The Spectrum of Behaviors and Emotions
Day by day we see residents that exhibit a complete spectrum of behaviors and/or emotions. Situations that arise in the early morning, will certainly give way for something new by the afternoon. This goes hand in hand with delivering quality dementia and Alzheimer’s care. Providing an environment that allows for these rapid, daily changes is a challenging and daunting task. As well as, learning how to provide “happiness” and “comfort” to a person with a declining mental state.
Happiness can be defined as simply as this, “the satisfaction of needs.” The needs, however, can change from age to age, year to year and goal to goal. In dementia care, finding the need that triggers “comfort” can make the difference in dealing with a difficult behavior and a “happy” resident. Pinpointing what a person requires to be happy and comforted is a talent that caregivers can learn through observation and application. “Comfort” can be explained best by saying, “to lighten the burden.” That may leave a lot to the imagination, but can be interpreted as easily as saying, “to make feel better.”
Each Resident – A Unique Individual
When introducing different therapies to residents, it will always enhance your skill set to learn as much about the resident as possible. Learning what they were like before the Dementia or Alzheimer’s, and since the onset, can prove successful when trying to implement a plan that provides comfort and happiness. Not every concept will work for every resident. Remember that each person, prior to diagnosis, was a unique individual with likes and dislikes, talents and skills. This has not changed. Each resident is still a unique individual. Some things do not differ from their essential personality. It will be your job to learn and determine what will compliment their current needs.
Innate Capacity for Love and Nurturing
The ability to love and the desire to be a needed and useful, contributing member of any society is part of our basic nature. Our capacity for love and nurturing is, by far, the strongest, innate basic need we have. This “need” can be utilized to provide comfort and happiness for the dementia/Alzheimer resident. Even when the proficiency of speech and the dexterity of movement have left, love and nurturing can still be a deep desire that needs to be fulfilled. That fulfillment can provide brief, or not so brief, moments that are needed for a resident’s mental success. Brief moments that they may not remember, but moments that gave them comfort and happiness. This is why I utilize “Baby Doll Therapy.”
Everyone Loves Babies
On any given day, it becomes apparent that someone is overly agitated, someone is aggressive, someone is non-verbally acting out, someone is reluctant to accept care, someone appears depressed, someone is more confused than usual or someone just needs to be busy with something. Everyone loves babies. Male and female residents both benefit from seeing a baby or a child. When families bring their children or grandchildren or even great grandchildren, the residents will come alive with smiles. Even when they can’t remember who their visitors are, they remember youth.
Universal Emotional Needs
Introducing baby dolls can provide moments when the resident can love and nurture another human being. The doll has a symbolic meaning and provides purpose and healing for people with dementia. Residents will often provide immediate feedback regarding what you do or say. Or, what they do or see. A baby doll can satisfy a universal emotional need that isn’t often fulfilled. Studies show that there are 5 significant emotional needs:
- 1) To feel needed and useful
- 2) To have the opportunity to care
- 3) To have self-esteem boosted
- 4) To love and be loved
- 5) To express emotions freely
Baby doll therapy can easily accomplish the satisfaction of these needs. Never does a person feel more accomplished than when caring for someone/something else. For a lot of my residents, it’s baby dolls. For others, it’s a stuffed animal that may remind them of a favorite pet. Both offer a comforting measure and happiness that allows the resident, even in a demented state, to feel as if they are providing and fulfilling a need for someone else. This is enormous in magnitude when you consider that these residents are completely dependent on others for their own care. Baby dolls, stuffed animals and the like, let them feel needed instead of always being “in need.”
Case Study – Nadine
Let’s take a look at Nadine. Nadine came to us after having lived in her own home for 60 years. Her husband had died several years before. Family had decided that “mom” wasn’t able to live on her own any longer. Her dementia had progressed to a point that she was unsafe to be living without supervision. It was a tough decision for the family. Guilt and worry clouded their minds and they obsessed over leaving their mother in this new unfamiliar place. Nadine, however, reacted like most new residents entering a memory care community, with retaliation!
Nadine had been a school teacher for many years. She had raised her children, tended to the needs of her husband and when he had passed away, she ran her house. She swam and walked daily. She cooked her own food, cleaned her house and minded her financial interests. This is clearly a woman that had been in control for many years. She began to try and run “our house,” so to speak. She, still being able to communicate fairly well, was telling other residents where to go and what to do. She found a dry erase marker (bright red) and began writing her “lessons” on the walls of the community. She prattled on endlessly about how we were all bad children, residents and staff included, because we didn’t listen to her teachings. She would write us notes of how to improve our business. Although the notes were mostly nonsense, to Nadine they showed structure and organization.
Hoping to find just the right balance, her medications were adjusted and readjusted by her physician. Some changes proved successful, others not so much. In dementia care, we realize that medications cannot fix everything. We still train to be knowledgeable in the things that medications cannot help with. We provide interventions that are resident specific, things that they can relate to from their own personal history.
Well after all the pharmacology and the personal attention, we offered Nadine a baby doll that had been donated. At first, she thought the baby was mine, as I had asked her to baby-sit for me. She held the “baby” carefully and was bright as the afternoon sunshine when she stared at the baby’s face. She spoke to the doll and coddled it like a new mother. Pretty soon, the baby was hers. She would find small articles of her own clothing to swaddle around the baby. She would share her food with the baby. That is somewhat messy but messes can be cleaned. She would discuss mothering techniques with other residents and proudly announce that this was her son, even when “he” was dressed all in pink. To Nadine, this was an area in her life that she had control over.
As time went by, Nadine’s unusual behaviors subsided. Her attentions were focused on taking care of the baby and not lecturing all of the other residents on how to be good students. Her demeanor became gentle and she would exchange pleasantries with staff. Her conversational skills were a bit of “word salad” but pleasant none the less. Staff began to provide necessities for her and the baby. A new t-shirt, tiny little diapers, a bottle, a diaper bag and even a stroller. This was an experiment that proved beneficial for both the staff and the resident. Everyone was involved in helping Nadine tend to this little baby.
After generating successful results, we began trying this with other residents. Although this does not work for every resident, it has proved to be a positive experience for most of them. We included male residents in this assay. We found that while the males do not necessarily “dote” over the babies like the females, they do find comfort in feeling the infant effigy lying in their arms. One gentleman will hold the doll during meal times. We find that if he is holding the baby, he eats more. This is a man who has had weight loss and is on hospice. Getting him to eat better has increased his strength.
Results – Pleasing and Surprising
In the beginning we were concerned over what family members might think, after all we don’t want to diminish the dignity of a grown adult. We found that most families were pleased and surprised at their loved one’s attachment to a doll or stuffed animal. Most wished they had thought of it themselves. Now, we are finding that families are bringing in dolls and animals for their mom, dad, grandma, grandpa, etc. What started off as an attempt to redirect difficult behaviors has turned into a constructive use of creative therapy.
Living In The Moment
Alzheimer ’s disease and Dementia is a grueling end to what should have been a perfect life. The seconds of clarity, the moments of reminiscing, the security of knowledge will all become parts of the past, which, too, will be forgotten. In a memory care community, you should be living in the exact moment that you are in. Offer that moment to your residents and make it special. It may be forgotten all too quickly, but for an instant, you provided something that made a personal connection. How priceless the moment is!