I recently spent a couple of weeks in a nursing home. At age 60, I was by far the youngest person there. I had an injury to my foot that made it difficult or impossible for me to tend to some daily tasks of living, like taking a shower or standing up to shave and brush my teeth, and my doctors thought it would be a good idea to get help for a while. I was by far the youngest person in the home. There was a 78-year-old woman there who thought I was young and handsome. I enjoyed that.
Many of the people in the home suffered age-related cognitive decline. Some just had mild memory loss. They needed a little longer to get certain words out. Others had Parkinsonian dementia. They were mostly "with it," but they harbored a few delusions about the world. Still others had full-blown dementia, either frontotemporal dementia or Alzheimer's. Everyone in the ward, however, enjoyed human interaction. If you happened to be a vibrant, young, 60-year-old, you might find yourself getting invited to every social activity in the ward.
- If the elderly person had a career, ask them about it. I had lunch every day with a retired three-star general, and I had dinner every day with a retired brain scientist. I addressed the retired general as "General." I addressed the retired brain researcher as "Doctor." I let them tell me, even if the words came slowly, what they thought about military and medical topics of the day.
- Be ready for excursions from good manners — on their part, not yours. A surprising number of people who have Alzheimer's and Lewy body dementia will pinch people to get their attention. These pinches can hurt. If you see a "claw" coming your way, move your arm or face so you don't get hurt (and they don't get embarrassed should they have a moment of clarity later). Speak to them calmly and kindly. Show your attention.
- Avoid witticisms, quips, and jokes. Some of the elderly simply won't understand them. The Jewish brain scientist and I were having a meal together a few days before Rosh Hashanah, the Jewish New Year. I made an observation that my mother had once, in the Great Depression, visited her Orthodox neighbors as they were preparing a ham to break the fast on Yom Kippur. "We're all in favor of the ecumenical movement," the neighbor said. My table companion was simply shocked. He couldn't come up with a response, and he left the table. I shouldn't have made the comment.
- Play music, preferably music that was popular "back when." Music can bring back happy feelings. Even if the listeners can no longer articulate what they were doing when they heard a song for the first time, they might remember it. My older neighbors in the rest home loved big band music of the 1940's. The activities director offered to play Alvin and the Chipmunks for me, that being the only music of the 1960's she could find, but I told her that wasn't necessary.
- Involve the elder in decisions whenever possible. Just be sure that the options you offer are all safe. "Would you like vanilla or chocolate?" is a safe question. "Would you like to cash your T-bills or sell your IBM stock?" usualy is not.
- Give elders time to get the words out. Don't be so eager to speak that they don't get to say the things they are struggling to say. In my conversations with the general, I quickly learned he was a fascinating man, who simply needed about 30 seconds to get his stories started.
People who have dementia may still enjoy their favorite foods. Make those available whenever you can. People who have dementia often still like to hear about the news. Don't force it on them, but make it available.
A memory box is a great idea. (I wish I had though of it first). So are having lots of photographs on the walls. It can be very pleasant to have time with pets, even if they aren't the elderly person's pets.The most important thing you can do for an elderly person in cognitive decline, however, is to give the gift of your presence. You can make an elderly person's day.
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