**2. Non-pharmacological treatment of Alzheimer's**

A regular daytime routine is an important part of care for a patient with dementia because in the advanced stages of dementia, patients benefit from a certain regularity of the daily routine. A natural rhythm comes from the time of eating, time for leisure activities or for hygiene. If we offer a variety of options to the patient and we program the individual activities for specific days, we fill the patient's time meaningfully, thereby preventing periods of troubles. Overly interesting or too many activities can have the opposite effect, so we emphasize the individual approach and accepting the patient's abilities.

**Nutritional support** is part of comprehensive therapy and has an important place in the comprehensive treatment of dementia patients. Nutritional care can improve the results of treatment [4]. Epidemiological and clinical studies abroad have shown that dietary supplements can reduce the risk of cognitive impairment and greatly improve its further course. Aging individuals who consume enough fish (sea fish two to three times a week) and fish products, omega-3 fatty acids

**77**

*Non-pharmacological Treatment of Alzheimer's DOI: http://dx.doi.org/10.5772/intechopen.84893*

undoubtedly support the health of the brain [6, 7].

recommended in the mild and moderate stages of the disease.

memory loss, and aids can be used to orient them in the real situation.

is to a great extent a specific need at this stage of the disease [10].

and have a preventive effect.

(tranquilizers) [8].

looking after a pet [9].

and *Ginkgo biloba* see an effect on their cognitive function which can slow down the development of cognitive deficits [5]. Walnuts are an important part of nutrition for a patient with dementia. They are rich in protein, vitamins, omega 3 fatty acids, trace elements, lecithin and oils. Walnuts are an important part of the diet with regard to brain activity. Compared to other nuts, which usually contain a large amount of monounsaturated fatty acids, walnuts contain especially polyunsaturated fatty acids. They have only a negligible amount of sodium and are free of cholesterol. They also contain enough folic acid and thiamine and a useful amount of vitamin E in the form of tocopherol. They contain manganese, magnesium, phosphorus and iron. The folk saying is that walnuts have the shape of a brain so they

Apples, spinach, extra virgin olive oil, grape juice and red wine, salmon, curry pepper and curcumin, cinnamon, coffee and hot chocolate improve brain activity

When stretching our thinking or memory, we lean towards the substances that irritate the nervous system. They are sometimes called 'memory poisons'. These substances stimulate the current intellectual capacity and improve memory and focus. Substances like this include: caffeine, nicotine, alcohol, calming drugs

**Leading the patient towards self-sufficiency** is an important principle in the care of a dementia patient. All care providers should be sufficiently qualified and have the patience to use gradual steps, instruction and help to lead patients to perform their own care by themselves. This approach too must be applied sensitively, with knowledge of the condition and the patient's capabilities, the patient cannot be expected to perform activities that they are no longer able to do. This approach is

Patient activation is understood the preservation and improvement of their capabilities by assigning different tasks. Particularly, pet therapy is more of a homebased type of therapy when the dementia patient's level of activity is maintained by

**Orientation in reality** is one of the oldest approaches to patients. At present, only some elements of orientation in reality are used. This approach, if applied consistently and thoroughly, improves patient orientation but at the cost of total discomfort [10]. Nowadays, orientation in reality is used mainly in the initial stages of Alzheimer's disease when the patient has short-term losses of memory. The patient has a calendar, saying the day, month, year, their name, address, and other information that would return them to reality during a short-term loss of memory. Suitable approaches include the colour coding of rooms and the use of pictograms to improve the spatial orientation of the patient. Orientation in reality is important in the light and moderate stages of the illness, when the patient experiences

**Programming activities** is suitable for people undergoing advanced dementia. The progression of the disease leads to a worsening of the overall condition, when patients need the most individualized care. In the event that the individual activities burden the patient, we stop trying to force their active participation and adapt to the specific pace, needs and possibilities of the patient. Programming activities is an important part of care in the advanced stage of the disease and it can be said that it

**Milieu therapy** is also known as environmental manipulation. Its use is appropriate in the mild and moderate stage of Alzheimer's disease. It is a comprehensive individual approach to the patient and the adaptation of the environment in which they function so that they feel pleasant and can better orient themselves through plenty of sensory stimuli provided. Some facilities for seniors that are specially

*Non-pharmacological Treatment of Alzheimer's DOI: http://dx.doi.org/10.5772/intechopen.84893*

*Redirecting Alzheimer Strategy - Tracing Memory Loss to Self Pathology*

regular part of the daily regimen of a patient with dementia [2].

ing problem areas:

toms of dementia.

• Support for carers [3].

tion approaches for Alzheimer's disease patients.

**2. Non-pharmacological treatment of Alzheimer's**

principles and recommendations for care.

accepting the patient's abilities.

them.

Activities should be comprehensive, adequately influence the mental and physical aspects and the psychosocial contacts. Activities should always promote the patient's strengths. It is important to have a familiar environment for the patient. The process of the activities themselves is important. An activity that does not come off successfully does not mean a loss. Treatment of this type should become a

Non-pharmacological approaches to dementia management focus on the follow-

• Mitigating or eliminating problematic behaviour and the psychological symp-

• Improving the communication between the patient and the doctor treating

• Improving the quality of life of patients in the terminal stages of dementia.

The aim of our work is to summarize current theoretical knowledge about nonpharmacological approaches with patients with Alzheimer's disease and to illustrate examples of the implementation of specific approaches. When formulating the theoretical basis, we used the available specialist and scientific publications. The practical examples are the result of qualitative research aimed at verifying activa-

Caring for a patient with Alzheimer's disease requires that we recognize the basic

A regular daytime routine is an important part of care for a patient with dementia because in the advanced stages of dementia, patients benefit from a certain regularity of the daily routine. A natural rhythm comes from the time of eating, time for leisure activities or for hygiene. If we offer a variety of options to the patient and we program the individual activities for specific days, we fill the patient's time meaningfully, thereby preventing periods of troubles. Overly interesting or too many activities can have the opposite effect, so we emphasize the individual approach and

**Nutritional support** is part of comprehensive therapy and has an important place in the comprehensive treatment of dementia patients. Nutritional care can improve the results of treatment [4]. Epidemiological and clinical studies abroad have shown that dietary supplements can reduce the risk of cognitive impairment and greatly improve its further course. Aging individuals who consume enough fish (sea fish two to three times a week) and fish products, omega-3 fatty acids

• Early diagnosis and patient support in the initial phase of the disease.

• Providing information, preserving or improving cognitive functions.

• Preservation or improvement of the patient's self-sufficiency.

• Improving the quality of life for the patient with dementia.

**76**

and *Ginkgo biloba* see an effect on their cognitive function which can slow down the development of cognitive deficits [5]. Walnuts are an important part of nutrition for a patient with dementia. They are rich in protein, vitamins, omega 3 fatty acids, trace elements, lecithin and oils. Walnuts are an important part of the diet with regard to brain activity. Compared to other nuts, which usually contain a large amount of monounsaturated fatty acids, walnuts contain especially polyunsaturated fatty acids. They have only a negligible amount of sodium and are free of cholesterol. They also contain enough folic acid and thiamine and a useful amount of vitamin E in the form of tocopherol. They contain manganese, magnesium, phosphorus and iron. The folk saying is that walnuts have the shape of a brain so they undoubtedly support the health of the brain [6, 7].

Apples, spinach, extra virgin olive oil, grape juice and red wine, salmon, curry pepper and curcumin, cinnamon, coffee and hot chocolate improve brain activity and have a preventive effect.

When stretching our thinking or memory, we lean towards the substances that irritate the nervous system. They are sometimes called 'memory poisons'. These substances stimulate the current intellectual capacity and improve memory and focus. Substances like this include: caffeine, nicotine, alcohol, calming drugs (tranquilizers) [8].

**Leading the patient towards self-sufficiency** is an important principle in the care of a dementia patient. All care providers should be sufficiently qualified and have the patience to use gradual steps, instruction and help to lead patients to perform their own care by themselves. This approach too must be applied sensitively, with knowledge of the condition and the patient's capabilities, the patient cannot be expected to perform activities that they are no longer able to do. This approach is recommended in the mild and moderate stages of the disease.

Patient activation is understood the preservation and improvement of their capabilities by assigning different tasks. Particularly, pet therapy is more of a homebased type of therapy when the dementia patient's level of activity is maintained by looking after a pet [9].

**Orientation in reality** is one of the oldest approaches to patients. At present, only some elements of orientation in reality are used. This approach, if applied consistently and thoroughly, improves patient orientation but at the cost of total discomfort [10]. Nowadays, orientation in reality is used mainly in the initial stages of Alzheimer's disease when the patient has short-term losses of memory. The patient has a calendar, saying the day, month, year, their name, address, and other information that would return them to reality during a short-term loss of memory. Suitable approaches include the colour coding of rooms and the use of pictograms to improve the spatial orientation of the patient. Orientation in reality is important in the light and moderate stages of the illness, when the patient experiences memory loss, and aids can be used to orient them in the real situation.

**Programming activities** is suitable for people undergoing advanced dementia. The progression of the disease leads to a worsening of the overall condition, when patients need the most individualized care. In the event that the individual activities burden the patient, we stop trying to force their active participation and adapt to the specific pace, needs and possibilities of the patient. Programming activities is an important part of care in the advanced stage of the disease and it can be said that it is to a great extent a specific need at this stage of the disease [10].

**Milieu therapy** is also known as environmental manipulation. Its use is appropriate in the mild and moderate stage of Alzheimer's disease. It is a comprehensive individual approach to the patient and the adaptation of the environment in which they function so that they feel pleasant and can better orient themselves through plenty of sensory stimuli provided. Some facilities for seniors that are specially

designed for dementia patients accept this concept in advance. In particular, it is important for the patient to be easily orientated in the interior. One problem may be, for example, an unusual design for flushing the toilet, which the patient may not know or the taps/faucets. Sometimes it is advisable to camouflage the entrance door, for example with wallpaper, so as not to tempt the patient to leave the ward. The space should be stable and should change as little as possible [10].

*Practical demonstration:*

*In the gerontological psychiatry ward, patients' rooms were numbered. Patients found it harder to orient themselves in this space and often did not return to their room. When the door of the room was marked with pictures of fruit (pear, apple, plum, banana, oranges), it turned out that the orientation of the patient in the space was easier.*

**Lifestyle approach** is sharing information among care providers. Patients may have different individual habits, which should also be accepted during dementia. They include the daily routine of the patient, their habits, way of dressing, using the toilet, the activities they perform by themselves, and those for which they need help. If the treating staff respect long-followed habits and rituals, it will facilitate care. Failure to do this often causes aggression, unrest, and other situations that lead to a worsening of the patient's condition. Some facilities have questionnaires, entry interviews to this end, which aim to get as much detail as possible. If the attending staff does not accept routine habits and rituals, it usually increases the aggressive behaviour of the patient. Practice shows that the experience of family carers is a valuable aid in the care of the sick [10].

### *Practical demonstration:*

*In a social care facility for the elderly, a patient did not evacuate into the toilet but always onto the floor. Repeated instructions from the treating staff did not help, nor did labelling the toilet with a pictogram. Unpleasant and bewildering situations occurred like this. In a deeper study into why the patient does not accept evacuating into the toilet, it was found that the patient was from a socially deprived environment and he only began using a toilet during adulthood. By simple intervention—removing the toilet door and the coloured curtain at the entrance to the toilet, the patient was able to learn where to evacuate. Another solution to the situation could be, for example, the use of a disposable diaper, which would be uncomfortable for the patient, but would facilitate the work of the attending staff. An individual approach can also bring about an easy solution to a seemingly simple situation.*

### **2.1 Cognitive training**

In the following section we list non-pharmacological approaches to dementia patients. For each approach, we provide practical examples of how we have used them in the care of patients with dementia.

Cognitive training is targeted stimulation of brain functions with a focus on multiple cognitive abilities. It is mainly used in initial and middle stage Alzheimer's patients who want to train their cognitive skills by themselves. It slows the development of the disease and improves the quality of life. Sometimes it also serves as a daily activity or fun, depending on how the patient takes it. Studies have shown that in some patients in the moderate and serious stages of the disease cognitive training leads to negative reactions, such as depression and frustration [11]. We can use the techniques of cognitive training in ordinary life. For example, we can go shopping without a shopping list, solve mathematical problems without a calculator, sometimes we can even learn something 'by heart' such as a song or poem, or we can imitate the main actors after a film has ended [12]. Cognitive training has a particularly important role to play in preventing cognitive decline, strengthening self-esteem, self-confidence, promoting self-sufficiency in day-to-day activities, helping maintain quality of life, promoting social contacts, and enhancing welfare

**79**

*Non-pharmacological Treatment of Alzheimer's DOI: http://dx.doi.org/10.5772/intechopen.84893*

*functions and train the brain in an unforced way.*

*Practical demonstration:*

*the supervision of the therapist.*

*institutionalized care.*

**2.2 Snoezelen therapy**

violent behaviour [15].

and enjoyment of success [13]. The worst thing for memory is inactivity and a lack of stimuli for processing. If the memory is not regularly stimulated it gets 'lazy' and

*Example 1: An 81-year-old patient has observed over several years that her memory is getting worse and she forgets everything quickly. She forgets everything she wants to buy or take out of the refrigerator, she does not remember her relatives' birthdays and other special days. All her information and appointments must be written in a calendar or diary. She does smaller shopping trips on her own, but she always has to prepare a shopping ticket. The client leads an active life. Every day she goes for 30-minute walks, which promotes brain oxygenation and supports memory functions. She attends university of the third-age and a retirees' club, where she gets new enthusiasm and meets people. She reads books every day, does crosswords, watches quizzes on television. These day-to-day activities are a natural part of the daily life of an active senior which stimulate cognitive* 

*Example 2: In a retirement home, seniors trained their memory functions. As an activity they chose preparing food. Patients under the supervision of their therapist, remembered a variety of different recipes, specifically for: pancakes. Because they are in a social care facility and are not preparing meals themselves they had to think more deeply about recipes. Together, they agreed on a recipe which they then prepared under* 

*This activation is an example of how we could implement cognitive training without realizing it and it can become a natural part of the daily program of senior citizens in* 

Snoezelen therapy is a multifunctional method that is performed in a particularly pleasant and adapted environment. This therapy offers patients with dementia a suitable alternative solution with the ability to become aware of their surroundings. It allows them to better respond to the environment they are part of. The stimulating environment helps to reduce aggression and improve the mood just by calming the body and mind, so it can induce inner balance and peace. Through stimuli, such as sound and light effects, relaxing music, tactile surfaces, or the pleasant smell of essential oil, it stimulates external senses such as hearing, sight, touch, smell or taste. It creates an environment that creates nice and pleasant

Snoezelen is the name for a multi-sensory room that provides beautiful sensory experiences using technology that generates sensual responses and reactions from the client. This room produces a sense of well-being, it releases and relaxes, activates and awakes the senses. But it also provokes memories, directs and unites stimuli, destroys fear, brings security, reduces aggression, self-destruction and

When using Snoezelen therapy, it is not possible to determine in advance how the patient will respond. Even if it makes us feel comfortable, we can equally expect the opposite reaction. Multi-sensory stimulation is recommended at least once or twice a week with an interval of at least 30 minutes to prevent the patient from becoming saturated with stimuli. Snoezelen therapy is appropriate in all stages of dementia, but it is especially beneficial if we are interested in a patient in a severe

*An 86-year-old patient with a severe degree of Alzheimer's dementia does not recognize his relatives, he is limited in movement, speaks incomprehensibly, sleeps during the* 

memories, and it also helps stimulate and activate old habits [14].

stage and we can stimulate the psyche and arouse pleasant feelings.

*Practical demonstration of a negative reaction:*

its functioning worsens, just like another organ or muscle [12].

*Non-pharmacological Treatment of Alzheimer's DOI: http://dx.doi.org/10.5772/intechopen.84893*

and enjoyment of success [13]. The worst thing for memory is inactivity and a lack of stimuli for processing. If the memory is not regularly stimulated it gets 'lazy' and its functioning worsens, just like another organ or muscle [12].

*Practical demonstration:*

*Redirecting Alzheimer Strategy - Tracing Memory Loss to Self Pathology*

designed for dementia patients accept this concept in advance. In particular, it is important for the patient to be easily orientated in the interior. One problem may be, for example, an unusual design for flushing the toilet, which the patient may not know or the taps/faucets. Sometimes it is advisable to camouflage the entrance door, for example with wallpaper, so as not to tempt the patient to leave the ward.

*In the gerontological psychiatry ward, patients' rooms were numbered. Patients found it harder to orient themselves in this space and often did not return to their room. When the door of the room was marked with pictures of fruit (pear, apple, plum, banana, oranges), it turned out that the orientation of the patient in the space was easier.*

**Lifestyle approach** is sharing information among care providers. Patients may have different individual habits, which should also be accepted during dementia. They include the daily routine of the patient, their habits, way of dressing, using the toilet, the activities they perform by themselves, and those for which they need help. If the treating staff respect long-followed habits and rituals, it will facilitate care. Failure to do this often causes aggression, unrest, and other situations that lead to a worsening of the patient's condition. Some facilities have questionnaires, entry interviews to this end, which aim to get as much detail as possible. If the attending staff does not accept routine habits and rituals, it usually increases the aggressive behaviour of the patient. Practice shows that the experience of family carers is a

*In a social care facility for the elderly, a patient did not evacuate into the toilet but always onto the floor. Repeated instructions from the treating staff did not help, nor did labelling the toilet with a pictogram. Unpleasant and bewildering situations occurred like this. In a deeper study into why the patient does not accept evacuating into the toilet, it was found that the patient was from a socially deprived environment and he only began using a toilet during adulthood. By simple intervention—removing the toilet door and the coloured curtain at the entrance to the toilet, the patient was able to learn where to evacuate. Another solution to the situation could be, for example, the use of a disposable diaper, which would be uncomfortable for the patient, but would facilitate the work of the attending staff. An individual approach can also bring about an easy solution to a seemingly simple situation.*

In the following section we list non-pharmacological approaches to dementia patients. For each approach, we provide practical examples of how we have used

Cognitive training is targeted stimulation of brain functions with a focus on multiple cognitive abilities. It is mainly used in initial and middle stage Alzheimer's patients who want to train their cognitive skills by themselves. It slows the development of the disease and improves the quality of life. Sometimes it also serves as a daily activity or fun, depending on how the patient takes it. Studies have shown that in some patients in the moderate and serious stages of the disease cognitive training leads to negative reactions, such as depression and frustration [11]. We can use the techniques of cognitive training in ordinary life. For example, we can go shopping without a shopping list, solve mathematical problems without a calculator, sometimes we can even learn something 'by heart' such as a song or poem, or we can imitate the main actors after a film has ended [12]. Cognitive training has a particularly important role to play in preventing cognitive decline, strengthening self-esteem, self-confidence, promoting self-sufficiency in day-to-day activities, helping maintain quality of life, promoting social contacts, and enhancing welfare

The space should be stable and should change as little as possible [10].

*Practical demonstration:*

valuable aid in the care of the sick [10].

them in the care of patients with dementia.

*Practical demonstration:*

**2.1 Cognitive training**

**78**

*Example 1: An 81-year-old patient has observed over several years that her memory is getting worse and she forgets everything quickly. She forgets everything she wants to buy or take out of the refrigerator, she does not remember her relatives' birthdays and other special days. All her information and appointments must be written in a calendar or diary. She does smaller shopping trips on her own, but she always has to prepare a shopping ticket. The client leads an active life. Every day she goes for 30-minute walks, which promotes brain oxygenation and supports memory functions. She attends university of the third-age and a retirees' club, where she gets new enthusiasm and meets people. She reads books every day, does crosswords, watches quizzes on television. These day-to-day activities are a natural part of the daily life of an active senior which stimulate cognitive functions and train the brain in an unforced way.*

*Example 2: In a retirement home, seniors trained their memory functions. As an activity they chose preparing food. Patients under the supervision of their therapist, remembered a variety of different recipes, specifically for: pancakes. Because they are in a social care facility and are not preparing meals themselves they had to think more deeply about recipes. Together, they agreed on a recipe which they then prepared under the supervision of the therapist.*

*This activation is an example of how we could implement cognitive training without realizing it and it can become a natural part of the daily program of senior citizens in institutionalized care.*

#### **2.2 Snoezelen therapy**

Snoezelen therapy is a multifunctional method that is performed in a particularly pleasant and adapted environment. This therapy offers patients with dementia a suitable alternative solution with the ability to become aware of their surroundings. It allows them to better respond to the environment they are part of. The stimulating environment helps to reduce aggression and improve the mood just by calming the body and mind, so it can induce inner balance and peace. Through stimuli, such as sound and light effects, relaxing music, tactile surfaces, or the pleasant smell of essential oil, it stimulates external senses such as hearing, sight, touch, smell or taste. It creates an environment that creates nice and pleasant memories, and it also helps stimulate and activate old habits [14].

Snoezelen is the name for a multi-sensory room that provides beautiful sensory experiences using technology that generates sensual responses and reactions from the client. This room produces a sense of well-being, it releases and relaxes, activates and awakes the senses. But it also provokes memories, directs and unites stimuli, destroys fear, brings security, reduces aggression, self-destruction and violent behaviour [15].

When using Snoezelen therapy, it is not possible to determine in advance how the patient will respond. Even if it makes us feel comfortable, we can equally expect the opposite reaction. Multi-sensory stimulation is recommended at least once or twice a week with an interval of at least 30 minutes to prevent the patient from becoming saturated with stimuli. Snoezelen therapy is appropriate in all stages of dementia, but it is especially beneficial if we are interested in a patient in a severe stage and we can stimulate the psyche and arouse pleasant feelings.

*Practical demonstration of a negative reaction:*

*An 86-year-old patient with a severe degree of Alzheimer's dementia does not recognize his relatives, he is limited in movement, speaks incomprehensibly, sleeps during the*  *day and is restless at night. At the entrance to the Snoezelen room, the patient sharpened his gaze and began to look around. The patient was placed in the centre of the room in the wheelchair, we began the light effects: bubble cylinders, starry sky, we quietly turned on the music. Through his knees, we passed interactive optical fibers that he touched with his hands. The patient was silent for about 10 minutes, observing the surroundings, playing with the interactive fibers in his hands. After a while the patient began to be nervous, he was fidgeting, he lowered his eyes, and muttered something quietly. After a while, he started to shout nonsensically. He was aggressive. We finished the Snoezelen therapy.*

*In repeat therapies, the patient responded in the same manner, so we will not use this multisensory stimulus for the specific patient, but we will choose another non-pharmacological approach.*

#### **2.3 Reminiscence therapy**

Reminiscence therapy is a method that uses memories and their recall using various stimuli. Of course, it is also suitable for healthy seniors, for its preventive and activating significance. It is mainly useful for patients with dementia, who have short-term memory disorders, but conversely, they are often have surprisingly good recall of events from the past [3].

Reminiscence therapy typically refers to a therapist's conversation with an elderly person (or group) about their life up to that point, their past activities, events and experiences, often using appropriate tools (old photographs, objects, tools and home appliances, and old working tools, fashion accessories, movies, folk or dance music, and so on). The activity may be more or less structured, but also completely spontaneous, unstructured, with the therapeutic aspect sometimes coming more or less to the fore. The use of reminiscence is especially useful for people with dementia, when it comes to reviving past experiences, especially those that are positively and personally important, such as family events, holidays, weddings, celebrations, etc. [16].

This type of therapy uses memories and stimulates their recall using various stimuli. Its goal is to improve the overall state and strengthen human dignity, and improve communication. It can be individual or group and its methods vary, such as: viewing photo albums, watching old films, telling old stories, and other activities such as singing, reciting, etc. [17].

In some facilities, memory rooms are also available for clients, in which the interior furnishings and environmental adaptations correspond to the period of the youth of clients [18].

#### *Practical recommendations:*

*In reminiscence therapy, different situations can arise that cause both positive and negative emotions, such as memories of parents, siblings, time that can no longer be returned. If the patient expresses anger or sadness, we do not have to worry about these emotions and avoid them at all costs. An individual approach is very important, because in some people the emotional expression will cause relief, while conversely in some people it will deepen their depressive mood. Aging is a natural cycle of life that must be accepted and accepted with respect and sometimes it is necessary to lead the patient to that.*

*If reminiscence leads to very unpleasant and painful memories, it is more appropriate to avoid such an approach.*

#### **2.4 Validation therapy**

Validation therapy is considered to be one of the first specific non-pharmacological approaches to patients affected by dementia.

Considering the specifications of the procedure we devote greater attention to the theoretical basis, which should be of more benefit to the reader. The validation

**81**

people.

*Non-pharmacological Treatment of Alzheimer's DOI: http://dx.doi.org/10.5772/intechopen.84893*

very old and confused people aged over 80.

tency in using new approaches to the patient.

emotions are true. The refusal of emotion causes uncertainty.

method was developed by Naomi Feil. Naomi Feil was born in Munich in 1932 and grew up in a retirement home where her father was the director. She was also employed by her mother, who worked there as head of the social department. After completing her studies of social work, she was awarded a Master's degree in social work, after which she started working with the elderly. Based on her dissatisfaction with the approaches and methods of old-age care of time, she began to develop a different manner of therapy. The whole development of this therapy took place between 1963 and 1980. In addition to the theoretical foundations, she developed her model primarily from her own experience. As long as she had spent almost all her life among old people, she had a lot of experience. As a child grew up among the seniors, she worked with them for 7 years. Later she worked for over 40 years with

Nowadays, the Naomi Feil Validation Concept is recognized as a method based

Validation as such is a sensitive generalization by experts dealing with people with dementia. Its main principle is respect for the person. We do not violently oppose the misconceptions of a person with dementia, nor do we support them in that. Validating someone means accepting their emotions, telling him that their

The purpose of validation is to help elderly people stay as long as possible in their home environment, to restore self-confidence, to reduce stress, to make sense of life as experienced, to deal with unaddressed conflicts of the past, to improve verbal and non-verbal communication, to prevent a return to vegetation, to

improve the ability to walk and physical health in general, to provide the carer with joy and energy, to help families communicate with their disoriented relatives [20]. There are several principles that a user of validation must consider if they want to perform validation therapy on old, disoriented people. One must realize a few facts:

1.Even porly oriented or disoriented seniors are unique and have their value.

3.We must be able to listen; empathic listening creates an environment conducive to confiding, reduces their anxiety and, above all, brings dignity.

4.Expressed, accepted and validated painful feelings become weaker. But if

5.There are reasons for the behaviour the poorly oriented and disoriented old

6.The behaviour of these people can be rooted in one or more human needs. Processing unresolved task for a peaceful and balanced death, the need to live

2.Do not try to change them at all costs, accept them as they are.

ignored and suppressed they remain strong.

on the latest knowledge in the care of elderly people with Alzheimer's disease, dementia or related diseases. This method is accepted in both palliative medicine and gerontology [19]. Validation is a form of communication and therapy used with old people suffering from dementia syndrome or other disorders whose manifestation is mental disorientation. It is based on the different principles of psychology, therapeutic approaches and biography [13]. The validation method is considered to be high moral support and a form of assistance we can provide to a senior with dementia syndrome. However, the springboard to providing it must be the willingness of workers to take a completely different view of this issue, to try to understand the right cause of the behaviour of disoriented seniors, and also effort and consis-

#### *Non-pharmacological Treatment of Alzheimer's DOI: http://dx.doi.org/10.5772/intechopen.84893*

*Redirecting Alzheimer Strategy - Tracing Memory Loss to Self Pathology*

*logical approach.*

**2.3 Reminiscence therapy**

recall of events from the past [3].

ties such as singing, reciting, etc. [17].

*Practical recommendations:*

*ate to avoid such an approach.*

ical approaches to patients affected by dementia.

**2.4 Validation therapy**

youth of clients [18].

*day and is restless at night. At the entrance to the Snoezelen room, the patient sharpened his gaze and began to look around. The patient was placed in the centre of the room in the wheelchair, we began the light effects: bubble cylinders, starry sky, we quietly turned on the music. Through his knees, we passed interactive optical fibers that he touched with his hands. The patient was silent for about 10 minutes, observing the surroundings, playing with the interactive fibers in his hands. After a while the patient began to be nervous, he was fidgeting, he lowered his eyes, and muttered something quietly. After a while, he started to shout nonsensically. He was aggressive. We finished the Snoezelen therapy.*

*In repeat therapies, the patient responded in the same manner, so we will not use this multisensory stimulus for the specific patient, but we will choose another non-pharmaco-*

Reminiscence therapy is a method that uses memories and their recall using various stimuli. Of course, it is also suitable for healthy seniors, for its preventive and activating significance. It is mainly useful for patients with dementia, who have short-term memory disorders, but conversely, they are often have surprisingly good

Reminiscence therapy typically refers to a therapist's conversation with an elderly person (or group) about their life up to that point, their past activities, events and experiences, often using appropriate tools (old photographs, objects, tools and home appliances, and old working tools, fashion accessories, movies, folk or dance music, and so on). The activity may be more or less structured, but also completely spontaneous, unstructured, with the therapeutic aspect sometimes coming more or less to the fore. The use of reminiscence is especially useful for people with dementia, when it comes to reviving past experiences, especially those that are positively and personally important, such as family events, holidays, weddings, celebrations, etc. [16]. This type of therapy uses memories and stimulates their recall using various stimuli. Its goal is to improve the overall state and strengthen human dignity, and improve communication. It can be individual or group and its methods vary, such as: viewing photo albums, watching old films, telling old stories, and other activi-

In some facilities, memory rooms are also available for clients, in which the interior furnishings and environmental adaptations correspond to the period of the

*In reminiscence therapy, different situations can arise that cause both positive and negative emotions, such as memories of parents, siblings, time that can no longer be returned. If the patient expresses anger or sadness, we do not have to worry about these emotions and avoid them at all costs. An individual approach is very important, because in some people the emotional expression will cause relief, while conversely in some people it will deepen their depressive mood. Aging is a natural cycle of life that must be accepted* 

*If reminiscence leads to very unpleasant and painful memories, it is more appropri-*

Validation therapy is considered to be one of the first specific non-pharmacolog-

Considering the specifications of the procedure we devote greater attention to the theoretical basis, which should be of more benefit to the reader. The validation

*and accepted with respect and sometimes it is necessary to lead the patient to that.*

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method was developed by Naomi Feil. Naomi Feil was born in Munich in 1932 and grew up in a retirement home where her father was the director. She was also employed by her mother, who worked there as head of the social department. After completing her studies of social work, she was awarded a Master's degree in social work, after which she started working with the elderly. Based on her dissatisfaction with the approaches and methods of old-age care of time, she began to develop a different manner of therapy. The whole development of this therapy took place between 1963 and 1980. In addition to the theoretical foundations, she developed her model primarily from her own experience. As long as she had spent almost all her life among old people, she had a lot of experience. As a child grew up among the seniors, she worked with them for 7 years. Later she worked for over 40 years with very old and confused people aged over 80.

Nowadays, the Naomi Feil Validation Concept is recognized as a method based on the latest knowledge in the care of elderly people with Alzheimer's disease, dementia or related diseases. This method is accepted in both palliative medicine and gerontology [19]. Validation is a form of communication and therapy used with old people suffering from dementia syndrome or other disorders whose manifestation is mental disorientation. It is based on the different principles of psychology, therapeutic approaches and biography [13]. The validation method is considered to be high moral support and a form of assistance we can provide to a senior with dementia syndrome. However, the springboard to providing it must be the willingness of workers to take a completely different view of this issue, to try to understand the right cause of the behaviour of disoriented seniors, and also effort and consistency in using new approaches to the patient.

Validation as such is a sensitive generalization by experts dealing with people with dementia. Its main principle is respect for the person. We do not violently oppose the misconceptions of a person with dementia, nor do we support them in that. Validating someone means accepting their emotions, telling him that their emotions are true. The refusal of emotion causes uncertainty.

The purpose of validation is to help elderly people stay as long as possible in their home environment, to restore self-confidence, to reduce stress, to make sense of life as experienced, to deal with unaddressed conflicts of the past, to improve verbal and non-verbal communication, to prevent a return to vegetation, to improve the ability to walk and physical health in general, to provide the carer with joy and energy, to help families communicate with their disoriented relatives [20].

There are several principles that a user of validation must consider if they want to perform validation therapy on old, disoriented people. One must realize a few facts:


in peace, the need to regain their balance, as mobility memory and senses are lost, the need to give meaning to a gloomy reality, to find a place where they can feel happy, the need for status, recognition, self-sufficiency, the need to be productive and useful, the need to be respected and to belong, the need to express their feelings and be heard, the need for human contact, the need for certainty and security, not limitation, the need for any stimulation, and finally the need to reduce pain and complications.


During validation, we do not quarrel with the old person and do not confront them with the opposite view, we do not try to provide a view of their behaviour, and we do not try to improve their orientation in time unless it is of interest to the old person. Individual or group therapy does not establish firm rules to target it over time. The user of validation is not perceived as an authority but as a diligent assistant.
