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Memory Special Report

Habilitation: A Better Caregiving Approach

A quiet revolution is taking place in Alzheimer's care. The approach is called habilitation, and it has been credited with easing caregiver and patient stress, improving communication, and helping to maintain emotional bonds between individuals with Alzheimer's and their family members.

Habilitation focuses on respecting the feelings of people with Alzheimer’s and making the most of their remaining capacities, rather than trying to restore lost abilities (rehabilitation) -- often in vain -- or impose rigid standards for thoughts and behavior. Although the tenets of habilitation may seem intuitive, they run counter to the ways in which many Alzheimer’s patients are treated in nursing homes and family caregiving settings.

Accepting Their Reality
In the past, Alzheimer's caregivers were encouraged to practice "reality orientation" with their patients or loved ones. This meant constantly reminding the Alzheimer’s patient of the date and correcting the demented person's faulty beliefs and inaccurate perceptions in order to pull them "back to reality."

For example, if a person with Alzheimer's insisted that she had talked with her deceased husband on the phone that morning, a caregiver would remind her that he had died many years earlier. Oftentimes an argument would ensue, with the caregiver insisting that the person accept the reality of her husband's death. These attempts at reality orientation are not only frustrating and fruitless, but they often trigger agitation and angry outbursts from the patient.

Habilitation takes the opposite approach. The caregiver interacts with the Alzheimer’s patient on his or her own terms. The concept involves entering the person's world, offering patience and acceptance of their reality. In the situation described above, a caregiver practicing habilitation would say something soothing and reassuring, such as, "You and Harry love each other very much, don't you?" or "Tell me about Harry."

The practice of habilitation acknowledges that while a person with Alzheimer’s may not have the ability to reason or remember, he or she still feels emotion. As a result, caregivers do not attempt to reason with or correct the Alzheimer’s patient. Instead, they try to connect with the individual on an emotional level. Communication involves identifying the emotion behind the person's words and finding a way to address and validate those feelings.

Streamlining Their Space
A major part of habilitation is accommodating your loved one's physical reality as well, which means simplifying the living environment and keeping it as free of distractions as possible. This can help the person to continue to perform self-care tasks and simple household chores that promote independence and feelings of competence. Keep clutter to a minimum, reduce noise, and adjust lighting to minimize shadows, which can confuse or frighten a person who has Alzheimer’s. Dimmer switches on lights can be used to control light intensity. This can be helpful in reducing late afternoon and early evening agitation known as sundowning by increasing light intensity at these times of day.

Remember to break chores into simple steps and to provide only a small amount of information at a time. A caregiver following the tenets of habilitation tries to remain positive, calm, and encouraging and to refrain from criticizing and pointing out mistakes.

Enriching Their World
Most individuals with Alzheimer's disease get pleasure from doing things that they have always enjoyed, so it's important to pursue leisure activities that they find pleasing. Create opportunities for success by considering what they liked doing in the past and determine if there are activities that the person can still accomplish without becoming frustrated or agitated. Depending on the stage of Alzheimer’s disease the person is in, these might include crafts and hobbies, making or looking at scrapbooks and photo albums, stringing beads, baking cookies, going for walks, listening to music, or any other enriching activity that can keep the person occupied and engaged.

Social contact and physical activity are also important. Taking walks together in the neighborhood or mall, window-shopping, gardening, and planned activities at a senior center are just a few of the possibilities.

Posted in Memory on August 31, 2009

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