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 one 100, are interested in the outside world. They 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. They cannot face the loss of memory, job, mobility, or control. These are the people who must now look inside. 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 the present.

Caregivers can help these people communicate their feelings and put past issues to rest. Rather than viewing them as diseased, we can see them simply as very old people in their 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. Then we are better prepared to listen with empathy rather than frustration when they step away from reality.

This is validation therapy—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, reality-oriented approaches to dealing with confused elders age 80 and older. Since then, it’s become state of the art and has been embraced by more than three thousand agencies nationwide. For many decades, validation therapy 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.

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