Alzheimer's

7/13/2020 | By Rachel Marsh

Alzheimer’s disease is the most frequent cause of dementia. The condition results in short-term memory impairment, affected judgement and decision making, and confusion. Currently, there is no cure for Alzheimer’s, and it is a progressive disease, meaning it inevitably gets worse over time. It is treated with drugs and therapy to slow the patient’s decline. One of the most popular therapies for Alzheimer’s and other dementia is reality orientation therapy, sometimes referred to as “RO.”

Reality orientation therapy is a treatment strategy first described in 1966 as a rehabilitation method for confused elderly patients. In RO, therapists present the patient with continuous reminders about the date, where the patient is, and sometimes personal details about the patient’s life. A therapist and the patient may discuss recent events and the patient’s daily routine. The goal is to ground the patient in the present while also fostering social interaction.

Goals and Benefits of Reality Orientation Therapy

With reality orientation therapy, therapists strive to reduce confusion and disorientation in dementia patients. Patients gain a stronger understanding of their surroundings and their place within them. This leads to a greater sense of control and increased self-esteem. This therapy slows down cognitive decline.

Therapists also realize the limitations of reality orientation therapy, noting that if a patient believes in their own reality very deeply, constantly disagreeing with them is counterproductive. Since the therapy’s development, therapists have been moving toward more personalized techniques to incorporate RO, instead of a strict, confrontational style.

Types of Reality Orientation Therapy

RO therapy focuses on presenting patients with facts about the time, the date, and the current environment. There are two main types of reality orientation therapy: immersive, 24-hour facilities and classroom therapy. Patients who live in a dedicated facility, like a memory care unit of assisted living or a skilled nursing facility may receive 24-hour therapy. This means that during every interaction health care workers and caregivers have with a resident, those workers reinforce the current date, time, location, and current events with the resident. Caregivers can even read the newspaper or watch television with the patient to reinforce reality. There may also be signs declaring the date, multiple clocks, and an emphasis on current events, seasonal festivals, and other ways to ground social interaction with reality.

Classroom therapy means patients attend group sessions in which therapists engage patients in orientation-related activities. These sessions last about 30 minutes, and meet once or twice a day. The “RO board” is often a focus in the classroom setting. This board displays the date, day, weather, name of the next meal, and other current details. During the session, the therapist might encourage the group to socialize and discuss current events and daily routines. One study suggests that it takes at least 600 minutes of formal RO therapy to see the benefits.

A Combination of Therapies Might Work Best

This type of therapy is often combined with other therapies, like music therapy and group activities to reduce symptoms of Alzheimer’s like agitation and behavioral symptoms. Reality orientation therapy is also related to and used in combination with reminiscence therapy; this is where therapists encourage patients to recall and describe past events in their life. These types of therapy combined might work as a memory training exercise. When reminders of the present and prompts about the past trigger memories, this may stimulate cognitive function, slowing the decline that Alzheimer’s and other dementia brings on.

Rachel Marsh

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