Reminiscence in Alzheimer’s and other kinds of dementia

reminiscence in dementia or Alzheimers

In Moving Your Soul we have started a podcast in Spanish, and our third episode is an interview about Reminiscence in dementia. Our special guest is Raül Vilar. Here you can find some links to know more about it:

European Reminiscence Network: http://www.europeanreminiscencenetwork.org/

Pam Schweitzer: http://www.pamschweitzer.com/international.html

Communicating from what remains

These days we are most specially thinking about our dear friend Bego, one of the souls who gave shape to Moving Your Soul – Another way of living with Alzheimer’s. We want to dedicate a special memory to her, as it is a year ago now that she left us. We herewith copy a text that she published in the blog she wrote for the Economist, in a post that specifically spoke about Moving Your Soul and in which she explained a very endearing anecdote. She left us, but she also continues to speak to us from what remains, from what she left behind… and we will be forever grateful…

“These weeks of absence from writing my blog, have been dedicated to ‘Moving Your Soul. Another way of living with Alzheimer’s', a web project, www.movingyoursoul.com, we have just launched between four female coaches committed to making the world a little bit more of a comfortable place to inhabit. On this website, a lot of testimonials share their experiences of communicating with their family members who are affected by Alzheimer’s or other dementias. What is innovative is that this website emphasizes maintaining communication and a relationship with what remains, not what has been lost through dementia.

I have thought so much about this proposition and, as I need to experience in order to gain insight, I headed to various care homes and centres to find out about the reality of Alzheimer’s and how some people manage to overcome the barrier of what is so terrible and embark on a relationshop with their family member. Some days I would return home happy with the progress of my own research, and others I would return broken by having witnessed scenes of such pain. And one day I met a man, Antonio S. who every afternoon went to visit a woman. They used to be lovers when they were young. Then, he emigrated to South America and continued his life, until he retired, childless, unmarried, and decided to return to Spain.

How thoughtful you are. Both times I have seen you, you have brought flowers!, I said to him one of the days we shared the lift. Are you visiting your wife?

No, and I’m not visiting, he replied serenely and with a very clear gaze. I come to be.

For an instant I thought of the film ‘Son of the Bride’ and felt a tear brimming, and I suddenly asked him “What do you mean by that?”

It’s the difference between coming to see her or to be with her, in the place where she is now, he replied simply.

Please forgive me, but I feel there are contradictions on this point because I don’t know if the woman even knows where she is, I openly declared my doubts.

I have nothing to forgive you, - he said expansively - Only if you listen, touch, feel, be, can you communicate with people who suffer from this illness. They haven’t gone, nor do they wander around like penitent souls in Limbo. They are still here or do you think they are invisible, he raised his voice in protest and waved his hand. It’s like a painting, sometimes the painter doesn’t need to fill in all the outlines to paint a portrait. And yet, the spectator never feels that any lines are missing to complete the work.

I felt a little breathless for a few minutes as I listened to this man of scant height yet immense wisdom and then with a small voice, I said: Is that how you see your loved one?

Yes, it is. The flowers make her enter into the beautiful love story we experienced together and which we have somehow resumed. For me, she is still the brunette who used to sing from the window of her house, back there in Lavapiés. And I don’t need any more lines to know that the beautiful women I once had to leave, is still here.

There are few romantics like you left. Please allow me to call you Antonio, I said.

I only expose it, everyone else silences it because it’s frightening to experience reality as it is. Crude, tough, tremendous, but also very powerful, very beautiful. You have to want to see it. This is what the geniuses do. Transcending moving from where they are, like Picasso. Excuse my simile, but this is my passion, my profession. I was an art history teacher for 20 years.

Do you think we could all experience what you speak of?, I remained curious and hooked on his wisdom.

Yes, I am sure of it. Of course, it requires honesty with oneself and parking our ego. The one that is full of masks and stereotypes. But look, we will all be old one day, decrepit, ugly, wrinkled, forgetful, sick and we will still continue being people. Although in order to remain so we need to be seen, listened to, dignified.

María is the luckiest woman in the world, having a friend who actually sees her, the way you see her.

My regret is not having taken her away from her parents home and taken her with me to Venezuela. So my advice is to always enjoy what remains and what is there right now, as it will always be much more than what has gone. He left the lift and headed for the lounge, where the people with Alzheimer’s were.

Standing in front of Maria, dressed in blue and sat on a chair with her head to one side, he gave her a white lily and said to her:

You are the love of my life, brunette..

Referencia: http://www.eleconomista.es/blogs/coaching-todos/?p=722

Nonverbal Communication and Coaching in dementia

In Moving Your Soul we have started a podcast in Spanish, and our second episode is an interview about Nonverbal communication and coaching in dementia. Our special guest is Susana Garcia Pinto, professional coach and trainer, and a member of Moving Your Soul.

“From my experience as a daughter in the intense journey of Alzheimer’s, and as a passionate professional in the fields of human relationships and communication , being part of Moving your Soul makes possible each day the realization of a dream: to be able to show the world that IT IS POSSIBLE, that there is room for plenty of light in the a priori dark path of dementia.”

Susana Garcia Pinto

Video with the Learnings from Alzheimer’s

At Moving Your Soul we have been collecting for years stories from great people who have discovered how to find in Alzheimer’s, beyond the pain and sadness, a reason for joy, growth and learning in their own lives. A few weeks ago we decided to ask a new question through the social media:

What have you learnt from Alzheimer’s?

In this video you can see the inspiring responses we have received, selected and translated with all our best intention and gratitude. Lots of people from different parts of the world have shared in few words a hopeful message from dementia/Alzheimer’s. Thank you everyone for participating!

Enjoy the video and if you know someone who can appreciate it, please share!!

The Role of Status in Alzheimer’s disease Interactions

As we love this article posted by Evan Bass on his blog, we have asked him permission to share it. And we love it because it talks about something very common in the relationship between family members or caregivers and people with Alzheimer’s: the difficult balance between taking a responsible role to someone who loses her capacities, and giving her all the respect that she deserves.

The Role of Status (Relative Social Position) in Alzheimer’s disease Interactions. Posted by Evan Bass

When approaching relationships in the context of improv theatre, it is essential to keep in mind how your status relates to the other person’s. Is the character you are playing higher, lower, or of equal status in relationship to the other? A butler is lower status to the person he or she is serving. Two butlers are essentially equal status—unless one is the butler in charge and the other is his subordinate. There is definitely a higher and lower status in the roles of a father with his young child. Each interaction we have with others reflects a specific status relationship.

Status is not a passive condition; it affects how we talk to and act with someone else. In general, a person of higher status may “talk down” to someone of lower status, and may not necessarily feel he or she needs to listen well to the other. Someone of lower status almost always listens well to the person with higher status, often attempting to placate him or her. Two people of equal status generally demonstrate mutual respect for each other.

We rarely think about this concept day-to-day, it is almost intuitive, but it is always present. When performing improv in front of an audience, improvisers who want to create believable relationships and situations need to actively think about status in every interaction. So how does this transfer to Alzheimer’s and why is it important? How you relate to someone living with Alzheimer’s—how you enact your status relationship—significantly changes how your interaction plays out.

Try to recall how you felt in an interaction where you assumed you were equal in status with someone, only to find that person “talking down” to you. It immediately makes you feel like you have lost control and, by the end of the interaction, you feel less important. It is natural for a caregiver of someone with Alzheimer’s to feel the need to “take care of” and “protect” the person in times of confusion. When this “protector” takes charge and starts making all the decisions, it results in that person in charge adopting the “higher status” role in the situation and naturally “talking down” to the person being cared for.

While every care partner takes special consideration to avoid treating the person with Alzheimer’s like a child—infantilizing him or her—we inadvertently assume the higher decision-maker status and infantilize without meaning to. An individual who once had control over his life can be lead to feel inferior if that control is completely taken away from him or her. 

Parents of very young children usually dress them, feed them, and make decisions for them while rarely asking the child’s permission for all of the decisions made on his or her behalf. Those with Alzheimer’s are often treated this way as well—having others make most decisions for them. Being grown persons, they not only lose much of the control they once had but also acutely feel that loss.

Returning to the question of relative status and its effect on the person with Alzheimer’s, clearly making decisions for those with Alzheimer’s without asking permission and without getting consent, exerts status dominance over the person. Not surprisingly, then, individuals with Alzheimer’s withdraw from such interactions and communication.

An amazingly simple way to counteract unintended infantilization is to approach every interaction with the idea of “status” in mind. Always treat an individual living with Alzheimer’s as EQUAL to or HIGHER status than you. This means always asking permission before acting on their behalf and never making decisions for them without asking for their consent. This includes, of course, never treating them in a way that would ever be construed as disrespectful (i.e. doing something to that person like dressing them, feeding them, or putting them to bed without their permission). A person can still respectfully help someone in daily tasks, even going to the toilet, by asking permission and allowing the other to do as much as she can herself—giving control back to her (or him).

To ask permission means asking a question, and questions can be overwhelming and cause confusion in those with Alzheimer’s. However it is not questions themselves that are confusing, but rather how the questions are presented that cause the problem. While complex sentences and open-ended questions can cause confusion, avoiding questions altogether leads to removing all control from an individual with Alzheimer’s.

In the Scripted-IMPROV study and the “I’m Still Here” approach, we generally find that asking simple, often binary questions —that is, questions in which two possible answers are provided (e.g., “Do you want to wear your red shirt or your blue shirt?”) – creates a sense of control for the individual with Alzheimer’s. By making the request simple enough for the individual with Alzheimer’s to fully understand and respond, the individual maintains control. You offer the options. They make the choice.

The other type of question that enables the person responding to maintain control is one that allows them to answer with a simple yes or no response. “Let’s eat some breakfast. Would you like that?” is such a question. You first set up the goal in a very simple way, but instead of telling an adult what they have to do, you lead them into it and ask their permission so they can give a simple, “Yes” or “No”, either answer actually controlling the outcome.

When you consider anyone at all at a higher status than yourself, including a person with Alzheimer’s, you naturally do the respectful thing. Even when treating someone as equal in status, you would never talk down or do something without their permission. As we try to “help” others, we unconsciously take on the role of the person who can help, and thus place those being helped in a lower helpless status to ourselves. It is unconscious, and we never mean anything negative by it, but it greatly affects how someone with Alzheimer’s feels around you.

People living with Alzheimer’s already question how much control they have in their lives. Their failing memory can make them even more self-conscious and worried about the control they have over their lives. When we respect a person with dementia by speaking to him or her in a way that makes him/her realize that he/she is of equal or higher status, it goes a very long way. Instead of hurting their self-esteem, we boost their self-confidence. This allows us to forge a meaningful relationship in which they are given the respect that they deserve.

Evan Bass

Image: Liz West

Alzheimer’s Learnings

At Moving Your Soul we have been collecting testimonials for years from great people who have known how to find in Alzheimer’s, beyond the pain and sadness, a reason for joy, growth and learning in their own lives.

Some weeks ago, we started a project, called #fromAlzheimersIhaveLearnt, and for the moment we have received the comments below. We encourage you to participate, in case you haven’t yet.

What have you learnt from Alzheimer’s?

Click here to participate: Learning From Alzheimer’s

What have you learnt from Alzheimer’s?

Click here to participate: Learning From Alzheimer’s

What have you learnt from Alzheimer’s?

At Moving Your Soul we have been collecting testimonials for years from great people who have known how to find in Alzheimer’s, beyond the pain and sadness, a reason for joy, growth and learning in their own lives. We now want to invite you all to leave, in just a few words, what you have learnt from Alzheimer’s.

Share what you have learnt so that between us all we can amount to so much more.

What have you learnt from Alzheimer’s? In your personal experience with the disease, or as family member or carer. Leave your message!

Within the next few weeks we will be creating a video with the most inspiring comments.

If you would like to receive the Video by electronic mail, leave us your e-mail address and we will send it to you.

How to participate? There are two ways:

- Leave a comment below
- Tweet your comment with this hashtag: ‪#‎fromAlzheimersIhavelearnt‬

Thank you for participating!

Moving Your Soul’s Team

Things are not what they seem

I have had the pleasure to work with people with Alzheimer’s. During that time I realized that every person is unique, and that there is always something to learn from every one of him or her. As I learnt from Maria with this anecdote I want to share with you:

One morning I entered Maria’s room, she had a gossip magazine on her bedside table. On the cover page was Mr. X (a famous politician). As every day, I asked her how she was feeling, how she had spent the night and how the previous evening had been. She told me her daughter had brought this magazine for her. She also told me that Mr. X had been her university classmate as well as her suitor.

I doubted weather the story was real or just the fruit of her imagination, nonetheless I have always understood that the relationship with the caregiver, me, can never be one of incredulity; there is no point in telling her that her story is a nonsense, no matter how absurd you may find it is. Who are we to break the happy feeling of telling that story on and on!

A few days later, Mr. X appeared on the news again, because he had, unfortunately, passed away.

That morning, as I was assisting María just like every morning, she spoke to me about him again and told me how sad she was for his fatal ending. It was she who took some of the heat out of the issue saying: “poor him, he was very old and he was very sick”. I changed topics.

During a staff meeting after a few days, I learnt that Maria had been a classmate of Mr X. Since that day, I am well aware that the stories told by people with or without Dementia can or cannot be real, but they are true for them and that is what matters. We have to respect that.

PS. The name “Maria” is invented but the story is real. And this is a gift that we, caregivers, receive from Dementia patients. We give them love and affection without their being part of our lives, and they finally become a part of it, in a way.

Maria: wherever you are, receive this big hug from Juan, as she used to call me. I will never forget you. Thank you for helping me improve as a caregiver and as a Person.

Joan Chias

@jfchias

Something has changed

change alzheimers

Something has changed. She chews the food I have just given her once or twice and then stops. To my surprise and desperation, she has stopped chewing and, with an inquisitive gaze, looks to one side and another, while the food remains immobile in her mouth. It is as if she has lost the automatic reflex to chew and swallow. I have to give her a little fluid so that this first impulse, which still remains, reactivates and finally my mother swallows everything in her mouth.

And all of a sudden fear, that old familiar feeling, rears its ugly head again. The fear of once again facing another backwards step on the descending stairway that Alzheimer’s represents in a person’s life. My mother, who I now feed as she used to feed me so many years ago, who watched me grow as I now watch her fade away. And I often get so frustrated in my determination to ensure she retains the faculties she has left. She, unaware of my fears and frustrations (or maybe not…) looks at me, smiles, then looks away, frowns, flitting in and out of her world and all of a sudden, within a fraction of a second, our eyes meet and we enjoy an instant of true connection.

She knows nothing of my fears, which change as the months and years go by. Looking back, I see I went through the fear of her no longer being an independent woman, the fear that she would stop walking, the fear that she would no longer recognise my brother or me, the fear that she would stop talking… All that has already happened and I now face new fears, the fear that she has forgotten how to eat.

At the care home my mother has lived in for the past five years, I witness this next phase that is now looming. Other residents who have already slipped down this step: choke when they eat, the food enters their airways and causes them anxious moments of suffocation. Others have a catheter inserted into an opening in their abdomen, which takes the food directly in their stomach.

I recently discovered that my brother and I can decide, when the times comes, about whether to feed my mother through a catheter or not. My first reaction was once again surprise and fear: will I soon have to make a decision that means life or death for my mother, perhaps within a few months? How am I going to decide one way or another? If we opt to refuse the catheter we will watch her die, by suffocation or starvation. If they insert the catheter, we will be prolonging a life with even less quality that she has had until now, as well as subjecting her to a surgical intervention and a very tough adaptation period.

This is one of the many painful and decisive moments in the life of someone with a family member suffering from Alzheimer’s or similar dementia. One of those moments in which we most acutely feel the loneliness and despair of accompanying and caring for someone we love so much. And it is one of those moments in which we need not only medical information to provide us with clarity on the progress of the disease and its consequences, but also the support of someone who can help us take these decisions in accordance with our values. Because no-one is going to tell us what is best for our loved one. What is best for my mother? I want to avoid her suffering, of course, but what is the best way to do that?

Many people will advise us, with the best of intentions. But at that time, us family members, the ones who must make these decisions, need to listen to our own voice and trust our own wisdom, the wisdom that is born from the lives we have lived and the deep love we feel for our loved one… and for ourselves. That is why, more than advice, we need someone who is able to listen to that wise voice that lives inside us and which sometimes gets drowned out amongst the fear, guilt or, simply, the sadness and pain.

I lift the spoon again, ¨come on mum, it’s really delicious¨. My mother looks at me and smiles, and opens her mouth, and then swallows… and I, with something as simple as this, am simply happy.

Olga Romanillos