Modern medicine, excellent health care and a high living standard have drastically increased the life expectancy of people. As life expectancy is higher, the number of old people suffering from disorientation has also multiplied. This article focuses on the technique of validation which is a hands-on technique aimed at helping professional caretakers, family members and friends in their daily, sometimes difficult- but very often rewarding, undertaking with the old.

The technique of validation

The term validation is used to refer to a specific technique of communicating with old, disoriented people, which was initially developed by Naomi Feil. Validation derives from the verb to validate meaning to recognise the worthiness or legitimacy of something. In Naomi Feil’s terms validation means to recognise and accept the view of reality of old disoriented people and to provide them with empathy and respect. After Naomi’s Masters Degree in Social Work from Columbia University in New York, she began working with old, disoriented people. It is from the daily work with the elderly that evolved the technique of validation.

The technique of validation helps old disoriented people, people suffering from dementia or Alzheimer’s disease. Although validation has positive effects on persons suffering from early-onset Alzheimer’s disease (Alzheimer’s disease diagnosed before the age of 65), the behaviour of these patients deteriorates regardless of which therapy is being applied. The age of the persons does not determine whether he/she should be treated with validation, since an old person (60- 90 years) can be disoriented, while a very old person (older than 90 years) can still be cognitively active. The neurologist has to determine whether the patient suffers from dementia or Alzheimer’s disease by testing him/her.

Understanding the behaviour of the very old: reasons for disorientation

Physical losses

Physical losses, such as the loss of eyesight, the loss of hearing, the loss of mobility, the loss of hair and, most importantly, the loss of memory, are severe losses the old have to endure. In addition, strokes and heart attacks may have contributed to further memory decline. The sensory perception of the outer world loses its importance due to its deficiencies, while the past and the inner eye considerably gain in importance.

Social losses

The death of their partners, their siblings and their friends entails that they have lost their social role. Besides having lost their social life, they have also lost their job; in fact, they have no longer any duties or tasks to accomplish. Moreover, having exchanged their home, synonymous for comfort, security and well-being, for a small clinical room in an old-peoples home, they can no longer independently live their life. The fact of having lost everything which was part of their life and important to them, may subsequently lead to a loss of identity.

The wisdom of disorientation

In the face of the above-mentioned losses, the outer world no longer stimulates old people. That is the reason for them escaping into the past with a view to restore their dignity. Frequently old people slip into their former professional and social roles, they perform movements they did during in their every-day professional life and accomplish typical duties.. When present reality becomes painful, stimulating memories from the past may be healing. The innovative step Naomi Feil takes, is to provide old people with an empathetic listener, someone who does not judge them, but accepts their view of reality. Validation does not judge the escape from reality inappropriate; in fact, the person validating does not question the truth of what he/she is told, but listens carefully and empathetically. Underlying is the belief that old people cannot be forced to change their behaviours; in fact, a change of behaviour can only be achieved if the old person wants it.

How to validate old, disoriented people

Communication is the key to the understanding of the needs of old people. As a first step the validating person has to collect information about the life of the person to be validated. Knowing about the values, interests, the role of religion and former social roles is an important premise in order to understand the person’s needs and wishes.

When talking with disoriented, old people it is important to ask easy, concrete questions. “Have you lived in this old-people’s home for a long time?” is an easier question to answer than “How long have you been living in this old-people’s home”, since this question anticipates precise information in the answer, which may overcharge the old person. Paraphrasing what the person has expressed beforehand is a very promising tool in communicating with old people. Firstly, it gives them the feeling that the validating caretaker is honestly interested in what they say, secondly, it gives them the impression that the person validating accepts their view of reality without modifying it.
Old, disoriented people, plagued by irrational fears, may complain about nasty persons who deliberately annoy them and make life hard for them. A useful technique is to have them imagine the contrary. In practical terms this means asking them questions such as the following: “Can you think of a time where he/she does not annoy you?”

In order to build up trust it is important to visit the validated person regularly, it might also be important to tell him/her when there will be the next meeting, so the person has something to look forward to. Preferably visits should take place at a time of the day where the old, disoriented people are most active, this usually is the case in late morning or noon.

Outcomes of validation

The Australian scientist Colin Sharp conducted a study in two Australian old-people homes, whereby one group was being validated, whereas the control group was not. The results of the behaviour analysis proved that the persons being validated sit more erect and have more positive interaction and communication with others.

In 2002/ 2003 the Suisse Tertianum (an educational institute for social professions) lead a research in cooperation with the German research institute Idea-1 which researched the quality of interpersonal relationships between the validated people and the validating caregivers. Both the validating caregivers as well as the control group, consisting of caregivers not trained in validation, had to fill in questionnaires. Results proved that caretakers using validation manage difficult situations more efficiently and job satisfaction is generally higher.

However, serious studies concerning the outcomes and long-term effects of validation are rarely found. There may be two underlying reasons: the first being that behaviour of the old and disoriented is subject to fluctuation. The second being that positive effects of validation, such as reduced fear and increased satisfaction cannot easily be measured statistically.

Conclusion

Respect for the old and disoriented and the acceptance of their temporary disorientation are of highest importance. Due to the technique of validation, next of kin or friends, no longer need to angrily tell old, disoriented persons that they have lost the touch with reality, but listen empathetically when old persons express their feelings, worries and desires. Being familiar with the reasons underlying disorientation further promotes an understanding of the elderly.

References

Feil, Naomi. Validation. Ein Weg zum Verständnis verwirrter alter Menschen. München: Reinhardts Gerontologische Reihe, 2005.

Weblinks

Validation Training Institute: http://www.vfvalidation.org (17 April 2009)