If you never watch another YouTube video, this one is the one you should watch. Validation Therapy is a cornerstone of the person centred approach to relating with people living with dementia and with many other conditions that impair their capacity to be peaceful.
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Michael Merzenich is the most well known of the experts in brain plasticity.
He shares his work here in this TED talk. Enjoy.
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“A life worth living” is the phrase we hear a lot these days when discussion moves to what life should be like for people living in aged care homes. It’s an international discussion and it takes on different flavours in each country.
In the US there is the Eden Alternative which began some years ago in the hands of Dr Bill Thomas who wanted to address the three “plagues” of long-term care: Loneliness, boredom, and helplessness. He devised a green, child friendly and homelike model of care that is being practiced in several organisations in Australia including DutchCare Ltd and in the Embracia Group (formerly ACSG).
Many countries have local initiatives that push forward into new ways of providing care for our elders. And not all of them are new.
About thirty years ago I travelled to Europe as many young Australians still do. I visited many countries and stayed for four months in Israel where I lived on a kibbutz as a volunteer. It was a memorable experience of community life.
The kibbutz I was sent to was Gvat, and at 1000 members it was a small village. It sat neatly in northern Israel about 30kms from Nazareth on a hot dry plain. Like most kibbutzim it was an agricultural community that began in the years after the Second World War. Some were older dating back to the early years of the 20th century.
Gvat had many older members who had farmed and established the community in struggling times of harsh summers and poor political and economic conditions.
Now however, many of these older members had poor physical health or had just become too frail to work out in the fields everyday. Yet they wanted to be of value and contribute to the wellbeing of the community. That was their ethic and their value as a person was tightly tied up with being productive and useful to the community.
So a solution had to be found.
One of the largest enterprises this modern kibbutz had engaged in was the manufacture of plastic piping for irrigation systems which they sold around the world. A large factory had been built on one of the fields and this had taken over as a major source of income for the kibbutz.
It was suggested that the older people could work here but some were not able to manage the heavy physical work of the factory. So the kibbutz community built a factory for them. They called it Hazrikah.
In this factory the old retired workers came each day to sit at tables and fit together the small pieces of the drippers that were needed for the irrigation systems. They sat for several hours or a whole shift as they could.
Many hours were spent as they worked, talking and discussing politics, the farm, local gossip, the economy and most of all remembering days when they stood in fields and worked the land. And they went home satisfied, contented they were still valuable. They mattered.
These people were still contributing to the wellbeing of their community and had a vital role to play in it. Most of all they were still a part of the life of the community. Their role had changed but their value had not. And this was recognised by the kibbutz.
There is a lesson here. In Australia can look to our older people as vital contributors who we can involve in life-giving projects that have ongoing importance to our community – if we have the imagination to see it.
I would like to see our aged care homes become vital places that house small enterprises that are self-supporting and engaging for the older people who live there.
At the moment we house them in inactivity and so we contribute to their illness and frailty. There is ample evidence of this in the science — use it or lose it. And most of them are losing it. Depression rates for people living in residential care are double those in the community.
What imagination can you bring to your situation? How can your older people get together to build, make, create, put together, sew, paint, cook, etc, etc. How can we structure it so that there is flexibility, productivity, fun and purpose to this activity?
Perhaps you can link in with some local businesses to construct a small enterprise on a commercial basis that benefits the local community and the older people who are aching to still be important enough to be taken seriously.
Is there a retired person with business acumen who can manage this fledgling enterprise with you and get it going? Get your heads together and give the people in your care a chance at a life worth living.
Why do we get anxious? The usual explanation is that it is designed to help use fight or flee from danger or threat. This is true but it also functions to keep our feelings away from our conscious awareness. Take for example when you get angry. You know you are angry but your body reacts with tension in muscles , raised heart rate, chest tightness and dry mouth. This combination is signs of anxiety and not anger. But how can this be even though you know you are feeling angry?
In addition to helping us respond to external threats by activating our sympathetic nervous system releasing adrenaline into our bloodstream, anxiety is triggered when we experience emotions that have become unacceptable to us, effectively becoming an internal threat or danger to our psyche. So our system perceives them as a threat and we react with physical anxiety.
This is a very common problem and often in therapy I find clients will identify the feeling they have as anger or sadness and then go on to describe anxiety in their body.
What can do about this? Firstly we can be clear about what is what. Call it what it really is. Anxiety is anxiety – not feelings of anger or sadness etc..
The effect of living with anxiety being mislabelled as anger and other feelings is that we are deceived by our own psyche into not paying close attention to ourselves. Effectively we ignore ourselves thinking we are being so attentive but in reality we are living with an internal deception.
By being clear about it in our minds we can begin the work of self-awareness, paying attention t ourselves and noticing what is going on inside us. Then we can make decisions about whether this is the way we want to live.
Euphemisms are easy to use and give us a quick way of speaking that saves time, are readily understood, allow us to be funny about serious topics and sometimes protect us from hurtful reality.
The example that has grabbed my attention recently is the euphemisms we use for death. We have many: passed, passed away, passed on, passed over, croaked it, carked it, lost him, shuffled off this mortal coil, fell off the twig, kicked the bucket, pushing up daisies, in a better place, bought it, bought the farm, resting in peace, been taken, checked out, no longer with us, etc..
Each of these terms is designed to avoid have to say “dead”, or “died”. And they allow us to be humorous about it without being irreverent or disrespectful.
They also keep us from the emotional reality of sadness, anger and grief that we feel if we let ourselves feel the reality of the death of someone we have come close to or know, or for whom we have a feeling reaction. The terms above are cover words for death. They cover it up so we don’t have to feel the pain and hurt of losing someone we love in death or being reminded of our own mortality by hearing of the death of another person. The illusion of immortality or amortality perhaps (the ignoring of death) is something we all live with and hold on to. To live with the constant awareness of our own death takes phenomenal courage and concentration which mystics can manage. However, mere mortals like you and me struggle to maintain the awareness that we will die, that we will have a specific death at a specific time and that it will end our lives and the relationships we have with everyone who we value and cherish will be ended. Even if we have belief in a life after death our relationships as we know them will be ended. The faith that there is a life after death allows you to believe that the relationships you have will be ended and re-created or at least changed. It won’t be the same.
Euphemisms about death are sometimes necessary but we need to be able to use the real words at important times so that we can maintain a link to the very real pain of sadness and anger which are the common feeling reactions to the death of someone we love. Sadness is important for us to be able to feel because it tells us that we love, value, cherish people who we have become close to and do not want to lose in our lives. Sadness is also important for its ability to show us how to live then in relation to those we love and value, i.e., so if we feel sad about a friend’s death, maybe we need to visit/contact/call our friends more. Feeling our sadness gives us choices so we can live in integrity with our values.
Anger is important to feel because it tells us we feel threatened and in danger. If we don’t feel these important feelings because we use euphemisms and “protect” ourselves from feelings about death (and probably about many aspects of life) then we can make decisions that are not good for us, we live defensively, avoidant and blocked off from what is real in our lives. We can get so used to this that it seems real instead and so the painful void in us seems like that is all life is really about.
Using euphemisms for death, covers up an important reality of our lives and the lives of those we love, can keep us away from our feelings and so we miss out on recognising how out of sync with our values we have become.
Social life remains a need for everyone who has dementia even until the final palliative moments at end of life. They may have profound impairment but we can stop it becoming profound disability if we stimulate social life with them.
We are social beings. We need and crave contact with others. Our entire make up is geared to interaction. We have language to express our inner experience to others. We crave to be understood by another who recognises us. We know this by paying attention to the relief that floods us when someone really understands us, gets us.
Social life is talking, holding, touching, listening, looking at each other, stroking, kissing, massaging, turning your head to look. All these small actions are what we might call micro-behaviours and if we pay attention to them in the person in our care we can see the small indicators of a desire to make social contact, to connect, bond with us.
The person with dementia lying in a chair without verbal language, unable to walk, toilet themselves, dress themselves, or eat independently, may crave social connection just as much as you and I do. Let’s look for the small micro-signs that tell us they are wanting to be connected.
Perhaps they are unable to show us even small signs. However, when you make the contact watch for their response. This response can be a micro smile, eye-contact, head-turn, flinch or flicker of movement. This is social response to our approach and contact. Engage and sustain your contact and you will notice small signs of change, lower stress, less agitated movement, less calling out, less moaning and groaning. Perhaps you may even notice signs of engagement now, sustained looking where there were closed eyes.
We can meet and engage successfully with the person with such profound impairment. We can stop it becoming profound disability if we make the connection with them and stimulate social life with them.
In Australia next week is Dementia Awareness Week and around the world on 21st September its World Alzheimer’s Day.
Raising awareness of the disease and the life people lead with the condition will be important in helping our neighbourhoods to become more dementia friendly.
One of the major reasons people are having to go into residential care is that they can no longer live safely at home and the reason for this in many cases is that there is no-one to check on them, look in or have friendly word each day or even notice that they have not collected the post from the mailbox today.
How many neighbours do you know and could you rely on your neighbours if you had dementia and wanted to stay in your own home?
This week is a chance to make our towns and neighbourhoods more dementia friendly. No more fear of Alzheimer’s. Lets create understanding and a compassionate will to act.
Caregiving in dementia can be conceived as being a secure base or safe haven for the person with dementia.
This requires an atunement of the caregiver with the needs and wants of the person with dementia much the same way a mother is attuned to the cues for food, comfort and safety that an infant gives to the mother.
Separations and reunions are the moments when this need for a safe haven becomes most keenly felt. When a caregiver leaves or walks back into the room the person with dementia is most likely to feel the sense of anxiety or relief/anger that can be evident with infants in Ainsworth’s Strange Situation.
What does it require of you to be a secure base for the people you care for? What can you do to be more a source of security and safety for the people you care for?
What do you do currently that causes people to feel safe and secure in themselves, not just physically but emotionally?