Recently a very astute care manager, Elaine, mentioned to me the real concerns she had about the trend in dementia care which advocates reminiscence therapy. Reminiscence broadly involves the deliberate focus on a particular time, often when the person with dementia was much younger by invoking memories thorough music, questions and objects representative of the period. Caring for individuals who were reaching the more advanced stages of the condition, Elaine told me how she had changed her approach to dementia care. As an experienced professional she told me how, over time, she had decided to change her practices. In short she has shifted from prescriptive reminiscence sessions to focusing on making new opportunities which foster a sense of contentment and enjoyment. Notably this helped her dedicated care staff, family members and most importantly the person with dementia to connect with each other. In the here and now moments of the everyday.
Exploring this comment, Elaine suggested that most of her staff were young and as such did not have first hand experience of the 1980’s let alone the swinging 60’s or the war years. Expressing her opinion that care staff are generally not modern historians, she considered the practice of trawling through these periods as potentially frustrating for staff and the person with dementia. Indeed reminiscence can provoke stark feelings of loss, fear and confusion. Staff can understandably regret words and actions which can prompt such negative feelings. Care which focuses on the building of positive connections helps to foster a sense of meaningful connections among staff who are engaged in highly emotional and physical work. Feeling valued and useful is important to help staff remain motivated in their work.
Elaine trains her staff to focus on building positive shared moments between her residents and staff. Regardless of the ability to recall these moments is not a requirement as Elaine considers that the sense of well being remains beyond the moment. This means that a day out to the seaside may have dissipated rapidly within hours of the visit but the sense of enjoyment whilst eating ice cream by the sea will remain. Memories of times gone by are respected but new experiences are nurtured. Contemporaneous photos abound so that the residents, visitors and staff can share recent experiences with each other. This in turn prompts conversations about future plans for things to do.
So what are the benefits of this approach? Firstly it fosters choice and opportunities: the remit is not to reconfigure past activities or experiences but to enable new possibilities. An accomplished painter may no longer wish to engage in painting in later life but would enjoy sitting quietly among lavender in the sensory garden. Likewise a person previously teetotal would enjoy a wee dram in the company of a friend. Music by the band Cold play is enjoyed by a carer and resident during bathing, previously a stressful event. Yes the memories of this might not adhere but the sense of contentment and being in the moment can bring beneficial connections with others.
Dementia care is about acknowledging that cognitive changes are present and ever changing but the dementia itself can be pushed aside during moments of connections in the everyday. These moments matter. They bring hope and contentment.