The approach we currently use to care for people with dementia in the United States has a name. It’s called appropriate care. We began using this approach decades ago – back when the poor, elderly, and senile were cared for in poorhouses and nursing homes. Appropriate care is really a general term that applies to any treatment in which the expected clinical benefits outweigh the expected negative side effects.

Today, in our care facilities, medical staff and aides typically use the appropriate care approach. Part of appropriate care is a technique called reality orientation. Staff members correct the residents’ confusion about what is true and real. People who have dementia are often confused about reality because they are losing their memory and their ability to use their rational thought processes.

Reality orientation, or the correction of someone’s confused beliefs, is what well-meaning family members and caregivers tend to use at home as well. It seems like the right thing to do because we believe in telling the truth. In America, we revere integrity. However, just as we do for children, we need to make allowances for people who have dementia. We need to adjust what we say to allow for their cognitive limitations.

When people have dementia, it changes their version of reality. They will never regain their memories or become better at using the rational thought functions they are losing. They often have problems differentiating between dreamed and real events, and soon lose the ability to track the passage of time. The result is that those experiencing dementia increasingly have their own personal versions of reality.

When caregivers demand that their charges accept the caregivers’ reality, the result is either fear or anger: they are fearful if the caregiver can convince them that their brains are giving them the wrong information, or angry if they cannot be convinced. This approach seems entirely nonsensical to me. Why would a caregiver want to cause someone with progressive cognitive impairment to be angry or afraid?

To Be Continued….

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