Intervention Methods and Therapies
 

The following section contains brief explanation methods and therapies currently in use.  It should be remembered that what works for some people may not work for others.

Further Information on the intervention methods and therapies mention below is available from the Cork Alzheimer Foundation Tel. 021-4964683 (Monday-Friday, 10am- 5 pm.)

Validation

Validation is an intervention method which originated in theUSA in the 1960s.  It was developed by Dr. Naomi Feil for use in the treatment of elderly people who suffer from dementia in general and Alzheimer disease in particular.  Dr. Feil says that dementia in general and Alzheimer disease in particular. Dr. Feil says that Validation is “based on the premise that many old people enter into a final resolution stage on their lives and that certain techniques…  Help them to resolve the past”.  It is essentially a communication therapy and it is based on an attitude of respect and empathy for older adults with dementia of the Alzheimer’s type.  The primary goal is to maintain communication skills, thereby preserving and maintaining for as long as possible a good quality of life.

To use Validation one does not need to be a professional in the medical, nursing or caring fields.  Dr. Feil suggests that anyone can be a Validator provided they have ability to empathise with and genuinely respect older people.  Successful Validator is built on a relationship of respect and trust between validator and client.

The following resource book and videos provide essential information on the use and practice of validation.

Book: “Communicating with the Alzheimer’s type Population” by Naomi Feil.  Available from reputable bookshops or direct from Winslow, Telford, Bicester, Oxon OX6OTS, United Kingdom.

Videos: “The More We Get Together” and The More We Feel” Available from Winslow, Telford Road, Bicester, Oxon 0X6OTS, United Kingdom.

Reality Orientation
 

This intervention method was developed in the USA in the 1950’s.  It is a therapeutic technique which can help confused older people maintain awareness of time and place through a process of repeated reminders and other forms of stimulation this therapy also helps to keep open the channels of communication between those with Alzheimer’s disease and those who care for them.

Reality Orientation works by stimulating the individuals into relearning things about him or her and the environment in which they live.  A reality orientation board prominently positioned on a wall is a popular means of providing up-to-date visual cues about such matters as place and time

Reality Orientation can be used on a one-two-one basis or in a group situation.  Sensitivity to the person’s feelings and beliefs is essential; for example it is not helpful to orientate a person to the fact that a loved one passed away more than a decade ago if such information is going to be a source of distress.

Reminiscence
 

Reminiscence is an intervention method which values the past.   It uses the past to enrich the present reality.  Developed in USA during the 60’s, Reminiscence helps to maintain the communication skills of those with Alzheimer’s disease by establishing a point of contact between the client and the carer.  The therapeutic value of reminiscence to help adjust to the experience of the present and to work through unsolved issues is self-evident.

The role of the carer giver is to initiate the communication, to encourage and nurture participation, to listen attentively and to show genuine interest.  Experience of working with Alzheimer’s patients had shown that a good means of initiating reminiscence is to have something for them to touch, smell and see.  A relaxed and comfortable environment is essential. 

Music Therapy
 

The aim of this therapy is to enhance the quality of life for those with Alzheimer’s disease.  Music often succeeds when other methods of communication have failed.  Notwithstanding the obvious therapeutic value of music to all, for people with Alzheimer’s it can also be useful to stimulate communication and activities which are beneficial.  For example, a familiar and well known song or tune from one’s earlier life may have a calming effect on someone who is agitated.  It may also bring something that is familiar in to the present world of the Alzheimer’s patient.  It may stimulate conversation or at least some form of interaction, and it may also stimulate coordinated physical activity such as hand clapping.

It is well documented that music also has the power to bring about physiological changes to do with respiration, pulse and blood pressure. In terms of psychology, music can be used to influence the listener .  When used on a group setting, music often promotes interaction and a group sense of relaxation, well-being and togetherness.

One to One Communication

The goal of most intervention techniques is to facilitate and maintain communication between the private and inward world of the Alzheimer’s patient and the outside real world in which he/she lives.  The success or failure of one to one communication depends very much on attitude, skill and patience of carer.  It works on the basis that nothing is meaningless; every word whether meaningful or not and every action, if only establishing eye contact, is significant and has meaning.  The carer’s task is to show total positive regard for the person and to make every effort to decode the communication and meet the need being expressed.

A kind, caring and non patronizing attitude on the part of carer is essential.  Clearly the carer also needs to be sensitive to the feelings and believes of the client.  One-to-one communication works best in a non-judgmental, unhurried and relaxed atmosphere.  It is important to speak clearly and slowly, never to argue, and to use a level of language that is appropriate.

Social Skills

This therapy focuses on the skills that the person with Alzheimer’s disease may have used and enjoyed during their lifetime, for example gardening, baking, poetry reading or sociable tea-time sessions.  It is used to assist in maintaining these social skills as much as possible and for as long as possible.  Social activities are likely to stimulate verbal and/or behavioral interaction, thereby keeping line of communication open.  Providing opportunities for social activities may also help greatly as a therapeutic intervention to reduce episodes of anti-social and so-called problem behaviour.

Sonas

This therapy enables people with Alzheimer’s disease to become more aware of the external environment and of each other.  It is a program which is aimed at enriching the quality of life and as such it is especially useful in long term residential care, nursing homes or other similar environments.  Sonas is an established and widely-rear multi-sensorial approach which makes extensive use of music and sense of touch.  It is normally used in a group session to stimulate communication and interaction between group members.  Sonas was developed in Ireland and information including cassette tapes and a manual are available from Sr. Mary Threadgold RSC, Director of Sonas Project, Sisters of Charity, St Mary’s, Merrion Road, Dublin 4 tel: 01 2608138,

e-mail sonaspc.iol.ie

Physical Activity

Appropriate physical exercise helps to maintain mobility in the elderly.  It improves muscle tones and circulation.  It can also benefit those with sleeping problems.  There are physiological benefits.  For example, physical activity can help reduce frustration and aggression because it requires mental concentration which helps to distract the mind.  Physical exertion provides a channel to work off feelings of frustration and aggression.  Physical activity sessions are often followed by relaxation sessions.

  

Sensory Stimulation


  Verbal communication becomes more and more difficult as dementia progresses.  Consequently activities which involve senses become more and more important.

Ideas for Sensory Stimulation:

Aromatherapy
 

This therapy uses oils to help calm or stimulate Alzheimer’s patients.  The calming influence of various oils such as geranium and lavender may assist to reduce agitation and aggressive behaviour.  These oils may also benefit those with sleeping problems.

Oils which stimulate, such as lemon, can be uses to assist in maintenance of concentration and communication.  It is essential that reaction to aromatherapy are monitored at regular intervals so that treatments are tailored for individual differences, tolerances and preferences.  Prolonged use of the same oil is not recommended.

Below are some examples of how the various oils can be used:

Suitable bases are aqueous cream, vegetable oil (sunflower, almond, sesame), bland lotion.  Useful application methods are hand/foot massage, hand/foot baths, compresses, baths, a few drops on clothing, and diffusers.

It is essential to ensure that the oils used are appropriate for the individual and to be aware of high blood pressure, epilepsy and heart or kidney disease.  If unsure about the contraindications of oils, check in “the A-Z of aromatherapy” by Patricia Davis, or by consultation with Nikki Darrell, B.Sc. (Hons), at Evergreen Clinic of Natural Medicine, 79 Evergreen Road, Cork. Tel. 021 4966209.

The use of aromatherapy in Alzheimer care is increasing as its benefits become better documented and more widely appreciated.  For example, fairly recent studies have shown that aroma groups improve the quality of life in Alzheimer’s disease.  As long ago as 1988 it was reported that aromatherapy was being used in some Oxford hospitals and that two Oxford hospitals in particular were using Lavender and other essential oils, in place of minor tranquillisers.

Since then aromatherapy has been increasingly employed in the care of people with Alzheimer’s disease in UK hospitals and clinics, even within the National Health Service.

Other Intervention Methods
 

There is a range of other intervention techniques such as diversion and behaviour modification.  There are commonsense psychological techniques to help deal with specific problems as they arise.

Diversion is a technique used to modify negative or inappropriate behaviour.  It requires the carer to provide a pleasant distraction once the negative behaviour begins.  For example, the offer of a cup of tea may distract a person who is wandering.

Behaviour modification refers here to the modeling of appropriate behaviour.  People with Alzheimer’s will often respond to the behaviour of others by imitation.  Hence if a person becomes confused at table, unsure of how to proceed, this can be dealt with by the carer giving example of the appropriate behaviour.   The idea is that the confused person will observe this and model his or her behaviour accordingly.

Another technique is based on the principle known to psychologists as operant conditioning.  Essentially this is based on the observation that people change their behaviour depending on the consequences.  If a person is rewarded for behaving in a certain manner; he or she is more likely to continue to behave in the same manner.  The use of positive rein forcers to change behaviour can be useful, especially in the early stages of illness.  Of course, in the case with people with Alzheimer’s disease such behaviour change is likely to be temporary, due to memory loss, but the techniques is nevertheless useful and effective in the immediate situation.