tell someone who is absolutely certain whatever they are seeing or thinking is true, that it is NOT true, instead you just go along with it. They think you are their long dead sister? Don’t correct them. You don’t have to impersonate their sister to do this, but you can just smile and then steer the conversation to something safer, like “what do you think we’re having for dinner today?”

An example of this was a resident who had been a POW. This often involved quite harrowing delusions, including nightmares and sleepwalking. If confronted or touched, the resident became very violent. It was not easy to manage, but staff had learned that the best thing to do was to speak in an authoritative manner, and “order” the resident to follow simple instructions. We used the appropriate title to address the resident, and would say things like soldier, return to your bunk, or soldier stand to attention! It was simple, yet effective, and a few moments later things would usually return to normal as if nothing had happened.

Another resident had been a nurse, and in the early stages of her disease progression firmly believed that the nursing home was the hospital that she had worked in. Staff provided her with a desk, and some old files to sort through. She would accompany staff on morning rounds, and make sure everything was in order before retiring to do her “paperwork” quite happily.

Yet another resident had been a teacher, and was confined to a chair. She would get very lonely if no one stopped to talk to her, but often her conversations were very muddled and she would get upset at her inability to converse properly, so the other residents tended to give her a wide berth. This often resulted in crying or screaming out for attention whenever someone walked past. Handing her a book, and putting a teddy bear or doll on a chair in front of her would instantly transform her back into Teacher, and she would happily read her “student” a story.

Simple things like this can deescalate aggression, distress and paranoia very quickly. Knowing something about your residents past life, their job or their families, something that meant a lot to them can be a very handy tool when challenging behaviours come out. There are times when you will need to challenge their reality – for example if they are convinced that their food is poisoned, or that they simply must get home at 2am, but stepping into the alternate world they are living in really helps to normalise things for them.

You do not need to lie to them, or make them promises you don’t intend to keep. It does take practice, but you will find that it helps to foster trusting relationships, and that ultimately makes it much more likely that they will cooperate with care, and be less anxious and demanding.

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