Improvisation in Dementia Care

Watching a loved one getting older can be uncomfortable. It’s difficult when there is an unmistakable sense that the person we once knew and our interactions with them are, sadly, no longer the same due to their cognitive decline.

They may experience memory impairment, disorientation, or a separation from reality. When that occurs, our natural inclination is to “tell the truth” — to correct their errors and remind them of things they may have forgotten.

This “reality orientation” is understandable — we assume it will benefit them.

In fact, as certified dementia practitioners who have worked in assisted living and nursing homes for many years, Alyson and I know that reality orientation creates a disruption and adds to their confusion. It also creates feelings of shame.

Besides, correcting factual errors is not our first priority. Rather, we are trying to enjoy our time together and provide our loved one with the best quality of life possible.

For that, we recommend applying a few proven techniques when interacting with those experiencing dementia…

#1. Validation therapy

Validation therapy encourages us to join our loved ones in their reality, rather than trying to bring them back to ours. By entering their world, we begin to increase their sense of security.

We do this by taking a page from improv comedy and its well-known approach of going wherever the other person takes the conversation. This requires a little bit of practice, but it can be applied in so many ways.

For example, if mom is walking with you outside and says, “I used to work in this building,” rather than remind her that she actually worked in another city entirely, you might say, “Really? Tell me more about what that job was like.” 

The beautiful thing about this technique is that it allows the older adult to express themselves without shame or confusion and for you to remain in the moment with them. It doesn’t really matter if what they are saying is factual; what matters is that they feel comfortable.

#2. Redirection

Our client Phyllis lived in assisted living. She was starting to ask staff when her husband would be coming to pick her up and take her home — her husband had died 10 years earlier. Reminding Phyllis that her husband had passed away would only cause her to experience that pain over and over again. 

Redirection is a technique in which the person’s attention is diverted to something else — something they find more pleasant. So, when Phyllis asked about her husband, a staff member might say something like, “I haven’t heard from him yet; can you tell me more about how you two met? Let’s go sit and have a cup of coffee, I’ll let you know right away as soon as we hear from him.”

To be clear, we are not talking about dismissing real or urgent concerns. Nor are we telling people something will happen that won’t. We are just encouraging a different activity to redirect their attention onto something more pleasant.

#3. Therapeutic Fibs

This refers to telling less than the entire truth in order to help the other person feel better and less resistant.

For example, one of our clients found a wonderful community for her husband who had dementia. He would not be moving for several weeks, and we coached her not to tell him about the move very far in advance. He would not remember, and it would only increase anxiety.

We also suggested she avoid calling the move “permanent” (even though it was). It feels much less heavy to say, “Let’s give this a try for a little while and see how things go.” (Spoiler alert: it almost always goes well.)

Comfort is Our Top Priority

Spending time with someone who is experiencing dementia can be triggering. We want to connect with our loved ones — we want them back the way they were.

But they are no longer living in our reality and our goal is not necessarily to uncover the truth. It’s to help them feel safe, comfortable, and happy. After all, is there anything more our loved ones would want that we can still give to them?

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