This article has been contributed by Abhilash K. Desai, M.D. He is the medical director of geriatric psychiatry at Sheppard Pratt and director of the memory clinic of the neuropsychiatry program at Sheppard Pratt. Dr. Desai is also an associate professor at the Saint Louis University School of Medicine and at the University of Maryland School of Medicine.
The portrait of seniors with Alzheimer’s and other forms of dementia needs to change from “exuberant life, gloomy aging” to one of “exuberant life, peaceful and happy aging.” There is no reason for these seniors to not experience fullness of life. The connection dementia sufferers have to others and to their own past lives can be sustained at a far higher level than is generally believed. Boredom and loneliness have a tremendous negative impact on a person’s sense of happiness and contentment.
The basic principles in bringing back fun and joy are adopting a philosophy of care that emphasizes quality of life, a supportive environment that stresses life purpose, and respecting the “personhood” of seniors. The goal should be to create a positive, fulfilling life for people with dementia in a warm, comfortable, and compassionate setting. Personalized care plans build on a person’s strengths, enhance positive self-image, and promote autonomy. We need to shower people with dementia with affection, stimulate them by a joyous atmosphere of loving people (especially children) and pets, and treat them with honor and dignity.
Planning structured, individualized activities that involve and interest the person with dementia may reduce many of the more disturbing behavioral symptoms of dementia, such as agitation, anger, frustration, depression, wandering, or rummaging. Therapeutic activities should focus on a person’s previous interests and take advantage of their remaining skills. Successful activities support a sense of self – bringing out their skills, memories, and habits – and reinforce the sense of being in a group, which can provide friendship, mutual support, and spiritual connections. Any former hobby or interest is a candidate, including gardening, cooking, painting, singing, and playing or listening to music. Activities that are done regularly, at the same time every day if possible, may help establish routine and increase the person’s sense of stability. Planned programs of physical activity such as walking and dancing can improve not only mood, but also physical function, communication abilities, and agitated behaviors, and promote engagement with the environment and decrease daytime sleeping.
Gentle, silent contact is often all that a person with dementia needs to feel less lonely, to feel one is still a living human being. It is equally important to use the “magic” of music to keep the people living with dementia truly alive. Music is a superb way of maintaining connections to the past and other people. People with dementia who can play a musical instrument (such as a piano) may not know what they had eaten twenty minutes ago but at the piano, may recall, play, and sing dozens of songs that made up their repertoire. No matter how much they are upset or having a bad day or just not happy with the world at the moment, music can make them happy and change their mood. By playing music, people with dementia can not only communicate with others, but also create a rapport with people and become recognized because of that.
Often people with dementia who are withdrawn and are not very responsive to anything brighten up in response to seeing a dog or cat walk up to them. They are suddenly present, captivated, and reaching down to touch the pet. It is a chance for people with dementia to show love and bask in the memory of something warm. Physical contact, whether it is a human touch or a furry animal, creates relaxation and a sense of connection. The presence of children often brings a smile, a laugh, or a caress. Often people with dementia, even those who are usually silent, will initiate conversations in the presence of children.
Quality caregiving includes spending quiet time with dementia patients when they need companionship and loving. Skill-appropriate activities not only facilitate engagement and maintain skills but also enhance the enjoyment received by them. Attending a concert at a local theater, going out fishing with friends or family, participating in a community service project, or playing with local children through an intergenerational program can be fun and give a sense of being a part of the greater community.
Despite the serious health problems people with dementia experience, they are able to share moments of tenderness and love for their family and caregivers. Although they have lost some of the characteristics that their loved ones treasured, they are still capable of living and loving, and they are in need of and responsive to loving attention in return. We need to approach caring for behavioral disorders in dementia with a new vision, focusing on life-enhancing care with experienced caregivers. Such an environment includes respect, choices, love, spirituality, and music. Care providers need to offer hope and stories of inspiration to people with dementia and their loved ones.
Ongoing stimulation of the mind, body, and soul of a person with dementia at home as well as in an institutional setting can sustain older adults with dementia at a far higher level than is generally believed. It is important to realize that there are things that can be done to allow people with dementia to remain alive, not just living with the disease. In learning this lesson, the lives people with dementia as well as their loved ones and all other caregivers and care providers will be enriched.
Senior Helpers North NJ 