Naomi Feil developed the Validation method in the 1960s and 70s. From that time on, she advocated for us, care partners, to give more respect and honor to older adults whether they were oriented to our reality or not. She advocated for getting rid of the word ‘dementia’ because it means ‘mindless’; she said, “these people aren’t mindless, they are in a personal reality.” So I would rather speak about older adults living with cognitive decline, whether that cognitive decline comes from simply being very old or from a specific disease process, like Alzheimer’s.
The word ‘comforting’ also needs some definition. The dictionary says, ‘something that gives consolation or relief’, ‘alleviation of distress or discomfort’, ‘to console or cheer’. In the context of communicating with individuals living with disorientation, perhaps we can look at and redefine the definition of ‘comforting’. One of the important principles of the Validation method is:
Painful emotions, when expressed to a validating listener, lessen. Painful emotions that are ignored or repressed, grow stronger.
To make someone feel happy when they are remembering something very sad, like the loss of a child, could be the exact opposite of offering comfort. It could add to the pain. If a woman is angry because she’s been spoken to like a child, telling her that’s it’s okay and she doesn’t need to be angry, only makes her feel angrier.
Taking this into account, perhaps comforting someone means allowing them to have the painful feelings, to move through them, accompanied by someone else who has empathy and is willing to share the emotions.
If an older adult has withdrawn into themselves and no longer communicates verbally, how can we know what they need? We need to move closer to them. We need to use what Naomi Feil called ‘exquisite observation’ and calibrate ourselves to match what we see, hear and feel in order to find empathy, to ‘cross the street’ to accompany that person.
In the final stage of life, older adults need the same things younger people do. These are basic human needs and they include: to belong, to feel useful, to express emotions, to feel loved. Each individual is unique so for some, feeling loved is most important. For others, feeling a part of a group or family is most important. Everyone is different and needs shift as the individual moves into the final days of life.
I saw this in my mother. Her entire adult life was focused on being useful and being recognized for her work. Even a month before she died, when I asked what was most important for her right now, she longed to hear that her work was accepted by others, that she had made a difference in this world. In her last weeks, she was able to say, “I know my work will carry on and that people will teach others.” She had found resolution and peace in those final days.
She needed to hear from Validation practitioners that her efforts had not been in vain. That was comforting for her. Nothing I said or did could alleviate her distress. I needed to listen to her. Identify her needs and then accompany her.
Perhaps comforting someone who is living with cognitive decline means identifying their need in the moment. Listen to what is being expressed openly. Take it seriously. If an emotion is being expressed either verbally or non-verbally, having empathy or sharing that emotion with them can relieve the pain. If a person needs to relive a traumatic experience in order to let it go, we can accompany her so that she is not alone. In the case of my mother, our care team was able to fulfill her need by reaching out to the Validation community and asking them to tell Naomi how her life’s work had affected them. They responded overwhelmingly. The next step was to help Naomi read the hundreds of responses. By that time, she could no longer get onto her computer. Caregivers helped her read the postings every day. Hearing the message that her work changed the lives of so many people, helped her die in peace.
Note: when we validate someone who is disoriented and in another reality we do not agree or pretend that it is true and we don’t correct and try to reorient the person to our reality. We take a middle road; we explore with empathy.
For example: Mrs. Walter is 89 years old, living in a memory care community. She has stage IV cancer and chronic pain. Cognitively, she lives in a personal reality. Sometimes she feels like she is 10 years old after she had a terrible car accident which was quite traumatic. Sometimes she feels like she is almost 90 years old and sometimes she feels like she is 10 years old. One can hear the difference in her voice tone. When she speaks in a higher register, she’s 10 and when she’s old, her voice deepens. She can travel in time in her mind. What connects the two points in time is her physical pain. The pain she feels because of the cancer reminds her of the pain she felt after the car accident. She wants comfort. She wants her mother, who was always there with her in the hospital. She calls out, “mama” in a soft, high-pitched voice, with a yearning and sense of loneliness. A validating caregiver goes to her, slowly approaching to find a comfortable distance, gets eye contact with her and bends to eye level. She says, “You want your mama?”
“Yeesss. Mama.”
“Was she always there with you?”
“Yeess. Mama stays with me.”
“You’re all alone without mama?”
“I want mama here with me.”
The caregiver slowly and with loving intentions, uses the anchored ‘mother touch’, caressing the old woman’s cheek. She thinks of an old song a mother might sing to a child and starts to softly sing. After a few moments Mrs. Walter begins to sing with her. Her eyes soften and there is a moment of true connection and sharing. Mrs. Walter feels comforted.