Teachable Moments: The Plus Side of Dementia

L.T.Force, Ph.D.

Gerontologist

When we hear the words “dementia” or “Alzheimer’s Disease” they resonate with a theme of negativity….and more. It truly is a diagnosis that has powerful and impactful connotations for the individual and the entire family system.

When I entered the field of Alzheimer’s disease in 1979 - the trajectory of the disease was a shift and quick decline. Today, that has changed. Years ago, when a diagnosis of Alzheimer’s disease was arrived at the lifespan was shortened dramatically. In the year 2023, we now have the ability to increase lifespan after diagnosis. Today, we are also cognizant that there exists over 144 different forms of dementia….Alzheimer’s disease….aka Senile Dementia Alzheimer’s Type (SDAT) is only one form of a multitude of dementia's. The take away? Alzheimer’s disease as a diagnosis….should not be the 1st diagnosis you assume - when memory loss and confusion are present in older adults. In fact, Alzheimer’s disease as a diagnosis should be the last diagnosis arrived at….after you have ruled out every other thing (including the impact of poly-pharmacy, head injury, Traumatic Brain Injury (TBI) and long-term effects of Lyme Disease). The other thing to keep in mind is: “if you have seen one person with Alzheimer’s disease or dementia…. You have seen one person. The disorder impacts everyone individually - and the resulting behavioral or thought manifestations are unique and specific to each individual.” The question, are there positive lessons to learn from the actions, behaviors and thoughts exhibited by persons with dementia - where memory loss is present? My answer, based on observation and “lived -experience”is a resounding Yes! From a personal account, I have arrived at this perspective. (Although, I have heard and witnessed similar accounts both personally and professionally).

My Mother, Margaret Louise Dougherty Force died at the age of 97. Around the age of 91, it was becoming noticeable that: “Something is not right with Mom”. As a family, we started to notice gaps in her judgement and memory capacity. After working with her primary doctor we accessed a local memory Clinic - for a thorough and comprehensive diagnosis. Yes, after a complete battery of assessments: vascular dementia and Alzheimer’s disease (Mixed Dementia) was the diagnosis. Beyond the diagnosis….there is life. Our Mother lived independently and we accessed services to support her intentions. However, at the age of 92 she fell into the shower - and fractured her neck. The debate is: “do you treat this injury with drugs to relieve pain in combination with neck stabilization or do you operate on a 92 year old female?” At the onset, in concert with her physicians, we attempted the first protocol (medications and stabilization). Within 10 days we knew this was not working….we opted for surgery. After surgery there was a long rehabilitation. We also knew her interests in living independently were no longer feasible. We explored a variety of options - even expressing our interest that she live with my brother’s family or my own. My Mother, didn’t want to do that - she was proud and independent woman. Nursing Home care was accessed. At the beginning, adjustment was required. It took her about 6-weeks to have that “rebound effect” that is mentioned in the literature, i.e. the time it takes a person to adjust to a change in a residential setting. At the beginning it wasn’t easy - but she adjusted - and in fact, “she became a rock-star at the Nursing Home" . She loved the staff and they loved her! She lived in the Nursing Home setting for four years and then experienced what she would have called a: “Good Death”, i.e., a death without pain, surrounded by her family, her friends and the powerful presence of the rituals, practices and symbols of her religious belief (Jesus Christ and the Virgin Mary were her friends and steadfast companions across her life….and were present at her death).

But what are the: “Teachable Moments” I referenced in the Blog title? For me the biggest: “Teachable Moments and Plus Side of Dementia” was….”with exhibiting memory loss - you have a tendency to forget not only some of the good things in life, but as well, you forget the bad things”. Case in point, we would receive notification from the Nursing Home Staff that our Mother had fallen in the bathroom. They would say: “We want you to know - everything is Ok - but we found that your Mother had fallen in the bathroom this morning. Please know she is OK - but our staffing regulations require that we notify the family”. We would thank them profusely, for the call and alerting us about the falling incident. We would immediately drive to the Nursing Home: "to confirm with our own eyes and heart that all was well". There we would find our Mother sitting at the lunch table with her friends and would ask her privately: “Are you OK? Yes, she would say. Why are you asking that? Well we received a phone call from the Nursing Staff that you fell this morning. Her response was that wasn’t me. But Mom, they found you on the bathroom floor this morning! Her response would be: Sorry, that wasn’t me. How about joining us for lunch?".

The beauty of her cognitive limitations - was that she immediately forgot the negative things in her life and moved on. What a gift! Wouldn't it be great if we all had that gift? This is one of many incidents where she demonstrated the value in forgetting. And, in addition, I have heard a multitude of caregivers - both professionally and personally - give similar accounts of scenarios where negative episodes or actions were forgotten by the person who they were present and caring for.

Yes, there are “Teachable Moments and you can find the Plus Side of Dementia” that can be found....if you look for them. And yes, “It is a Gift!”