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Reality Orientation - Empirical Evidence

age aging social clinical psychiatry ‘‘reality dementia woods

It is beyond the scope of this entry to examine individual studies of RO. However, a number of reviews (see Kasl-Godley and Gatz; Spector et al.) cover empirical investigations of RO with both demented and nondemented older adults. Investigations tend to focus almost exclusively on the evaluation of classroom RO. In general, these investigations find that RO has circumscribed cognitive effects, largely on orientation, and little to no effect on behavioral functioning. When improvement is observed, it is usually in mildly impaired individuals. Continuation of gains after the discontinuation of treatment is uncommon. Conclusions, however, must be considered in light of a number of design issues. These issues include use of small sample sizes, use of mixed diagnostic groups, nonrandom assignment or lack of a comparison group, lack of standardized assessment, use of training material in the evaluation of the technique, and variability in the administration of intervention techniques. Interventions vary in duration of treatment, frequency and length of individual sessions, and use of additional potentially therapeutic components, such as increasing the number of activities available to residents. Nonspecific treatment effects (e.g., increased communication with staff, involvement in social activity, attention to appropriate behavior) apparently do help to explain treatment outcomes (see Woods, 1979; Gerber et al.). These results suggest that improvement in orientation may be facilitated through social activity and raise questions as to whether social activity (ongoing interactions with care providers that focus on maintaining communication and contact) is the more useful component of reality orientation.



DRUMMOND, L.; KIRCHHOFF, L.; and SCARBROUGH, D. R. ‘‘A Practical Guide to Reality Orientation: A Treatment Approach for Confusion and Disorientation.’’ The Gerontologist 18 (1978): 568–573.

FOLSOM, J. C. ‘‘Intensive Hospital Therapy of Geriatric Patients.’’ Current and Psychiatric Therapies 7 (1967): 209–215.

FOLSOM, J. C. ‘‘Reality Orientation for the Elderly Mental Patient.’’ Journal of Geriatric Psychiatry 1 (1968): 291–307.

GERBER, G. J.; PRINCE, P. N.; SNIDER, H. G.; ATCHISON, K.; DUBOIS, L.; and KILGOUR, J. A. ‘‘Group Activity with Cognitive Improvement among Patients with Alzheimer’s Disease.’’ Hospital and Community Psychiatry 42 (1991): 843–845.

HANLEY, I. G. ‘‘The Use of Signposts and Active Training to Modify Ward Disorientation in Elderly Patients.’’ Journal of Behavior Therapy and Experimental Psychiatry 12 (1981): 241–247.

HANLEY, I. G. Manual of the Modifications of Confused Behavior. Edinburgh: Lothian Regional Council, Department of Social Work, 1982.

HANLEY, I. G., and LUSTY, K. ‘‘Memory Aids in Reality Orientation: A Single-Case Study.’’ Behavior Research and Therapy 22 (1984): 709–712.

HOLDEN, U. P., and WOODS, R. T. Reality Orientation: Psychological Approaches to the Confused Elderly, 2d ed. Edinburgh: Churchill Livingstone, 1988.

KASL-GODLEY, J., and GATZ, M. ‘‘Psychosocial Interventions for Individuals with Dementia: An Integration of Theory, Therapy, and a Clinical Understanding of Dementia.’’ Clinical Psychology Review 20, no. 6 (2000): 755–782.

POWELL-PROCTOR, L. and MILLER, E. ‘‘Reality Orientation: A Critical Appraisal.’’ British Journal of Psychiatry 140 (1982): 457–463.

SPECTOR, A.; DAVIES, S.; WOODS, B.; and ORRELL, M. ‘‘Reality Orientation for Dementia: A Systematic Review of the Evidence of Effectiveness from Randomized Controlled Trials.’’ The Gerontologist 40 (2000): 206–212.

TAULBEE, L. R., and FOLSOM, J. C. ‘‘Reality Orientation for Geriatric Patients.’’ Hospital and Community Psychiatry 17, no. 5 (1966): 133–135.

WILLIAMS, E. M. ‘‘Reality Orientation Groups.’’ In Working with Older Adults: Group Process and Techniques. Edited by I. Burnside and M. G. Schmidt. Boston: Jones and Bartlett Publishers, 1994. Pages 139–152.

WILLIAMS, R.; REEVE, W.; IVISON, D.; and KAVANAGH, D. ‘‘Use of Environmental Manipulation and Modified Informal Reality Orientation with Institutionalized, Confused Elderly Subjects: A Replication.’’ Age and Aging 16 (1987): 315–318.

WOODS, B. ‘‘Reality Orientation and Staff Attention: A Controlled Study.’’ British Journal of Psychiatry 134 (1979): 502–507.

WOODS, B. ‘‘What Can Be Learned from Studies on Reality Orientation?’’ In Care-Giving in Dementia: Research and Applications. Edited by G. M. M. Jones and B. M. L. Miesen. New York: Tavistock/Routledge, 1992. Pages 121–136.

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