Did you ever wake up in the middle of a dream and wonder, for just a moment, if what you were dreaming about was real? It can feel so disorienting until you open your eyes and take in your familiar surroundings. An experience like this gives you just a brief peek into the ongoing disorientation for a person with dementia. Managing reality in dementia support can be tricky. When confusion about place, time, and even identity settle in for someone you love, you have two choices for responding: either stepping into their reality with them, or orienting them to yours.
Which Reality Is Best?
In a nutshell, each approach has its place in dementia care. Nonetheless, there are particular cautions to understand in using reality orientation. It’s important to first understand what is involved in both options and when they could be most appropriate.
Accepting Their Reality
Living in an alternate reality is quite typical for a person in the mid to later stages of dementia. The individual may believe they are a young adult engaged in their previous career (or a different one altogether), with a spouse and young children to care for. Going along with their perception of reality helps them maintain a sense of purpose and self-worth. It instills peace and comfort, and is frequently the recommended approach.
On the other hand, reality orientation, involves providing cues and prompts about the current time, date, and location. Studies have shown that it can improve cognitive functioning, especially when paired with donepezil, and help with some of the more challenging aspects of dementia.
However, reality orientation needs to be handled gently and with skill, compassion, and awareness of the person’s emotional state. For instance, if the individual asks where their mother is, it could be extremely harmful to respond, “Why, she died 25 years ago! You are 95 years old, so there’s no way your mother could still be alive.” In contrast, it might be useful in ordinary conversations. For example, if the person wakes up and asks what day it is, you might respond, “Today is Monday, the day you have your physical therapy appointment and then lunch with Steve.”
If the individual seems to become anxious or agitated with reality, it is always best to join them in the perceived reality that feels comfortable to them.
CareWorks Health Services’ specially trained caregivers are pros at knowing how to effectively engage someone with dementia and make each day the best it can be. We use creative, customized approaches which help with memory, communication, safety, and comfort, while promoting independence and a sense of purpose and self-worth.