The Reality of Reality Orientation

Yesterday afternoon in the secure unit for people with dementia, Betty* had been wandering around looking for a specialist for about an hour, asking everyone she saw where she should go to see the specialist for her appointment. I was doing other things so told her a few times that the specialist wouldn’t be in that afternoon, but that I’d make sure he saw her tomorrow morning and I think relatives and other staff members said similar things.

A bit later, I was sitting down in the dining room with a number of files in front of me, writing notes, it’s a new thing that my manager is pushing at the moment. Betty soon came and, probably seeing all the files, asked me if I was a specialist. I told her that I was and she asked me what kind, I told her I was a DT. She asked what it was and I explained it to her. I asked her why she had come to see me today and she told me she wanted to talk to me about her head. I asked her if she had a headache, and she said no, that she was worried about her head because she couldn’t remember where she was and what she was doing etc. I empathised and said that she must find it very frustrating and she nodded emphatically and continued talking about her concerns about her memory.

When I first started in DT, where I was working, the Reality Orientation Approach was where it was at. A quick google suggests that it was archaeic even at that point but to any theory there are always hangers on I suppose.

So of course the workplace had the once ubiquitous day/time/weather boards up everywhere (see below) and if Gladys* was looking for her mother, we were trained to say, “I’m sorry, Gladys, but your mother died in 1948 and it’s 2001 now” or something along those lines. Which never sat well with me.

The above anecdote is a good example of why. After a couple of mins of pouring her soul out and me trying my best to empathise, Betty told me that she had taken up enough of my time, said “thank you, doctor” and with that, went back to the lounge room where she sat contentedly watching Andre Rieu for the rest of the time I was doing my notes.

I’m not saying RO is completely useless; I’ve no doubt it is beneficial for some, but in my humble opinion blanket approaches and people mix like oil and water. We need to find unmet needs, people! Granted, they’re sometimes harder to find than others, but when you find them, Bingo!

http://ageing.oxfordjournals.org/content/31/3/155.full.pdf

*All names naturally changed for confidentiality.

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2 thoughts on “The Reality of Reality Orientation

  1. I work as a speech pathologist in long-term care facilities. I absolutely HATE reality organization. I don’t do it, and haven’t for years. I know there are still therapists out there who sit next to a resident and grill them, over and over. “What day is it? What town are we in?” and so on.

    Personally, I think it is far more important that a resident remember where his room is, how to get to the dining room, who that person is who sleeps in the other bed in his room, and so on. Does he remember that he had lunch just an hour ago, and does he remember to use his call light before he goes to the bathroom? Does he remember how to brush his teeth?

    That said, I do think it is very important to have those boards that say what day it is, and so on. Heavens, there are a lot of days I don’t remember what day it is without looking at a calendar. And these people have very little contact with the outside world; they don’t know if it’s raining or not. And some of them do like to know.

    As for that business of telling a resident that her mother was dead, shame on that person! The poor woman will only be more confused than ever, and now she’ll be sad to boot. Just a gentle, “She’s not here right now,” or re-directing the woman by getting her involved in another activity, are much more preferable.

  2. Yep, hear, hear! Heard Dr. Cameron Camp speak a few years ago on procedural interval learning and helping clients with dementia to learn what they need to know, i.e. dining room location and NOT the year or the current prime minister.

    You may have a point with those horrible boards…jury’s still out for me though. If they could only look a little less institutional/more adult…ours had big smiley suns and frowny thunder clouds…

    Great blog by the way!

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