Changing the way we look at dementia deficits, to change our stress level

Our “default” when it comes to caring for a loved one with dementia often is to focus on his or her deficits. Dad can’t drive anymore.  He cannot read books. He no longer can prepare meals as he used to. Dementias are a progressive deterioration, so we watch new deficits emerge. It’s depressing, and stressful.

Some kitchen tasks may be appropriate.

Clinical psychologist Cynthia Green writes on The New York Times’ New Old Age blog about the importance of engaging with our loved ones. The trick is to tailor activities to their abilities.

If Dad can’t focus on the written word, maybe he can listen to a book on tape. Preparing a whole meal is out, but he may delight in some kitchen tasks–such as mixing batter.

Green says ask yourself, first, what your loved one enjoys. “New activities aren’t impossible, but something totally outside his previous interest may be more challenging to get off the ground. You’re unlikely to make a baker out of a man who spent every spare hour on the golf course — but he may get a real kick out of watching golfing videos or teaching his grandson to putt,” she writes. “Then, find ways to modify hobbies so that they’re accessible. Some activities may now be too complex, but with imagination you can find similar nonverbal, multisensory avenues that still bring satisfaction. If your mom took great pride in her beautiful flower garden, perhaps she can plant small pots of flowers, look with you through garden books (big coffee-table volumes are ideal), or help you mix potpourri to use in sachets.

The post by Green is garnering many comments, including mine. It is also prompting at least one doctor to be reflective. Dr. Ken Covinsky writes on about reading through all the comments.

“Several family members noted that when they stopped mourning what their loved ones could no longer do, and instead learned to find joy in activities they could do together, their stress decreased and they found new meaning in their relationships,” he writes. “I wonder if I would do more good for my patients by just referring them to these snippets of advice than by writing another donepazil or memantine prescription.

“The post is making me think about a number of issues in terms of the how we learn to care for patients with dementia, and the dominant research paradigms in the field. We are rather dominated by a model in which the focus is on reversing and/or preventing declines in cognitive function. The problem is that current options, when directed towards that goal, are quite poor. Would management of dementia be improved if the “cure” paradigm were replaced with a quality of life paradigm?

“And why is there such limited research into practical approaches such as these towards improving quality of life and well being in persons with dementia? Why don’t we ever see any research examining this type of issue in medically oriented geriatrics and gerontology journals?”

Read Covinsky’s post.

Read Green’s post.

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