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Does Everyone with Dementia Withdraw?

Updated: Apr 15

By Oran Aviv

What if we can prevent someone living with dementia from regressing? Naomi Feil, the founder of Validation, believes that this withdrawal can be prevented and today we have proof that she is correct.

Late-Stage Dementia

We are all too familiar with the later stages of dementia when an individual withdraws and begins to lose their ability to respond to their environment.

As a person becomes more withdrawn, they may first lose their ability to speak and may communicate more with sounds and/or movement.

As the person’s condition continues to deteriorate:

Their eyes are mostly closed, not focused or blank.

They sit slumped in a chair or lie in bed.

They no longer speak and barely move.

They do not respond to people including close relatives.

Naomi Feil, the founder of The Validation Method, believes that this withdrawal can be prevented.

Naomi teaches that this withdrawal happens when the person no longer has a connection with others and that this regression can be prevented by continuing to engage, interact and allow the person to express their feelings.

Escape From an Unbearable Reality

What do you do when you are in a difficult situation and have no way of escaping? Personally I close my eyes and escape into my own world.

Many years ago when my husband and I were backpacking through Southeast Asia, we boarded a bus in India. We sat down and kept a distance so we wouldn’t stick to each other from the heat and humidity. To our surprise, a man boarded the bus and chose to sit down between the two of us! Apparently in India 3 people sit on a seat for two,

My husband switched places with him, and I was crushed next to the window. The heat, the sweat the smell – it was dreadful. I remember laying my head on the window, looking outside at the rice paddies, and closing my eyes to escape into a half conscious state. This allowed me to make that difficult 2-hour bus journey.

Now imagine someone living with dementia, who can no longer bear their present reality. They may want to escape into their own world. It may be to a place and time when their life was much better:

A man sitting slouched with his eyes closed moves his fingers back and forth on the arm of his wheelchair as he dances with his late wife in a dance hall.

A woman sits folding and opening the hem of her skirt feeling useful again filing papers as a secretary.

An older woman with closed eyes, curls up and rocks herself as her mother did to her when she was a baby and felt safe and secure.

All these people may become withdrawn to escape their unbearable reality, and in time they will be living more in their own world and less in ours. However, we may be able to prevent this from happening.

Validation Prevents Withdrawal

I remember the first time I went to a nursing home for people with late-stage dementia. I saw a line of wheelchairs with older people, all with eyes closed, sitting slouched or in awkward positions, no longer able to support their own body weight. I came to this nursing home to work with a client who was non- verbal, and I knew that in a few months, I would also begin working with one those lost souls in wheelchairs as part of my practical work for my Validation Course.

At the time, it was very difficult for me to see these residents as I’m sure it is for most people who are not working this field. My non-verbal client was sitting in her chair, eyes closed and folding back and forth the end of her shirt. She was oblivious to what was happening around her. I first centered myself to remove all the thoughts and fears I had working in this nursing home.

Using Validation I connected to my client. It took several weekly visits until I began feeling comfortable, but I discovered the wonderful woman who was “hiding’ inside those closed eyes.

It reminded me of the movie “Awakening.” For those few moments that I spoke to and validated this woman, she became more aware of her surroundings and more verbal. She would kiss me every time I came.

This was my first understanding that rather than just let these people continue to withdraw, we can connect, allow them to express themselves, help them fulfill their needs and in doing so help them stay connected with their environment. A few months later I came to validate one of those people sitting with closed eyes in wheelchairs, I was no longer scared and I was able to connect with that client too. He didn’t talk, but he did move and reacted to my being there.

Naom Feil, the founder of Validation just turned 90 this week and at her on-line birthday party people from all over the world shared how much she has helped older people with dementia as well as inspire hundreds more around the world.

For those of you who didn't see this clip, it shows how by using Validation, Naomi is able to connect with Glady Wilson, a woman who was withdrawing. I have seen this clip over a hundred times, and I am touched each time I view it. I also feel sad that there are so many people in the Gladys Wilson’s state who are being ignored.

I do feel the need to add a warning about this clip. Naomi is using many Validation techniques to connect deeply with Gladys Wilson. Using techniques without understanding how to use the Validation attitude of empathy could cause a client to withdraw more.

What Causes Regression and Withdrawal?

This week I was saddened to see a man I know regress and begin to withdraw into his own world, becoming unaware of his environment. He lives at home with a live-in caregiver as well as his wife.

When I saw how much this man had regressed, I spoke to his caregiver to try to understand what the cause might be.

Sadly the man’s wife reacted to her husband’s condition by totally disconnecting from him. The wife hired the live-in caregiver to take care of her husband and now the wife does not feel she needs to be in the picture. His wife moved into another room where she keeps busy with her own work and lets the live-in caregiver take full responsibility for her husband.

The caregiver, with tears in his eyes, told me that the husband who is not very verbal, calls for his wife at night. The caregiver also said he tries to get the wife to at least sit at the table while they eat so the husband will have some contact with her.

Imagine what this man who is living with dementia must be going through. He is confused, not able to express what he wants and needs and the person closest to him has basically abandoned him. No wonder he wants to escape from this terrible reality.

Please remember that regression and withdrawal are not only caused by the condition but may be due to a variety of reasons.

Where People with Dementia Don’t Regress

One of the plus sides of the Pandemic and isolation is the connections we now have with people all over the world. I recently learned about what is happening in nursing homes in Germany and it may surprise you.

Diakonissen Speyer, is a large provider with a wide range of facilities, providing for both the elderly, children and youth as well as running hospitals in Germany,

Hedwig Neu who is the head of Diakonissen Speyer, and a Master Validation Teacher, spoke at the Validation First World Congress about their facilities for people living with dementia.

Today Validation has been taught and implemented in 10 of their care homes for the elderly. In these facilities everyone (from the manager to the janitor) all learn the basic Validation attitude, plus there are trained Validation workers and volunteers working at these facilities. Family members also learn Validation.

Hedwig explained that since implementation of Validation in these homes, none of the residents have regressed to the stage of being non-verbal. Let that sink in for a moment. At their homes that have adapted Validation, the residents do not withdraw to a stage of being non-verbal. They pass away living with dementia while they are still verbal!

Hedwig also explained that when the students from these facilities participate in the Validation Workers Course, they cannot find late stage clients to practice on in their own facility because after about 5 years of Validation at a facility, they no longer have residents who regress to these later stages!

Hedwig did share that during Covid and isolation there were residents who began to withdraw into non-verbal phases because they were isolated in their rooms.

Today in Germany many families look for a facility for their loved ones where the staff uses Validation. Wouldn’t you? They try at each facility to make sure a resident is validated at least once a day. A validation session is only a few minutes. Hedwig also explained that the workers are "having much more fun" at their jobs caring for the residents when Validation is being used. You can hear Hedwig Neu's remarkable presentation in this clip. She begins speaking at about the 18:30 time mark - although I'm sure you will also enjoy hearing Naomi Feil and her daughter Vicki de Klerk who is the executive director of the Validation Training Institute.

Withdrawal and becoming non-verbal may be preventable, but we need to change the way we communicate and understand those who are living with dementia. I’ll finish this blog with a Google-Translated quote from the Diakonissen Speyer website.

“People with dementia increasingly lose the ability to organize everyday life independently and to satisfy their own needs... Professional care and support should help to recognize self-determination, to stabilize self-esteem and to promote the abilities of the persons concerned.”

Doesn’t everyone living with dementia all over the world deserve this same care?


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A older man looking at a woman show seems to calming him with her hand on his shoulder. The next reads: Practical Validation Training for People who want to better communicate with older adults living with dementia.

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