ln their old world

Elderly people may withdraw to escape loss

Naomi Feil

In the Alzheimer's wing of the nursing home, 93-year-old Ellie Turner stuffs more napkins in her worn-out black purse. The tarnished gold clasp clicks into place for the 100th time in one hour.

"I have to fix the Underwood," she says as she moves toward the bathroom to change her pants.

Mrs. Turner is called Alzheimer s demented, but I have found that her behavior — and the behavior of thousands like her — makes sense.

Her behavior is caused not only by damage to her recent memory, her logical thinking and her inability to tell clock time — but also by the way she has lived her life. If someone enters her world, accepting or validating her needs, she will not become one of the living dead. She will die with dignity and self-respect.

If we tune into their inner world, we begin to understand that a retreat into personal history is a survival strategy, not mental illness.

As a bookkeeper and file clerk for a large electric company, Mrs. Turner used an Underwood typewriter for 50 years. When she was retired against her will at the age of 65, she put her trusty office companion in her dining room. Every morning Mrs. Turner's daughter found her typing for her "company."

Mrs. Turner knew that she was retired, but she could not roll with the punches of aging. Her work was the most important thing in her life, and she could not give it up.

When, at age 93, she could not accept the fact that she was losing bladder control, she associated the loss of her Underwood with the loss of control. She went to the bathroom to fix her machine. The Underwood became a symbol of her old-age losses.

Very old people who have not prepared for the physical and psychological blows of aging often use symbols to express their human needs. They have not learned to face pain, anger, frustration, shame, guilt. Throughout life, they have denied painful emotions. In very old age, the denial worsens. They blame others for their own failures.

Each age has its own, unique tendencies. A 3-year-old who talks to an imaginary playmate is not hallucinating she is developing her imagination and verbal skills. If, at age 13, she talked to an imaginary playmate, we would worry.

By the same token, an 85-year-old is very different — physically, socially and psychologically — from a 70-year-old. We lose thousands of brain cells each year, beginning in our late 20s. Not surprisingly, this loss of brain tissue can affect our logical thinking areas after eight to 10 decades of wear and tear.

Many autopsies have uncovered Alzheimer plaques and tangles in brains of very old people who were never diagnosed with dementia.

Many very old people, 85 to 100, are interested in the outside world. These people have learned to roll with the punches of aging. They do not hang onto outworn roles. They accept what they cannot change.

But there are many very old people who have never learned to deal with their losses or their emotions. Now, in very old age, they cannot face the loss of memory, job,

Elder comfort Naomi Feil talks to an Alzheimer's patient.

mobility or control. These are the people who must now look in-side. Their job is not to know the outside world. In their old age, they are simply preparing for their final move. They no longer care about present time.

Caregivers can help these people communicate their feelings and put past problems to rest. Rather than viewing them as diseased, we can see them simply as very old people in a final life struggle.

When we tune into their inner world, we begin to understand that a retreat into personal history is a survival strategy, not mental illness. We are then better prepared to listen with empathy rather than frustration when they step away from reality.

This is Validation method — a tested method that can be used by both professionals and family members. I developed the therapy in 1963 when, as a social worker, I became frustrated with traditional al, reality-oriented approaches to dealing with confused elders 80 and older.

Since then, it's become state-of-the-art, embraced by more than 3,000 agencies nationwide.

For three decades, the Validation method has helped the very old restore the past, relive good times, and resolve past conflicts.

In doing so, it has reduced their stress, enhanced their dignity and increased their happiness and sense of well-being.

Feil is executive director of the Validation Training Institute in Cleveland.
Article originally appeared in the Democrat and Chronicle, Rochester NY

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