Reality orientation has its roots in a technique used with confused older people to help them engage in, and connect with, their surroundings.It’s an approach where the environment, including dates, locations, and current surroundings, is frequently pointed out and woven into the conversations with the person. Reality orientation, when used appropriately and with compassion, can also benefit those living withAlzheimer’s diseaseandother dementias.
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The tools for reality orientation aim to reinforce the naming of objects and people as well as a timeline of events, past or present. This typically involves:
Effectiveness
Multiple studies have demonstrated that the use of reality orientation has improved cognitive functioning for people living withdementiawhen compared to control groups who did not receive it.
There may be further benefits as well. After reviewing six randomized controlled trials, a study in theCochrane Libraryconcluded that there may be some benefit for not only cognition but also in thechallenging behaviorsthat can reduce the quality of life in people with dementia.
Reality Orientation vs. Validation Therapy
Reality orientation has, until more recently, experienced a decline in popularity over the years, especially in comparison tovalidation therapy. This is due, in large part, to a concern of people applying the reality orientation broadly without taking into account the person’s emotions and mental health.
Validation therapy aims to acknowledge a person’s feelings and to discuss those feelings to help orient when events occurred, what they mean, and how they relate to current behaviors.
Tests Used to Evaluate Orientation in Dementia
Precautions
As a rule, reality orientation must be mixed with compassion and used appropriately to benefit someone living with the confusion of dementia. Applying it without evaluating if it might cause emotional distress to the individual since there are some times when it would not be appropriate.
Broadly speaking, reality orientation may be better suited for people with mild to moderate cognitive impairment. In this context, it not only helps delay nursing home placement but also provides an improved sense of control and self-esteem.
A Word from Verywell
Clearly, those who use reality orientation must apply sensitivity and wisdom. In clinical and home settings, an understanding of both validation therapy and reality orientation is beneficial. Depending on the person’s emotional state, personality and situation, the response that is most beneficial to the individual can then be used.
19 Myths About Alzheimer’s Disease and Dementia
Frequently Asked Questions
Reality orientation is a therapeutic technique used with people who have dementia or are otherwise disoriented. The approach is to weave details of their surroundings into the conversation, including where they are, who they are with, and what day it is. The goal of reality orientation is to improve cognitive and psychomotor function.
Using reality orientation techniques with people living with dementia has been shown to slow cognitive decline and may even improve cognitive functioning. In addition, the use of reality orientation can help to delay nursing home placement.
To use a reality orientation approach, include information about time, place, and names in conversation. These things can help refresh the person’s memory in a way that does not make them feel self-conscious.
Details to sprinkle into conversations:
The goal is to seamlessly slip in details that can help orient the person to the present reality. For example, when talking about the weather, mention the month and state, such as, “It is a beautiful April day in New Jersey.”
Learn MoreNon-Medication Therapies for Dementia
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Camargo C, Justus F, Retzlaff G.Effectiveness of reality orientation in the treatment of Alzheimer’s disease (P6.181).Neurology. 2015;84(14 Supplement):181–6. doi:10.1177/1533317514568004Onder G, Zanetti O, Giacobini E, et al.Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer’s disease: randomised controlled trial.Br J Psychiatry.2005;87:450-455. doi:10.1192/bjp.187.5.450Carrion C, Aymerich M, Baillés E, López-Bermejo A.Cognitive psychosocial intervention in dementia: A systematic review.Dementia and Geriatric Cognitive Disorders.2013;36:363–75. doi:10.1159/000354365Woods B, Aguirre E, Spector AE, Orrell M.Cognitive stimulation to improve cognitive functioning in people with dementia.Cochrane Database Syst Rev. 2012 Feb 15;(2):CD005562. doi:10.1002/14651858.CD005562.pub2Erdmann A, Schnepp W.Conditions, components and outcomes of Integrative Validation Therapy in a long-term care facility for people with dementia.Dementia. 2016;15(5):1184-1204. doi:10.1177/1471301214556489
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Camargo C, Justus F, Retzlaff G.Effectiveness of reality orientation in the treatment of Alzheimer’s disease (P6.181).Neurology. 2015;84(14 Supplement):181–6. doi:10.1177/1533317514568004Onder G, Zanetti O, Giacobini E, et al.Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer’s disease: randomised controlled trial.Br J Psychiatry.2005;87:450-455. doi:10.1192/bjp.187.5.450Carrion C, Aymerich M, Baillés E, López-Bermejo A.Cognitive psychosocial intervention in dementia: A systematic review.Dementia and Geriatric Cognitive Disorders.2013;36:363–75. doi:10.1159/000354365Woods B, Aguirre E, Spector AE, Orrell M.Cognitive stimulation to improve cognitive functioning in people with dementia.Cochrane Database Syst Rev. 2012 Feb 15;(2):CD005562. doi:10.1002/14651858.CD005562.pub2Erdmann A, Schnepp W.Conditions, components and outcomes of Integrative Validation Therapy in a long-term care facility for people with dementia.Dementia. 2016;15(5):1184-1204. doi:10.1177/1471301214556489
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Camargo C, Justus F, Retzlaff G.Effectiveness of reality orientation in the treatment of Alzheimer’s disease (P6.181).Neurology. 2015;84(14 Supplement):181–6. doi:10.1177/1533317514568004Onder G, Zanetti O, Giacobini E, et al.Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer’s disease: randomised controlled trial.Br J Psychiatry.2005;87:450-455. doi:10.1192/bjp.187.5.450Carrion C, Aymerich M, Baillés E, López-Bermejo A.Cognitive psychosocial intervention in dementia: A systematic review.Dementia and Geriatric Cognitive Disorders.2013;36:363–75. doi:10.1159/000354365Woods B, Aguirre E, Spector AE, Orrell M.Cognitive stimulation to improve cognitive functioning in people with dementia.Cochrane Database Syst Rev. 2012 Feb 15;(2):CD005562. doi:10.1002/14651858.CD005562.pub2Erdmann A, Schnepp W.Conditions, components and outcomes of Integrative Validation Therapy in a long-term care facility for people with dementia.Dementia. 2016;15(5):1184-1204. doi:10.1177/1471301214556489
Camargo C, Justus F, Retzlaff G.Effectiveness of reality orientation in the treatment of Alzheimer’s disease (P6.181).Neurology. 2015;84(14 Supplement):181–6. doi:10.1177/1533317514568004
Onder G, Zanetti O, Giacobini E, et al.Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer’s disease: randomised controlled trial.Br J Psychiatry.2005;87:450-455. doi:10.1192/bjp.187.5.450
Carrion C, Aymerich M, Baillés E, López-Bermejo A.Cognitive psychosocial intervention in dementia: A systematic review.Dementia and Geriatric Cognitive Disorders.2013;36:363–75. doi:10.1159/000354365
Woods B, Aguirre E, Spector AE, Orrell M.Cognitive stimulation to improve cognitive functioning in people with dementia.Cochrane Database Syst Rev. 2012 Feb 15;(2):CD005562. doi:10.1002/14651858.CD005562.pub2
Erdmann A, Schnepp W.Conditions, components and outcomes of Integrative Validation Therapy in a long-term care facility for people with dementia.Dementia. 2016;15(5):1184-1204. doi:10.1177/1471301214556489
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