When You Should – and Should NOT – Use Reality Orientation in Dementia Care

A young woman using reality orientation in dementia care points to the date on the calendar with her elderly mother who is in a wheelchair.
Learn the pros and cons of using reality orientation in dementia care.

Did you ever wake up in the middle of a dream and wonder, for just an instant, if what you were dreaming about was real? It can feel very disorienting until you open your eyes and take in your familiar surroundings. An experience like this can give you just a brief peek into the ongoing disorientation for someone with dementia. When confusion about place, time, and even identity settle in for someone you love, you’re faced with two options for responding: either stepping into their reality with them, or orienting them to yours. Knowing when to use reality orientation in dementia care (and when to avoid it) is crucial to the person’s emotional wellness.

Which Reality Is Best?

In short, each approach has its place. Nonetheless, there are specific cautions to be familiar with when using reality orientation in dementia care. It’s important to first understand what is involved in both options and when they might be most appropriate.

Accepting Their Reality

Living in an alternate reality is quite common for someone in the mid to later stages of dementia. The person may believe they are a young adult engaged in their previous career (or a different one altogether), with a spouse and young kids to look after. Going along with their perception of reality helps them maintain a sense of self-worth and purpose. It instills peace and comfort, and is oftentimes the recommended approach.

Reality Orientation

Reality orientation, on the other hand, involves providing cues and prompts about the current date, time, and location. Studies have shown that it can improve cognitive functioning, especially when paired with donepezil, and help with a number of the more challenging aspects of dementia.

However, reality orientation should be handled gently along with compassion, skill, and awareness of the person’s emotional state. For example, if the individual asks where their mother is, it could be extremely harmful to respond, “Why, she died 30 years ago! You are 95 years of age, so there’s no way your mother could still be alive.” In contrast, it may be effective in ordinary conversations. For instance, if the individual wakes up and asks what day it is, you may respond, “Today is Tuesday, the day you have your exercise class and then dinner with Janice.”

If the individual appears to become agitated or anxious with reality, it is always best to join them in the perceived reality that feels comfortable to them.

Our specially trained caregivers are pros at knowing how to effectively engage someone with dementia and make each day the very best it can be. We make use of imaginative, customized approaches that help with memory, communication, comfort, and safety, while promoting independence and a sense of self-worth and purpose.

Contact us at 213-383-2273 for more information regarding our dementia care in West Los Angeles, Sherman Oaks, Santa Monica, and the surrounding areas.