*2.4.1 Forms of validation therapy*

The basic forms of validation therapy include individual and group forms. In the **individual form**, the therapist works in three steps.


**Group therapy** is conditional on the creation of mutual trust so that individual members can express their own feelings, communicate verbally and non-verbally, solve problems, be active in selected social roles, learn the highest possible degree of control and, in particular, to gain a feeling of their own about their own value. The goal of group validation is to reduce fear, reduce the need for limiting and calming methods, and prevent vegetation in old dementia patients. Another less important goal for relatives and staff is for validation to reduce their risk of burnout syndrome [21].

**83**

new topics.

boredom, searching for a new sense of life.

information available to help the meeting.

*Practical demonstration:*

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

The therapy itself in the group consists of seven steps.

It is possible, for the best use of the validation team, to involve all workers—not only nursing staff, but also staff from cleaning, kitchens, offices, social workers or physiotherapists. The most appropriate solution is to create a validation team that would stimulate the client or patient with the same validation techniques [22].

**The first step** is getting to know the person. At this point it is necessary also to evaluate the phase or stage of disorientation in individual validation too. For the correct evaluation, it is possible to use the questionnaire 'Selecting members of the validation group' or the 'Life story and basic behaviour' form can be used. All this is necessary, because the knowing the group members is also the basis for its success. **The second step** is selecting the group members. As the group is diverse, it is necessary to assemble it so that everyone has its place in it. A former clergyman can begin by praying, a former teacher of singing can lead singing. Naomi Feil exactly describes what the composition of the members should be like and at what stage of disorientation they should be. There should be five to ten people in the group—one leader personality, one wise and hospitable person, four or five people who like discussion, about two people in the third stage who could respond to the validation therapist, and two people still do not feel threatened by disoriented persons.

**The third step** is to find a role for each member. At each meeting an individual should play the same role, because it represents a certainty for him and promotes dignity. As an example, Naomi Feil gives an introducer, who opens and ends the meeting, a singer who sets the rhythm and conducts, someone who reads in the group, the person who prepares the chairs, the flowers, the secretary, the host.

In **the fourth step**, it is appropriate to involve all the staff in the validation. This can help with preparation and implementation. They can provide a room and/or refreshment, bring individual members of the group, and suggest new members or

**The sixth step** is to schedule a meeting. This step consists not only of a meeting plan, but also of the preparation of materials and room, of the timetable and all the

In **the seventh step** is meeting itself alone. It should be done at least once a week at the same time and in the same place. It is composed of four parts—introduction, life, conclusion and preparation of the next meeting [21]. The basis for validation meetings is how and what a person with dementia really wants to express themselves, and even if it does not coincide with reality, appropriately and adequately respond to it [23].

*An 82-year-old patient in a severe stage of Alzheimer's disease was admitted to the psychiatric ward. The patient was disoriented in time and space. The patient had an increased risk of falls due to his advanced age and limited mobility. The patient used antipsychotics and sedatives. Hospitalization was necessary because in the domestic environment the patient was always going away, not accepting the guidance of the carers, he was restless at night, he shouted. During hospitalization, despite the psychopharmaceuticals, the patient's behaviour did not change. During the day he was restless, always wanting to go home, he ran out of the room. The treating staff constantly focused on reality and reminded him that he was hospitalized, could not go home, must lie in bed…The patient's behaviour was difficult to handle. According to the Naomi Feil validation concept, we are not trying to improve his orientation, we do not argue and do not confront him with the opposite view. We tried to use these recommendations in communicating with the patient. If the patient requested to go home, we did not give him the reasons why he could not go* 

**The fifth step** is music itself, the discussion, movement, eating. The music should start and end the session, and one song is enough. For the discussion, it is advisable to choose the topics in advance—the loss of a loved one, home or work,

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

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

the need to reduce pain and complications.

represent them and have an emotional charge.

patterns of behaviour return.

ness, often at the same time.

*2.4.1 Forms of validation therapy*

**individual form**, the therapist works in three steps.

the past.

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

7.In the case of failure of verbal expression and short-term memory, old learned

8.Things, persons, or objects of the past are replaced by personal symbols that

9.Disoriented or partially oriented seniors live at different levels of conscious-

10.By weakening the five senses, these seniors can stimulate and use their own 'inner meaning', seeing through their inner vision and hearing the tones from

11.Various emotions, colours, sounds, coincidences, smells, tastes and images can now awaken emotions that recall similar emotion from the past [21].

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.

The basic forms of validation therapy include individual and group forms. In the

1.In the first step, they collect all available information that is needed for the validation itself, but also for evaluating its effectiveness. The therapist gets information on things 'here and now' and about 'things then and there'.

2.The second step involves determining the phase in which the person is. In this step, they compare the information obtained with the individual's statements

3.The third step is the validation therapy itself. A therapist should come regularly and use validation techniques that can help them at different stages.

**Group therapy** is conditional on the creation of mutual trust so that individual members can express their own feelings, communicate verbally and non-verbally, solve problems, be active in selected social roles, learn the highest possible degree of control and, in particular, to gain a feeling of their own about their own value. The goal of group validation is to reduce fear, reduce the need for limiting and calming methods, and prevent vegetation in old dementia patients. Another less important goal for relatives and staff is for validation to reduce their risk of burnout syndrome [21].

and determines the stage or phase in which the old person is located.

**82**

It is possible, for the best use of the validation team, to involve all workers—not only nursing staff, but also staff from cleaning, kitchens, offices, social workers or physiotherapists. The most appropriate solution is to create a validation team that would stimulate the client or patient with the same validation techniques [22].

The therapy itself in the group consists of seven steps.

**The first step** is getting to know the person. At this point it is necessary also to evaluate the phase or stage of disorientation in individual validation too. For the correct evaluation, it is possible to use the questionnaire 'Selecting members of the validation group' or the 'Life story and basic behaviour' form can be used. All this is necessary, because the knowing the group members is also the basis for its success.

**The second step** is selecting the group members. As the group is diverse, it is necessary to assemble it so that everyone has its place in it. A former clergyman can begin by praying, a former teacher of singing can lead singing. Naomi Feil exactly describes what the composition of the members should be like and at what stage of disorientation they should be. There should be five to ten people in the group—one leader personality, one wise and hospitable person, four or five people who like discussion, about two people in the third stage who could respond to the validation therapist, and two people still do not feel threatened by disoriented persons.

**The third step** is to find a role for each member. At each meeting an individual should play the same role, because it represents a certainty for him and promotes dignity. As an example, Naomi Feil gives an introducer, who opens and ends the meeting, a singer who sets the rhythm and conducts, someone who reads in the group, the person who prepares the chairs, the flowers, the secretary, the host.

In **the fourth step**, it is appropriate to involve all the staff in the validation. This can help with preparation and implementation. They can provide a room and/or refreshment, bring individual members of the group, and suggest new members or new topics.

**The fifth step** is music itself, the discussion, movement, eating. The music should start and end the session, and one song is enough. For the discussion, it is advisable to choose the topics in advance—the loss of a loved one, home or work, boredom, searching for a new sense of life.

**The sixth step** is to schedule a meeting. This step consists not only of a meeting plan, but also of the preparation of materials and room, of the timetable and all the information available to help the meeting.

In **the seventh step** is meeting itself alone. It should be done at least once a week at the same time and in the same place. It is composed of four parts—introduction, life, conclusion and preparation of the next meeting [21]. The basis for validation meetings is how and what a person with dementia really wants to express themselves, and even if it does not coincide with reality, appropriately and adequately respond to it [23].

*Practical demonstration:*

*An 82-year-old patient in a severe stage of Alzheimer's disease was admitted to the psychiatric ward. The patient was disoriented in time and space. The patient had an increased risk of falls due to his advanced age and limited mobility. The patient used antipsychotics and sedatives. Hospitalization was necessary because in the domestic environment the patient was always going away, not accepting the guidance of the carers, he was restless at night, he shouted. During hospitalization, despite the psychopharmaceuticals, the patient's behaviour did not change. During the day he was restless, always wanting to go home, he ran out of the room. The treating staff constantly focused on reality and reminded him that he was hospitalized, could not go home, must lie in bed…The patient's behaviour was difficult to handle. According to the Naomi Feil validation concept, we are not trying to improve his orientation, we do not argue and do not confront him with the opposite view. We tried to use these recommendations in communicating with the patient. If the patient requested to go home, we did not give him the reasons why he could not go* 

*home and where he was, but we turned the communication in a different direction. We asked why he wanted to go home, what he would do at home, what he used to do outside in the garden, with whom he met…The patient began to talk about what he used to do at home and where he worked. This does not mean that the patient was getting better, but he lightened his tone in communication, he did not shout, after a group walk around the department, the patient could be directed and was sitting quietly in the chair. We have found a way how we can influence patient behaviour and actions….*

**2.5 Doll therapy**

Doll therapy is a very effective form of comprehensive therapy in patients with various forms and degrees of dementia, mental retardation, physical disability, and various psychiatric disorders. It is known for its low financial burden and easy accessibility. The therapeutic dolls resemble young children in terms of their size and appearance. Dolls are made with natural material, which is also anti-allergic. To touch it is pleasant, soft and positively stimulates the patient's senses. The individual body parts are specially balanced for better handling. The legs are malleable, suitable for enveloping the patient and encouraging hugging. Such manipulation is used as part of basal stimulation. The indirect gaze of all the dolls (eyes do not look ahead) is deliberately neutral. It feels peaceful to the patients and does not cause negative emotions. Doll therapy is based on long-term memory paths. It is normal that these patients, especially women, are looking for their children and want to take care of something or someone. It is through dolls that we try to stimulate this ability. Furthermore, we try to stimulate fine motor skills, nerve activity, especially attention, memory, supporting patient activity, dialog, establishing relationships, inducing a sense of security, love and peace. In some cases, the use of psychopharmaceuticals has been reduced.

The use of dolls with a patient is associated with a number of benefits that include increasing welfare, inducing positive emotions, good sleep, improving eating habits, reducing agitation, irritability, anxiety episodes, apathy, depression, aggression and tension by distraction towards a substitute, improving communication and sociability. In spite of the benefits, the use of therapeutic dolls also has its negatives, such as the infantilization of the senior, thereby breaking ethics. For these reasons, we must emphasize the individual approach and we cannot generalize their mass use under any circumstances [24].

Before starting to use therapeutic dolls with a patient with Alzheimer's disease, it is necessary to train the attending staff or relatives. It is essential to realize the benefits and potential problems that may arise over time. Success also depends on the attitude of the staff. In the case of an uncommitted or negative attitude on the part of the staff, success will usually not occur. Before starting doll therapy, one needs to get some fundamental information about their role as a mother or father, because sometimes negative experiences in the life of the patient may render the use of doll therapy inappropriate. This is, for example, the death of a child, a severely ill child, or a child not interested in the parent….

Each patient should have their own doll. It is recommended to find out whether the patient had a son or daughter, to find their hair colour and choose the type of doll accordingly. Dolls should be different, whether in terms of their faces, height or clothing, to minimize confusion issues. Clothing may vary according to the wishes of the patient or be supplemented with appropriate accessories such as a cap, socks, gloves, boots, blankets, and the like. We try to keep them clean. With doll therapy, we begin slowly and gradually to avoid problems that may be expressed as negative behaviour on the part of the patient, or repulsion from therapy, or the therapist.

**85**

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

that we perceive it in the same way they do.

*Practical example:*

*revive the patient's psyche.*

dependence on care [25].

**2.6 Ervin Böhm's psychobiographic model**

We leave the doll for a short time, it is not appropriate to leave it all day, because the feelings that we should re-find in a patient with dementia may be lost that way. We give the doll to the patient in an unforced manner, in order for them to decide whether to pay attention or not. It is appropriate if we place it in a wellvisible and easily accessible place, where it can be seen and asked about or taken. If the patient is immobile or has a bad eyesight, we take the doll in our arms, sit down near them and start talking about it and talking to it. We monitor the patient's responses carefully, and when they show interest, we give it to them. Women and men may equally be interested in the doll, we do not discourage them from being so. When the patient communicates with their doll, we monitor and listen carefully to how they address her. We make sure we use their form of address to reassure them

Some patients think the doll is their baby and they expect emotions and surprises, in which case we only leave it only for a short time. We take it only with their permission, with a logical explanation and detailed descriptions of where we are taking it and when we will return it. We do not leave the doll all day with the patient because it will stop interesting them. We never use the doll as something to negotiate or force the patient to do something. They can become emotionally attached to it, and so this can cause negative behaviour (anxiety, agitation, aggression). We can

use it as an intermediary for other activities such as walks, talking and work.

*We used doll therapy with a patient who had been diagnosed with Alzheimer's disease at a moderate level. She is aware of her illness, so she is reticent when talking about herself. From her past, she remembers most about the countryside near her home village. She answered every question asked after a pause and often indefinitely. She does not sufficiently show her emotions externally. She attributes her memory loss to age. Sometimes she has hallucinations and attention disorders. Sometimes she talks nonsense. When communicating, she avoids direct gaze. We decided to use a therapeutic doll with the patient. We started in an unforced manner. One morning we brought the therapeutic doll that we held in our hands to the patient, and after a while the patient began to ask who it was, she wanted to take it in her arms. She began talking with her, singing her nursery rhymes. At other meetings she even named her after her daughter. We left the baby 1 or 2 hours, according to the interest shown. We did not use the baby every day so that the therapy did not become jaded but a pleasant emotional experience to* 

Ervin Böhm's psychobiographic model is an internationally recognized nursing model and is currently the most widely used in German-speaking countries in the field of geriatric and gerontological psychiatric care. The model is aimed at supporting the ability to care for oneself, for old and confused people, and at ways to retain or restore this ability for as long as possible, by resurrecting the seniors' interest and reviving their psyche. In the psychobiographic model, one seeks to broaden the perspective on the patient—the senior, when care must become more tolerant and leave the 'caring mother' role. Previous methods of care, where the attending staff took care of all the tasks, did not reflect the retained skills and knowledge of the client, focused primarily on fulfilling needs, and created client

must identify these events and pacify the patient appropriately.

There can also be undesirable situations in doll therapy. One of these is the recall of memories of a patient's negative life experiences. In such situations, the therapist

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

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

**2.5 Doll therapy**

maceuticals has been reduced.

ize their mass use under any circumstances [24].

child, or a child not interested in the parent….

*home and where he was, but we turned the communication in a different direction. We asked why he wanted to go home, what he would do at home, what he used to do outside in the garden, with whom he met…The patient began to talk about what he used to do at home and where he worked. This does not mean that the patient was getting better, but he lightened his tone in communication, he did not shout, after a group walk around the* 

Doll therapy is a very effective form of comprehensive therapy in patients with various forms and degrees of dementia, mental retardation, physical disability, and various psychiatric disorders. It is known for its low financial burden and easy accessibility. The therapeutic dolls resemble young children in terms of their size and appearance. Dolls are made with natural material, which is also anti-allergic. To touch it is pleasant, soft and positively stimulates the patient's senses. The individual body parts are specially balanced for better handling. The legs are malleable, suitable for enveloping the patient and encouraging hugging. Such manipulation is used as part of basal stimulation. The indirect gaze of all the dolls (eyes do not look ahead) is deliberately neutral. It feels peaceful to the patients and does not cause negative emotions. Doll therapy is based on long-term memory paths. It is normal that these patients, especially women, are looking for their children and want to take care of something or someone. It is through dolls that we try to stimulate this ability. Furthermore, we try to stimulate fine motor skills, nerve activity, especially attention, memory, supporting patient activity, dialog, establishing relationships, inducing a sense of security, love and peace. In some cases, the use of psychophar-

The use of dolls with a patient is associated with a number of benefits that include increasing welfare, inducing positive emotions, good sleep, improving eating habits, reducing agitation, irritability, anxiety episodes, apathy, depression, aggression and tension by distraction towards a substitute, improving communication and sociability. In spite of the benefits, the use of therapeutic dolls also has its negatives, such as the infantilization of the senior, thereby breaking ethics. For these reasons, we must emphasize the individual approach and we cannot general-

Before starting to use therapeutic dolls with a patient with Alzheimer's disease, it is necessary to train the attending staff or relatives. It is essential to realize the benefits and potential problems that may arise over time. Success also depends on the attitude of the staff. In the case of an uncommitted or negative attitude on the part of the staff, success will usually not occur. Before starting doll therapy, one needs to get some fundamental information about their role as a mother or father, because sometimes negative experiences in the life of the patient may render the use of doll therapy inappropriate. This is, for example, the death of a child, a severely ill

Each patient should have their own doll. It is recommended to find out whether the patient had a son or daughter, to find their hair colour and choose the type of doll accordingly. Dolls should be different, whether in terms of their faces, height or clothing, to minimize confusion issues. Clothing may vary according to the wishes of the patient or be supplemented with appropriate accessories such as a cap, socks, gloves, boots, blankets, and the like. We try to keep them clean. With doll therapy, we begin slowly and gradually to avoid problems that may be expressed as negative behaviour on the part of the patient, or repulsion from therapy, or the therapist.

*department, the patient could be directed and was sitting quietly in the chair. We have found a way how we can influence patient behaviour and actions….*

**84**

We leave the doll for a short time, it is not appropriate to leave it all day, because the feelings that we should re-find in a patient with dementia may be lost that way.

We give the doll to the patient in an unforced manner, in order for them to decide whether to pay attention or not. It is appropriate if we place it in a wellvisible and easily accessible place, where it can be seen and asked about or taken. If the patient is immobile or has a bad eyesight, we take the doll in our arms, sit down near them and start talking about it and talking to it. We monitor the patient's responses carefully, and when they show interest, we give it to them. Women and men may equally be interested in the doll, we do not discourage them from being so. When the patient communicates with their doll, we monitor and listen carefully to how they address her. We make sure we use their form of address to reassure them that we perceive it in the same way they do.

Some patients think the doll is their baby and they expect emotions and surprises, in which case we only leave it only for a short time. We take it only with their permission, with a logical explanation and detailed descriptions of where we are taking it and when we will return it. We do not leave the doll all day with the patient because it will stop interesting them. We never use the doll as something to negotiate or force the patient to do something. They can become emotionally attached to it, and so this can cause negative behaviour (anxiety, agitation, aggression). We can use it as an intermediary for other activities such as walks, talking and work.

There can also be undesirable situations in doll therapy. One of these is the recall of memories of a patient's negative life experiences. In such situations, the therapist must identify these events and pacify the patient appropriately.

*Practical example:*

*We used doll therapy with a patient who had been diagnosed with Alzheimer's disease at a moderate level. She is aware of her illness, so she is reticent when talking about herself. From her past, she remembers most about the countryside near her home village. She answered every question asked after a pause and often indefinitely. She does not sufficiently show her emotions externally. She attributes her memory loss to age.*

*Sometimes she has hallucinations and attention disorders. Sometimes she talks nonsense. When communicating, she avoids direct gaze. We decided to use a therapeutic doll with the patient. We started in an unforced manner. One morning we brought the therapeutic doll that we held in our hands to the patient, and after a while the patient began to ask who it was, she wanted to take it in her arms. She began talking with her, singing her nursery rhymes. At other meetings she even named her after her daughter. We left the baby 1 or 2 hours, according to the interest shown. We did not use the baby every day so that the therapy did not become jaded but a pleasant emotional experience to revive the patient's psyche.*

#### **2.6 Ervin Böhm's psychobiographic model**

Ervin Böhm's psychobiographic model is an internationally recognized nursing model and is currently the most widely used in German-speaking countries in the field of geriatric and gerontological psychiatric care. The model is aimed at supporting the ability to care for oneself, for old and confused people, and at ways to retain or restore this ability for as long as possible, by resurrecting the seniors' interest and reviving their psyche. In the psychobiographic model, one seeks to broaden the perspective on the patient—the senior, when care must become more tolerant and leave the 'caring mother' role. Previous methods of care, where the attending staff took care of all the tasks, did not reflect the retained skills and knowledge of the client, focused primarily on fulfilling needs, and created client dependence on care [25].

Böhm puts the following goals at the forefront of care:

a. reviving the human psyche,

b.reviving the interest of the carers, and

c.broadening the perception of social normality.

Reviving the Human Psyche—the ultimate goal of Böhm's care is to revive the soul of the old person, described as the human energy of the soul, the 'elan vital', which is the original source of our action and life-motivation. Revitalizing the interest of carers—reviving the professional interest of care providers can be achieved by increasing their expertise [25].

Böhm perceives his model of care as a complete systemic theory to supplement medical care. Regardless of whether a patient has organ damage, therapeutic treatment must be based on a thymopsychic biography, and must provide an improvement in their mental and physical well-being, even without psychopharmaceuticals [25].

If we focus on the medical and nursing diagnosis, then we take care of dementia, whereas if we focus on the biography of the client, we look after patient as a personality, so we see a person with his soul as a priority [26].

*Practical demonstration:*

*A 67-year-old patient with a severe degree of Alzheimer's disease is hospitalized in the psychiatric ward for behavioural disorders, verbal and physical aggression, insomnia. At the age of 62 he had a stroke. The patient is disoriented with increased irritability and impulsiveness. Despite pharmacotherapy, the patient's behaviour is difficult to manage, and cooperation is limited. We focused on the biography of the patient, and together with the patient's wife, we looked for options that could influence patient behaviour and actions. The wife began talking about a special blanket that the patient had received as a wedding gift, having an emotional relationship, so we decided to use it during the hospitalization. The patient immediately recognized his blanket and expressed interest in it. The patient did not immediately reverse his behaviour, but with an empathic approach we managed to influence collaboration with the patient and mitigate aggressive behaviour.*

*Sometimes human desire is enough to achieve great goals.*

## **3. The patient in the home environment**

The family plays an essential role in the care of Alzheimer's disease. Most often it is the care provided by husbands, wives or children. In addition to the role of family members in the care of the sick, it is necessary to provide the carers with the support required. A common component of Alzheimer's disease is, in addition to behavioural disorders from disturbed cognition, various psychiatric symptoms. These are the main source of burden for carers and the most common cause of institutionalization of the sick. Problem behaviour by a sick person is often an effort to express or demonstrate their need. It arises as a result of the lack of consistency between the patient's needs and the ability of the environment to meet these needs. It may be a consequence of boredom or fatigue or the consequence of a psychiatric disorder. It is only a symptom of dementia, not deliberate or a bad intention. If we learn to recognize the needs of the sick, to satisfy them, then we can prevent these difficulties. Most often, this includes non-cooperation with care, restlessness, aggressive behaviour, wandering, getting lost and sleeping disorders [10].

**87**

**4. Discussion**

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

add a third pillar, namely caring for the carer.

possibilities and the requirements of society [27].

The treatment of Alzheimer's disease stands on two pillars, but some authors

Nursing care provided in the home social environment is a historically proven form of effective care for an individual, family or community. It has a series of benefits for the care recipient themselves. The management of nursing care in the natural social environment varies in the individual countries of the European region, depending on historical development, the educational system, the financial

The family is the simplest, best and at the same time the most important source

The family is the guarantor of the interconnection and continuity of individual generations and, under optimal functioning, forms an irreplaceable environment of mutual assistance, support and understanding for all its members, despite the

A home carer who provides care to a family member has an important place in the social and healthcare system. A home carer is a person who helps meet the needs of their family member—the person cared for. They also carry out activities that the patient would perform themselves if they had enough strength, will or the necessary knowledge [29]. The carer's role in the care of a sick person with dementia is a key factor. The work of caring for an elderly person is a task requiring a great deal of patience, empathy and sensitivity; it cannot be compared to normal work, especially if they do not feel satisfaction. Being the carer of an older person is to take on the responsibility of another person and includes the overall care for the person cared for. The carer must perform their duties extremely conscientiously and must think primarily

People who have to take care of the sick are exposed to many negative influences, because care is physically and mentally strenuous. Families often go through financial problems. The carer often loses the option of leaving the sufferer and it completely alters their rhythm of life. They may have problems at work, or have to leave employment. In addition to the above-mentioned negatives, they often feel helpless because they cannot help as they would wish, because the medical and

The perceived burden on the carer may be physical, psychological, social and financial. It can be a burden in areas such as free time, obligations towards one's

Counselling, self-help groups and nursing education programs are proven to de-institutionalize the patient, improve their quality of life and the satisfaction of

In 2012, we conducted research aimed at identifying the extent and nature of the burden on people caring for relatives with Alzheimer's disease in the home environment. As a method for collecting empirical data, a valid, reliable questionnaire, The Zarit Caregiver Burden Interview, was used. The sample group consisted of 50 respondents, family carers for people with Alzheimer's disease. The results of the survey concurred with the results of several studies confirming that dependence of the patient on one caregiver is the most important factor affecting the caregiver's subjective burden.

Caring for a patient with dementia is demanding, whether in the form of home or institutionalized care. Many experts have devoted large periods of their professional

own family, employment, but also relationships with others [29].

family members and those affected by dementia [3].

**3.1 Burden on the carer**

of support in old age and aging.

intergenerational differences [28].

of the welfare of the other person.

nursing options are limited.

## **3.1 Burden on the carer**

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

Böhm puts the following goals at the forefront of care:

a. reviving the human psyche,

increasing their expertise [25].

*Practical demonstration:*

maceuticals [25].

b.reviving the interest of the carers, and

c.broadening the perception of social normality.

ality, so we see a person with his soul as a priority [26].

*with the patient and mitigate aggressive behaviour.*

**3. The patient in the home environment**

*Sometimes human desire is enough to achieve great goals.*

Reviving the Human Psyche—the ultimate goal of Böhm's care is to revive the soul of the old person, described as the human energy of the soul, the 'elan vital', which is the original source of our action and life-motivation. Revitalizing the interest of carers—reviving the professional interest of care providers can be achieved by

Böhm perceives his model of care as a complete systemic theory to supplement

If we focus on the medical and nursing diagnosis, then we take care of dementia, whereas if we focus on the biography of the client, we look after patient as a person-

*A 67-year-old patient with a severe degree of Alzheimer's disease is hospitalized in the psychiatric ward for behavioural disorders, verbal and physical aggression, insomnia. At the age of 62 he had a stroke. The patient is disoriented with increased irritability and impulsiveness. Despite pharmacotherapy, the patient's behaviour is difficult to manage, and cooperation is limited. We focused on the biography of the patient, and together with the patient's wife, we looked for options that could influence patient behaviour and actions. The wife began talking about a special blanket that the patient had received as a wedding gift, having an emotional relationship, so we decided to use it during the hospitalization. The patient immediately recognized his blanket and expressed interest in it. The patient did not immediately reverse his behaviour, but with an empathic approach we managed to influence collaboration* 

The family plays an essential role in the care of Alzheimer's disease. Most often it is the care provided by husbands, wives or children. In addition to the role of family members in the care of the sick, it is necessary to provide the carers with the support required. A common component of Alzheimer's disease is, in addition to behavioural disorders from disturbed cognition, various psychiatric symptoms. These are the main source of burden for carers and the most common cause of institutionalization of the sick. Problem behaviour by a sick person is often an effort to express or demonstrate their need. It arises as a result of the lack of consistency between the patient's needs and the ability of the environment to meet these needs. It may be a consequence of boredom or fatigue or the consequence of a psychiatric disorder. It is only a symptom of dementia, not deliberate or a bad intention. If we learn to recognize the needs of the sick, to satisfy them, then we can prevent these difficulties. Most often, this includes non-cooperation with care, restlessness, aggressive behaviour, wandering, getting lost and sleeping disorders [10].

medical care. Regardless of whether a patient has organ damage, therapeutic treatment must be based on a thymopsychic biography, and must provide an improvement in their mental and physical well-being, even without psychophar-

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The treatment of Alzheimer's disease stands on two pillars, but some authors add a third pillar, namely caring for the carer.

Nursing care provided in the home social environment is a historically proven form of effective care for an individual, family or community. It has a series of benefits for the care recipient themselves. The management of nursing care in the natural social environment varies in the individual countries of the European region, depending on historical development, the educational system, the financial possibilities and the requirements of society [27].

The family is the simplest, best and at the same time the most important source of support in old age and aging.

The family is the guarantor of the interconnection and continuity of individual generations and, under optimal functioning, forms an irreplaceable environment of mutual assistance, support and understanding for all its members, despite the intergenerational differences [28].

A home carer who provides care to a family member has an important place in the social and healthcare system. A home carer is a person who helps meet the needs of their family member—the person cared for. They also carry out activities that the patient would perform themselves if they had enough strength, will or the necessary knowledge [29].

The carer's role in the care of a sick person with dementia is a key factor. The work of caring for an elderly person is a task requiring a great deal of patience, empathy and sensitivity; it cannot be compared to normal work, especially if they do not feel satisfaction. Being the carer of an older person is to take on the responsibility of another person and includes the overall care for the person cared for. The carer must perform their duties extremely conscientiously and must think primarily of the welfare of the other person.

People who have to take care of the sick are exposed to many negative influences, because care is physically and mentally strenuous. Families often go through financial problems. The carer often loses the option of leaving the sufferer and it completely alters their rhythm of life. They may have problems at work, or have to leave employment. In addition to the above-mentioned negatives, they often feel helpless because they cannot help as they would wish, because the medical and nursing options are limited.

The perceived burden on the carer may be physical, psychological, social and financial. It can be a burden in areas such as free time, obligations towards one's own family, employment, but also relationships with others [29].

Counselling, self-help groups and nursing education programs are proven to de-institutionalize the patient, improve their quality of life and the satisfaction of family members and those affected by dementia [3].

In 2012, we conducted research aimed at identifying the extent and nature of the burden on people caring for relatives with Alzheimer's disease in the home environment. As a method for collecting empirical data, a valid, reliable questionnaire, The Zarit Caregiver Burden Interview, was used. The sample group consisted of 50 respondents, family carers for people with Alzheimer's disease. The results of the survey concurred with the results of several studies confirming that dependence of the patient on one caregiver is the most important factor affecting the caregiver's subjective burden.
