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A 24-hour reality orientation programme was initiated in a long-stay geriatric ward. Nursing and occupational therapy routines were changed specifically to meet the needs of the 20 patients participating in the programme. The assessments included the Clifton Assessment Procedures for the Elderly, the Holden Communication Scale, the Holden Orientation Facilities Scale, and the Oberleder Scale (adapted by Holden et al.). These scales were administered before, during and after completion of a study lasting 4 months. The CAPE scales showed no significant results. However, the Holden Communication Scale indicated that there were significant differences for certain groups of patients. Those patients with high scores initially tended to continue to have high scores and showed no real change. However, patients who had scores in the medium range initially, showed improvement. This finding indicated that severity at onset of the experiment was an important variable when considering outcome of treatment. Expectations regarding the future of the very elderly must be realistic, and to anticipate a return to previous vitality and total independence should not be expected. However, to find a means by which functional levels can be maintained, and even slightly improved, is desirable. It would seem that the 24-hour reality orientation programme achieved this goal.