Some innovative ideas about Dementia

No, nothing about a miracle cure, just some good ideas about how we may be able to cope with the growing challenge of dementia (until a cure emerges). The majority of recommended interventions for people with dementia are certainly pharmacological, but, increasingly, treatment guidelines recognise the need for psycho-social interventions and acknowledge the importance of relationships and interactions between the person with dementia and others.

Men’s Sheds

The first positive thing I heard about dementia was from a lecture given by Hal Kendig, on the (then) new initiative of Men’s Sheds in Australia. At that time, group meetings were held in actual sheds, moving around the garden sheds on each members’ property. One of the members of this particular group was a man– call him Bob – who had dementia and who had not spoken for many months. The meeting convened in a shed which had photos of sports teams on the walls. Bob went up to one photo and began naming the team members. It had awoken a part of his memory which was previously sealed.

Dementia-friendly cities and communities

Much later, when I was writing about the Age Friendly movement for the Office for Seniors, I found that dementia-friendly cities and communities (DFCC) is a part of this.

The Alzheimer’s Society defines a DFC as “a city, town or village where people with dementia are understood, respected and supported, and confident they can contribute to community life. “

I was especially impressed by the concept of “legibility”; which includes the importance of the outside environment, the character of street networks and the presence of landmarks. People with dementia prefer short, narrow and gently winding streets rather than long, wide or straight streets. The latter have the potential to cause a loss of concentration leading to disorientation.

Different shapes, features and colours and a variety of doors, windows and gardens are useful tools for successful navigation. Practical and decorative items, such as public seating and bus shelters, trees or planters all act as landmarks to help people with dementia to clarify their location and to determine which route they need to take.

Group Singing

Dementia and caring responsibilities can affect spousal relationships, leading to  loss of emotional intimacy, reduced relationship quality and loss of communication. An important aspect in preserving the couple relationship is the idea of doing things together, especially in a social context. A recent study examined how group singing benefits people with dementia and their partners[1]. Some research has suggested that musical memory is preserved above other types of memory. And several studies have reported positive feelings of achievement, belonging, and decreased social isolation through group singing. Singing is frequently perceived to be an activity that most people have had experience of. And singing is an accessible activity regardless of ability level or singing history.

The study noted that, while singing, differences between the people with dementia, facilitators, and caregivers become less important. Participation in group singing brings beneficial sense of belonging to a social group and sharing an experience. A number of those with dementia described increased confidence, for themselves and other members of the group. On their part, caregivers experienced a “release” from caring responsibilities. One caregiver described how “it was something we could do together, where I wasn’t responsible…”  Caregivers also reported that this allowed for equal participation between themselves and their partners.

In one case, reminiscent of the Men’s Shed example, one caregiver began singing a familiar tune to their partner, a person with advanced dementia, who had mostly lost the capacity for speech. But she audibly attempted to join in with the words of the song.

The Restaurant of Mistaken Orders

This restaurant has just opened in Tokyo and it only hires waiters and waitresses with dementia. The staff may get orders wrong but “if you go there knowing that, you won’t dwell on it too much – and it might change your perception about those suffering from the illness”. It also shows that dementia patients can be functioning members of society.  One commentator ordered a hamburger, but dumplings came instead. ‘I’m fine – dumplings came and I had a good laugh.’ [2] One older woman shows her guests to a table and then sat down with them. Another serves a hot coffee with a straw. Yet another older woman struggles to twist a large pepper mill. Everybody at the table pitched in to help, and with cries of “We did it!”

The creator, Shiro Oguni, says “Like everybody else, my awareness of dementia at first tended towards negative images of people who were ‘radically forgetful’ and ‘aimlessly wandering about.’ But actually, they can cook, clean, do laundry, go shopping and do other ‘normal’ things for themselves. The restaurant is not about whether orders are executed correctly or not. The important thing is the interaction with people who have dementia.”

Two out of three Japanese with dementia live at home, conditions conducive to isolation. Many would rather be useful to the community than receive assistance. The restaurant gives them a cheery place to do just that.

 

[1] Shreena Unadkat, Paul M. Camic, Trish Vella-Burrows (2017) Understanding the Experience of Group Singing for Couples Where One Partner Has a Diagnosis of Dementia. The Gerontologist, Volume 57, Issue 3, 1 June 2017, Pages 469–478.

[2]  http://www.mistakenorders.com/en/home.html