Cognitive disorders: understanding to act — validation, redirection and anchors
Working with elderly people affected by cognitive disorders at home or in a facility requires specific, proven, and compassionate approaches. This practical guide explains and illustrates three of the most effective techniques: validation, redirection, and anchors.
It is 10:30 AM. Mrs. C., 83 years old, asks you for the third time since your arrival if she has taken her medication. Mr. T., 78 years old, refuses to wash for two days because he is convinced he has just done it. Mrs. L., 80 years old, cries as she tells you that she needs to pick up her children from school — her children who are now over 50 years old. These situations, experienced daily by home helpers, nursing assistants, nurses, and supporting families, reveal the painful gap between the objective reality and the subjective reality of the person with cognitive disorders. Correcting, reframing, insisting on the facts — these natural reflexes turn out to be not only ineffective but often exacerbating. This guide presents three approaches validated by research and decades of clinical practice: validation, redirection, and anchors. Together, they form a respectful, effective, and profoundly human support framework.
1. Cognitive disorders at home: understanding the intervention context
1.1 Profiles encountered and specificities of each pathology
Home caregivers and family caregivers face a wide spectrum of cognitive disorders, each with its own characteristics that directly influence the approaches to be used. Alzheimer's disease — the most common — is characterized by an early and progressive alteration of recent episodic memory, then semantic memory, with a relative preservation of emotional and procedural memory until advanced stages. The person often lives in a subjective past time — their parents are still alive, their children are young, they need to go to work. This subjective reality is coherent for them, even if it is disconnected from the objective present.
Lewy body dementia presents a fluctuating profile with episodes of confusion alternating with periods of relative lucidity, frequent visual hallucinations, and severe sleep disturbances. Vascular dementia is more progressive and stable, often with specific deficits related to the affected brain areas. Frontotemporal dementia preferentially affects personality and social behavior before memory — producing disinhibited or apathetic behaviors that can be very distressing for those around. Each profile requires specific adaptations of the validation, redirection, and anchors approaches.
people affected by Alzheimer's disease or a related disease in France — 3rd most common chronic disease
of people with dementia live at home, mainly with the help of family caregivers and home helpers
of episodes of agitation in nursing homes that adopted the validation approach vs. standard approach (Feil, 2018)
of professional caregivers report feeling better equipped after training in non-confrontational approaches (CNSA, 2022)
1.2 Why intuitive approaches fail
Faced with the puzzling behaviors of a person with cognitive disorders, the most natural and common reactions are correction (“No, your husband passed away ten years ago”), reality reorientation (“You are in 2025, not in 1975”), and logical confrontation (“You just ate an hour ago, you are not hungry”). These approaches are intuitively logical for intact brains — but they consistently fail with people presenting severe cognitive disorders.
The reason is neurobiological: in advanced dementia, the prefrontal cortex — which allows for the integration of contradictory information, updating beliefs, and accepting logical correction — is severely affected. The person no longer has the cognitive capacity to integrate information that contradicts their subjective reality. What they can do, however, is feel the emotion associated with the interaction: correction generates shame, anxiety, and agitation; validation generates calm, trust, and cooperation. Emotional memory — supported by the amygdala and largely preserved subcortical circuits until advanced stages — remains functional long after cognitive memory has failed.
🧠 Foundational principle: In supporting cognitive disorders, the subjective reality of the person is their reality. It is not a mistake to be corrected — it is a lived experience that deserves to be welcomed with respect. Our role is not to bring the person back to our reality, but to join theirs to create a safe and caring interaction.
2. Validation: joining the person's reality
The validation approach (Naomi Feil)
Welcoming emotions and subjective reality without correcting or confrontingThe validation therapy was developed in the 1960s by American psychologist Naomi Feil, after decades of observation of people with dementia in American nursing homes. Her foundational observation: people with dementia are not “elsewhere” randomly — they are processing unresolved emotions and experiences from their past lives through their present behaviors and verbalizations. Asking for their mother (deceased), wanting to pick up their children (adults), or looking for their husband (missing) are not symptoms to be managed but deep emotional needs to be welcomed.
Validation does not mean lying — it means welcoming the emotion without correcting the content. When Mrs. L. says she has to go pick up her children, the caregiver does not say “your children are 55 years old and live in Paris.” They say: “You are thinking about your children — you love them so much. What are their names?” This response validates the feeling of maternal love and the need to protect her children — real and legitimate needs — without fostering dangerous confusion.
2.1 Validation techniques in practice
2.2 What validation does not do
Several common misunderstandings about validation deserve clarification. Validation does not involve actively lying (“Yes, your husband is waiting for you”), which can create hope followed by disappointment and worsen confusion. It involves not correcting, not affirming false things. Validation also does not apply indiscriminately to all content: if the person expresses ideas that could endanger them (“I’m going out alone on the street”), redirection or a kind but firm refusal is necessary. Finally, validation is not a universal technique that works for everyone in all contexts — some people have partial anosognosia and may benefit from a more direct approach on certain topics. Regular observation of the person and continuous adjustment of the approach are essential.
Situation: “Where is my mommy? I want to see my mommy.”
“Your mommy passed away 40 years ago.” — This correction instantly generates intense sadness and sometimes a disproportionate crying fit. The person relives the grief with each correction.
The same situation, approached differently
“You miss your mommy right now. She was important to you. What was your mommy like?” — Validates the absence, explores the memory, creates a positive emotional connection.
Situation: “I haven’t eaten all day.”
“But you just had lunch an hour ago! I made the soup myself!” — The contradiction generates anxiety and distrust towards the caregiver.
The same situation, approached differently
“Are you hungry? Let’s see together what we can prepare for you.” (Then offer a small snack or accompany them to the kitchen.) The emotion of hunger/need is taken into account, the conflict avoided.
3. Redirection: steering attention towards a calmer territory
Redirection
Shifting attention from disturbing content to neutral or positive contentRedirection is a behavioral technique that involves diverting a person's attention from a problematic situation, behavior, or thought to something more neutral or pleasant — without confrontation or repression. It is different from validation: while validation welcomes and explores the emotion, redirection offers a movement, an activity, or a different theme to interrupt a difficult dynamic. Both techniques are complementary and are often used in sequence: validation first (welcoming the emotion), then redirection (proposing a transition to something else).
Redirection works because people with cognitive disorders often have very limited short-term memory — which means their attention can be relatively easily shifted to a new stimulus, especially if that stimulus is sensory, concrete, and familiar. Redirection takes advantage of this characteristic not to manipulate the person but to offer them an exit to a more comfortable emotional space.
3.1 Types of Redirection
🎯 Direct attentional redirection
- Propose an immediate concrete activity
- “Come help me set the table”
- “I need you for something”
- “Let's look at the photos together”
- Change rooms or environment
💬 Thematic redirection
- Derive towards a related positive topic
- Start from a keyword to go towards a pleasant memory
- “That reminds me of...” + positive topic
- Use the person's past interests
- Appeal to a rewarding social role
🌸 Sensory redirection
- Propose a pleasant sensation (herbal tea, smell, texture)
- Play familiar music
- Bring a meaningful object (photo, work-related item)
- Go outside or change the lighting
- Propose a pleasant body care (cream, hairstyle)
🤝 Redirection through involvement
- Assign a simple and rewarding task
- Ask for the person's help or opinion
- Create a sense of usefulness and competence
- Simple motor activities (folding, sorting, watering)
- Reading aloud to the caregiver
3.2 The "Yes-and" Technique
The "Yes-and" technique, borrowed from improvisational theater, is one of the most effective forms of redirection in supporting people with dementia. Instead of contradicting or correcting (“No, you don’t have to go out”), the caregiver welcomes the person's suggestion (“Yes”) and enriches it with a new direction (“and”). Mr. T. wants to go outside at 10 PM? “Yes, it’s a nice evening, and I was just about to suggest we look at the garden from the window — come, the moon is beautiful.” This “yes-and” is not a lie — it is an invitation to something real and pleasant that partially satisfies the expressed need for movement or freedom.
Situation: “I want to go home.”
“But you are home! This is your house!” — Generates anxiety, confusion, and often escalates the request.
The same situation, approached differently
“I understand that you want to go home. First, we will have a coffee together, and then we will see about that.” (Then redirect to a gentle activity.) In most cases, the request dissipates on its own after a few minutes.
Situation: resistance to the shower
“You need to wash, you have no choice.” — Often triggers active resistance, sometimes a crisis, and associates personal care with constraint.
The same situation, approached differently
“I have prepared your favorite cream — it smells so good. We are going to take care of you.” Offer care as a pleasant moment rather than an obligation, with a positive sensory reinforcer.
4. Anchors: bridges to preserved emotional memory
Anchors
Stimulate preserved emotional and procedural memory to maintain connection and identityAn anchor is a stimulus — sensory, emotional, or identity-related — that activates memories, emotions, or automated behaviors linked to the person's life history. The specificity of anchors lies in the fact that they rely on types of memory that are long preserved in dementia: emotional memory (emotions associated with significant experiences remain accessible even when facts are forgotten), implicit memory (automated learned behaviors — riding a bike, preparing a known recipe, playing an instrument), and old autobiographical memory (memories from youth resist better than recent memories in the majority of dementias).
Anchors are not tricks or manipulations — they are doors to the person that the disease has put in the shadows. They allow for maintaining a relational connection, preserving the sense of identity and dignity, and creating moments of sincere well-being even in advanced stages of the disease.
4.1 The four types of anchors
| Type of anchor | Concrete supports | How to use it | Examples |
|---|---|---|---|
| Sound-musical anchor | Childhood songs, familiar tunes, hymns, lullabies sung in the past | Hum, play on a tablet or radio, invite to sing or keep the beat | The Marseillaise, song from a cult film of the 60s, popular dance tune |
| Olfactory anchor | Smells associated with significant moments (fresh bread, usual cologne, coffee, garden flowers) | Gradually expose to the smell, observe the reaction, encourage storytelling | Lavender if the person had a garden, morning coffee, childhood laundry smell |
| Identity anchor | Objects related to profession, hobbies, life roles (kitchen apron, tools, family photos, collectibles) | Present the object, observe the automatic behaviors that emerge (job gestures), encourage storytelling | Knitting for a former seamstress, playing cards, kitchen apron, recipe notebook |
| Relational anchor | Photos of loved ones, voice of a relative, presence of a pet, visits from children | Use photos as storytelling support, facilitate regular contact with loved ones, encourage visits from children or pets | Commented photo album, video call with daughter, visit from the family dog |
4.2 Building a person's anchor profile
The most effective anchors are specific to each individual — what triggers a positive emotional response in one may be neutral or even anxiety-inducing in another. Building a person's anchor profile is a work of observation and information gathering done in collaboration with the family. Some key questions for the family upon entering care: What was the person's favorite music in their youth? What was their profession? Their hobbies? Their favorite dishes? Their smells associated with happy moments (garden, kitchen, perfume)? Their usual phrases or expressions? The people they particularly loved?
The DYNSEO Liaison Notebook is a valuable tool for documenting and sharing this anchor profile among all stakeholders — family, home care aide, nurse, doctor — ensuring that the same anchors are used consistently and that new information collected is shared with everyone. The DYNSEO Session Tracking Sheet allows for noting, at each intervention, which anchors were used and with what effects — gradually building a deep understanding of the person.
5. Combining the three approaches: quick decision guide
5.1 Choosing the right approach according to the situation
| Situation | Priority approach | Secondary approach | To avoid |
|---|---|---|---|
| Strong emotional agitation (crying, distress, repeated calling) | Validation — Acknowledge the emotion, reflect, contact | Musical or olfactory anchor | Correction, minimization, too quick redirection |
| Non-dangerous fixed ideas (believing husband is alive, wanting to go to work) | Validation then Redirection | Identity anchor related to the theme | Direct correction, insistence on objective reality |
| Refusal of care or activities | Redirection — Yes-and, involvement, sensory reinforcer | Positive anchor related to care (smell, music) | Insistence, obligation, confrontation |
| Wandering and pacing | Redirection + Anchor — Propose a meaningful motor activity | Validation of the need for movement | Restraint, prohibition, reprimands |
| Moments of lucidity and connection | Anchor — Explore preserved memories | Validation of life history | Focusing on deficits, correcting minor inaccuracies |
| Apathy, withdrawal, absence of reactivity | Anchor sensory — Musical, olfactory, tactile stimulation | Involvement in a simple past activity | Too demanding cognitive stimulation, complex speech |
5.2 The typical intervention sequence
- Observe and assess emotional state — Before any intervention, take 30 seconds to observe: what is the level of agitation (low, moderate, intense)? Is there a dominant identifiable emotion (fear, sadness, confusion, anger)? Is there an apparent trigger (fatigue, pain, change of environment)? The DYNSEO Emotion Thermometer can help structure this observation for less experienced caregivers.
- Regulate your own reaction — Check your own emotional state before intervening. If you are irritated, rushed, or anxious, this will immediately transmit to the person. Take 3 slow breaths before entering the room or initiating contact.
- Make contact through validation — Start by joining the person's emotional reality. Name the emotion, use their name, a gentle tone. Do not correct in the first few seconds.
- Propose a redirection if necessary — If the situation is difficult to resolve (refusal of care, dangerous fixed idea), introduce a redirection proposal in the natural continuation of validation: "I understand you, and actually..."
- Activate a meaningful anchor — Depending on the situation and the person's profile, introduce an anchor (music, object, activity) to ground the interaction in a familiar and secure emotional territory.
- Document and share — After the intervention, note in the DYNSEO Session Tracking Sheet: what situation, what approach, what effect. These notes gradually constitute a deep understanding of the person, shareable with the entire team via the DYNSEO Liaison Notebook.
6. DYNSEO tools for cognitive support at home
Behavioral disorders related to the disease — Methods and multidisciplinary coordination
This Qualiopi certifying training is specifically designed for professionals working with elderly people presenting cognitive disorders — home helpers, nursing assistants, home nurses, SAAD and SSIAD coordinators. It covers the neurobiological bases of dementias, validation approaches, redirection and anchoring, behavioral assessment tools, and multidisciplinary coordination. Deployable in teams, fundable by OPCO.
Discover the training →DYNSEO practical tools for home support
📊 Skills tracking table
Track the evolution of cognitive and behavioral abilities over time — identify regressions to adapt support and alert the medical team if necessary.
Download →📋 Session tracking sheet
Document each intervention: situations encountered, approaches used (validation, redirection, anchoring), observed effects. Essential traceability to build knowledge of the person and coordinate the team.
Download →📒 Liaison notebook
Coordination tool among all caregivers around the person — share information on effective anchors, recent behaviors, adaptations to test. Essential for the consistency of the approach.
Download →🌡️ Emotion thermometer
Evaluate and communicate the emotional state of the supported person — a common reference among all caregivers to describe the state of the day and choose the appropriate approach.
Download →🎡 Wheel of choices
Offer choices of activities or anchors in a visual and accessible way — maintain the decision-making autonomy of the person even at advanced stages, with a format adapted to their reduced cognitive abilities.
Download →DYNSEO applications for cognitive stimulation
👴 SCARLETT — Seniors
Cognitive stimulation application designed for seniors with neurological pathologies. Intuitive interface, progressive exercises, usable in supported sessions as a gentle and rewarding stimulation tool.
Learn more →💬 MY DICTIONARY — Communication
For people whose cognitive disorders affect verbal expression — maintain functional communication and preserve social interactions that nourish the sense of identity.
Learn more →🧠 CLINT — Adults
For people in the early stages of cognitive disorders who can still engage in structured cognitive exercises. Adaptive pathways according to the user's profile.
Learn more →🤖 DYNSEO AI Coach
Personalized support for caregivers and families: questions about approaches, anchors, specific adaptations to a behavior or particular situation.
Learn more →DYNSEO trainings
Behavioral disorders — Methods and multidisciplinary coordination
→ See the complete DYNSEO training catalog
🏠 Train yourself in validated approaches for cognitive support
The DYNSEO Qualiopi certified training for home care professionals provides the neurobiological foundations, validation techniques, redirection and anchoring, and multidisciplinary coordination tools. For families: the relatives training is accessible at your own pace online.
❓ FAQ — Validation, redirection and anchors in cognitive disorders
1. Does validation involve lying to the person with dementia?
No — and this distinction is fundamental. Validation involves not correcting the subjective reality of the person, not actively asserting false things. If Mrs. D. thinks her husband (deceased) will be there tonight, the caregiver practicing validation will not say "yes, your husband is coming tonight" — they will say "you are thinking about your husband, you miss him" and explore the associated emotions and memories. Conversely, the caregiver will also not say "but your husband died 15 years ago" — a correction that generates intense suffering without therapeutic benefit for a person whose brain can no longer integrate this information.
2. Doesn't redirection risk frustrating the person or making them feel manipulated?
The risk exists when redirection is clumsy — too abrupt, too transparent, or used to avoid a real interaction rather than to add something to it. Well-conducted redirection does not generate frustration because it does not eliminate the emotion — it first validates it, then proposes a transition to a more comfortable territory. In moderate to advanced stages of dementia, short-term memory is so impaired that the person generally does not remember the initial situation a few minutes later — which makes redirection effective without being perceived as manipulation.
3. How to identify the right anchors for a person you don't know well?
Identifying a person's anchors starts with families — they are the ones who know the songs from youth, passions, familiar smells. A few key questions during the first meeting with the family: what was their job, their hobbies? What music did they like? Are there any particularly significant objects in the house? Then, direct observation during interventions: what stimuli trigger a positive reaction (smile, relaxation, words, spontaneous activity)? These observations, documented in the DYNSEO session tracking sheet and shared via the liaison notebook, gradually build a rich profile.
4. Do these approaches work at all stages of dementia?
Yes, but with adaptations according to the stage. In early stages, validation, redirection, and anchors are accompanied by substantial verbal exchanges. In moderate stages, verbal content is less central — emotions, gestures, and sensory stimulation become more important. In advanced stages, when verbal communication is very limited or absent, sensory anchors (music, smell, gentle tactile contact) and the non-verbal aspects of validation (eye contact, touch, tone of voice) remain effective and valuable. Even at a very advanced stage, the emotion generated by the interaction remains accessible and influences the person's well-being.
5. How to manage caregiver burnout in the face of repetitive and exhausting behaviors?
The repetition of the same situations (the same question every 5 minutes, the same behavior every morning) is one of the most exhausting sources of cognitive support. A few strategies: name the difficulty without guilt (it is normal to find it exhausting), alternate caregivers on the heaviest tasks, use prepared response scripts for recurring situations (not having to think each time). The systematic use of positive anchors transforms some repetitive interactions into almost pleasant exchange moments, reducing their emotional load.
6. Are these techniques reserved for professionals or can families learn them?
They are accessible to families — and their appropriation by non-professional caregivers is one of the factors that most improves the quality of life of people with dementia at home. The DYNSEO training "Behavioral Changes Related to Illness — Practical Guide for Relatives" is specifically designed to convey these approaches to non-professional caregivers, with accessible language, concrete examples, and directly usable tools. It is Qualiopi certified and eligible for CPF funding for employed caregivers.
7. Can the validation approach be used with other pathologies besides dementia?
Yes — the principles of validation apply to any situation where correcting a person's subjective reality is counterproductive or hurtful: psychiatric disorder with delusional elements (psychosis, delirium), severe post-concussion syndrome, consciousness disorder after a long hospitalization, certain bereavement situations. In all these cases, welcoming the emotion before (perhaps) introducing a gentle corrective information is generally more effective than direct confrontation.
8. How to involve the medical team in using these approaches?
Consistency among all caregivers — home help, nurse, attending physician, family — is fundamental. The DYNSEO liaison notebook is the key tool for sharing effective anchors, approaches that work, and recent behaviors with all team members. During coordination meetings (ESS, CLIC meetings, coordination calls), explicitly mentioning the approaches used and their effects allows the doctor and care team to adapt prescriptions and interventions accordingly. DYNSEO training for professionals can be deployed to the entire team to ensure total consistency of approaches.
🏠 Accompany better, exhaust yourself less with DYNSEO approaches
Session tracking sheet, Liaison notebook, Tracking table, Emotion thermometer — DYNSEO tools structure and strengthen validation, redirection, and anchoring approaches in your daily life as a caregiver. The Qualiopi certified training complements your toolbox.
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