Reality orientation

Over time individuals with Alzheimer's disease may withdraw from contact with others and the environment as they become increasingly disoriented. This withdrawal results in a lack of sensory stimulation. To prevent understimulation, a therapy called reality orientation was developed. It is based on the belief that continually and repeatedly telling or showing certain reminders to people with mild to moderate memory loss will result in an increase in interaction with others and improved orientation. This in turn can improve self-esteem and reduce problem behaviors.

Reality orientation can be taught to caregivers and family members by a psychotherapist or other health care provider trained in these techniques. It can be performed in the home and should be structured around the area in which the person with Alzheimer's spends most of his or her time. Access to a window is recommended to facilitate orientation to the time of day and the weather.

In reality orientation, people with Alzheimer's are surrounded by familiar objects that can be used to stimulate their memory. Other materials, such as a family scrapbooks, flash cards, Scrabble games, a globe, large-piece jigsaw puzzles, and illustrated, large-print dictionaries, are also helpful.

Another tool, the reality-orientation board, is any board with a surface on which information can be changed easily, such as a blackboard, a pegboard, or an erasable memo board. Both the caregiver and the person with Alzheimer's fill in information such as current day of the week, date, and year, and the weather.

Reality orientation can also be used for persons who are severely confused. For these individuals, however, work focuses on less complicated information, such as their own name and address, the name of their caregiver, colors, and identification of everyday objects.

Reality orientation is around-the-clock therapy; the caregiver and anyone should be encouraged to apply the techniques. General guidelines include the following:

* Treat people with memory impairment with respect. Do not talk down to them or treat them like children.

* Every conversation you have with the person should include mention of the time, day of the week, and names of familiar people and objects. *

People with Alzheimer's should be encouraged to perform activities of daily living--that is, getting dressed, eating, taking care of personal hygiene---and should be complimented on all such attempts.