Practical Pharmacology for Alzheimer’s Disease
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It is based on the different principles of psychology, therapeutic approaches and biography [ 13 ]. The validation method is considered to be high moral support and a form of assistance we can provide to a senior with dementia syndrome. However, the springboard to providing it must be the willingness of workers to take a completely different view of this issue, to try to understand the right cause of the behaviour of disoriented seniors, and also effort and consistency in using new approaches to the patient. Validation as such is a sensitive generalization by experts dealing with people with dementia.
Its main principle is respect for the person. We do not violently oppose the misconceptions of a person with dementia, nor do we support them in that. Validating someone means accepting their emotions, telling him that their emotions are true.
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The refusal of emotion causes uncertainty. The purpose of validation is to help elderly people stay as long as possible in their home environment, to restore self-confidence, to reduce stress, to make sense of life as experienced, to deal with unaddressed conflicts of the past, to improve verbal and non-verbal communication, to prevent a return to vegetation, to improve the ability to walk and physical health in general, to provide the carer with joy and energy, to help families communicate with their disoriented relatives [ 20 ].
There are several principles that a user of validation must consider if they want to perform validation therapy on old, disoriented people. One must realize a few facts: Even porly oriented or disoriented seniors are unique and have their value. We must be able to listen; empathic listening creates an environment conducive to confiding, reduces their anxiety and, above all, brings dignity. Expressed, accepted and validated painful feelings become weaker.
But if ignored and suppressed they remain strong. The behaviour of these people can be rooted in one or more human needs. Processing unresolved task for a peaceful and balanced death, the need to live in peace, the need to regain their balance, as mobility memory and senses are lost, the need to give meaning to a gloomy reality, to find a place where they can feel happy, the need for status, recognition, self-sufficiency, the need to be productive and useful, the need to be respected and to belong, the need to express their feelings and be heard, the need for human contact, the need for certainty and security, not limitation, the need for any stimulation, and finally the need to reduce pain and complications.
In the case of failure of verbal expression and short-term memory, old learned patterns of behaviour return. Things, persons, or objects of the past are replaced by personal symbols that represent them and have an emotional charge. Disoriented or partially oriented seniors live at different levels of consciousness, often at the same time.
Various emotions, colours, sounds, coincidences, smells, tastes and images can now awaken emotions that recall similar emotion from the past [ 21 ]. During validation, we do not quarrel with the old person and do not confront them with the opposite view, we do not try to provide a view of their behaviour, and we do not try to improve their orientation in time unless it is of interest to the old person.
Individual or group therapy does not establish firm rules to target it over time. The user of validation is not perceived as an authority but as a diligent assistant.
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- Management of Alzheimer's Disease | The Journals of Gerontology: Series A | Oxford Academic.
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The basic forms of validation therapy include individual and group forms. In the individual form , the therapist works in three steps. In the first step, they collect all available information that is needed for the validation itself, but also for evaluating its effectiveness. The second step involves determining the phase in which the person is.
The third step is the validation therapy itself. A therapist should come regularly and use validation techniques that can help them at different stages.
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Group therapy is conditional on the creation of mutual trust so that individual members can express their own feelings, communicate verbally and non-verbally, solve problems, be active in selected social roles, learn the highest possible degree of control and, in particular, to gain a feeling of their own about their own value. The goal of group validation is to reduce fear, reduce the need for limiting and calming methods, and prevent vegetation in old dementia patients. Another less important goal for relatives and staff is for validation to reduce their risk of burnout syndrome [ 21 ].
It is possible, for the best use of the validation team, to involve all workers—not only nursing staff, but also staff from cleaning, kitchens, offices, social workers or physiotherapists.
The most appropriate solution is to create a validation team that would stimulate the client or patient with the same validation techniques [ 22 ]. The first step is getting to know the person. At this point it is necessary also to evaluate the phase or stage of disorientation in individual validation too. All this is necessary, because the knowing the group members is also the basis for its success. The second step is selecting the group members.
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As the group is diverse, it is necessary to assemble it so that everyone has its place in it. A former clergyman can begin by praying, a former teacher of singing can lead singing. Naomi Feil exactly describes what the composition of the members should be like and at what stage of disorientation they should be.
There should be five to ten people in the group—one leader personality, one wise and hospitable person, four or five people who like discussion, about two people in the third stage who could respond to the validation therapist, and two people still do not feel threatened by disoriented persons. The third step is to find a role for each member. At each meeting an individual should play the same role, because it represents a certainty for him and promotes dignity. As an example, Naomi Feil gives an introducer, who opens and ends the meeting, a singer who sets the rhythm and conducts, someone who reads in the group, the person who prepares the chairs, the flowers, the secretary, the host.
In the fourth step , it is appropriate to involve all the staff in the validation. This can help with preparation and implementation. The fifth step is music itself, the discussion, movement, eating. The music should start and end the session, and one song is enough. For the discussion, it is advisable to choose the topics in advance—the loss of a loved one, home or work, boredom, searching for a new sense of life.
The sixth step is to schedule a meeting. This step consists not only of a meeting plan, but also of the preparation of materials and room, of the timetable and all the information available to help the meeting. In the seventh step is meeting itself alone. It should be done at least once a week at the same time and in the same place. It is composed of four parts—introduction, life, conclusion and preparation of the next meeting [ 21 ]. The basis for validation meetings is how and what a person with dementia really wants to express themselves, and even if it does not coincide with reality, appropriately and adequately respond to it [ 23 ].
The patient was disoriented in time and space. The patient had an increased risk of falls due to his advanced age and limited mobility. The patient used antipsychotics and sedatives. Hospitalization was necessary because in the domestic environment the patient was always going away, not accepting the guidance of the carers, he was restless at night, he shouted.
During the day he was restless, always wanting to go home, he ran out of the room. According to the Naomi Feil validation concept, we are not trying to improve his orientation, we do not argue and do not confront him with the opposite view. We tried to use these recommendations in communicating with the patient. If the patient requested to go home, we did not give him the reasons why he could not go home and where he was, but we turned the communication in a different direction.
We asked why he wanted to go home, what he would do at home, what he used to do outside in the garden, with whom he met…The patient began to talk about what he used to do at home and where he worked. This does not mean that the patient was getting better, but he lightened his tone in communication, he did not shout, after a group walk around the department, the patient could be directed and was sitting quietly in the chair. We have found a way how we can influence patient behaviour and actions…. Doll therapy is a very effective form of comprehensive therapy in patients with various forms and degrees of dementia, mental retardation, physical disability, and various psychiatric disorders.
It is known for its low financial burden and easy accessibility. The therapeutic dolls resemble young children in terms of their size and appearance. Dolls are made with natural material, which is also anti-allergic. The individual body parts are specially balanced for better handling. The legs are malleable, suitable for enveloping the patient and encouraging hugging.
Such manipulation is used as part of basal stimulation. The indirect gaze of all the dolls eyes do not look ahead is deliberately neutral. It feels peaceful to the patients and does not cause negative emotions. Doll therapy is based on long-term memory paths. It is normal that these patients, especially women, are looking for their children and want to take care of something or someone. It is through dolls that we try to stimulate this ability.
Furthermore, we try to stimulate fine motor skills, nerve activity, especially attention, memory, supporting patient activity, dialog, establishing relationships, inducing a sense of security, love and peace.