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Using Reality Orientation in the Treatment of People with Alzheimer's Disease

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Updated April 01, 2013

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What Is Reality Orientation?

Reality orientation has its roots in a technique used with disabled veterans to help them engage in and connect with their surroundings. It's an approach where the environment, including dates, locations, and current surroundings, is frequently pointed out and woven into the conversations with the person who has dementia. Reality orientation is considered one of many Alzheimer's and other dementias.

How Does It Contrast with Validation Therapy?

Reality orientation has, until more recently, experienced a decline in popularity over the years, especially in comparison to validation therapy because of concern about people applying the theory without taking into account the person's emotions and mental health. Validation therapy emphasizes the feelings behind the behaviors or statements. It encourages the person to talk about the reality they're in, and postulates that by processing those perhaps unresolved issues, they'll eventually be able to be more at peace.

Strict reality orientation could result in a harsh imposition of the "real" reality and a heartless response to the question, "Where is my mother?" Pure reality orientation would respond, "She died a long time ago. You're 92 and your mother couldn't possibly be alive today." Validation therapy, meanwhile, would acknowledge the person's feelings, ask questions about the person's mother, and ask what you missed most about her.

Clearly, those who use reality orientation must apply sensitivity and wisdom. In my clinical experience, an understanding of both validation therapy and reality orientation is beneficial. Depending on the person's emotional state, personality and situation, the response that is most beneficial to the individual can then be used.

Is Reality Orientation Helpful?

Multiple studies have demonstrated that the use of reality orientation has improved cognitive functioning when compared to control groups who did not receive it.

It also has been shown to improve cognition when accompanied by medication. According to the British Journal of Psychiatry, the use of reality orientation by trained family members when coupled with the medication Aricept (donepezil) demonstrated an improvement in cognitive functioning but did not affect mood or behavior.

One study published in 2001 found that the use or reality orientation may delay nursing home placement by slowing cognitive decline.

Furthermore, after reviewing six randomized controlled trials, a study in the Cochrane Library concludes that there may be some benefit for not only cognition, but also behavior for people with dementia.

Strategies for Reality Orientation

  • Talk about the time of day, the date, and the season
  • Use the person's name frequently
  • Discuss current events
  • Refer to clocks and calendars
  • Place signs and labels on doors and cupboards
  • Ask questions about photos or other decorations

Sources:

Advances in Psychiatric Treatment (2004) 10: 171-177. Non-pharmacological interventions in dementia. http://apt.rcpsych.org/content/10/3/171.full

Archives of Gerontology and Geriatrics Supplement. (2002) Volume: 8, Pages: 15-22. The role of reality orientation therapy in restorative care of elderly patients with dementia plus stroke in the subacute nursing home setting. http://www.mendeley.com/research/role-reality-orientation-therapy-restorative-care-elderly-patients-dementia-plus-stroke-subacute-nursing-home-setting/

The British Journal of Psychiatry (2005) 187: 450-455. Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer’s disease: randomised controlled trial. http://bjp.rcpsych.org/content/187/5/450.full

Clinical Rehabilitation 2001;15(5):471-8. Reality orientation therapy to delay outcomes of progression in patients with dementia. A retrospective study. http://www.experts.scival.com/jad/pubDetail.asp?id=11594637&u_id=141

The Cochrane Library, Issue 1, 2003. Reality orientation for dementia (Cochrane Review). http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/health%20development/html/clients/cochrane/ab001119.htm

Cochrane Database Systematic Review. 2012 Feb 15;2. Cognitive stimulation to improve cognitive functioning in people with dementia. http://www.ncbi.nlm.nih.gov/pubmed/22336813

Dementia SOS. Colorado's Dementia News and Resource Center. Reorientation Strategies. Accessed March 27, 2013. http://coloradodementia.org/2012/02/03/reorientation-strategies/

Journal of Clinical Nursing. 2006 Nov;15(11):1440-9. Reality orientation: its use and effectiveness within older person mental health care. http://www.ncbi.nlm.nih.gov/pubmed/17038105

Penn State University. Care of the Cognitively Impaired Client. http://www.ed.psu.edu/educ/tte/nurse-aide-curriculum-guidelines-pdf-format/5.1.1%20-%205.1.3%20Care%20of%20Cognitively%20Impaired%20Clients.pdf/view

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