"I picked an Alzheimer Residential facility in Portland, Oregon from the internet because they were close to home and the facility looked "up-scale." When I met with the Assistant Director of the late-stage Alzheimer unit known as "Expressions," I came with an industrious proposal in hand. After reviewing my ideas, with a gentle smile, Judy politely suggested that I focus on using Reminiscent Therapy with the unit's 15 residents.
The residents were all end-stage Alzheimer or Parkinson patients between the ages of 80 to 100. She explained, "This is the end of the road for these folks. While their short-term memory is gone, they've retained their long-term memories. Allowing them to reminisce about their pasts would be the most therapeutic approach." I realized in talking with her that although I had studied it, I knew nothing of last-stage dementia.
Most of the patients I spent time with ranged from bedridden, catatonic and non-verbal to mobile and cognitively impaired, on a spectrum. Implementing Reminiscent Therapy was as straightforward as interviewing the residents armed with information about their age, diagnosis, and family histories. My objective was clear: encourage the residents to talk about past events in order to improve word finding, attention and concentration, and to get them sharing their thoughts and feelings.
I individually interviewed fifteen residents, spending between an hour to three hours collecting history, including: occupational, family, marital, military, and social. I also implemented Group Reminiscence Therapy in three sessions, for a period of 60-70 minutes, with the entire resident base (all mobile residents). This encouraged them to comment on one another's common past experiences. What did I learn from this experience?
This is where it becomes difficult to express all I learned in my short time at "Expressions." I thought, like any good social scientist, that I would objectively observe, collect, and record the various dementia symptoms, then clinically apply a simple group cognitive therapy. The reality, however, was quite different. I found there was no way to objectively use a therapeutic arsenal of techniques on these people. No, these were fathers and mothers, grandpas and grandmas. These were people with rich lives and stories to tell with hard-won wisdom and wit. These were people like the tough school teacher who was convinced I was her daughter; who took me quietly by the hand as she let the tears slip down her face when saying goodbye to me at the end of my day, admitting, "Nobody comes to see me anymore except for you." People like the German gentleman who, after being in Hitler's army as a youth of 14, escaped before being sent to a Russian concentration camp and fled to America where he converted to Christianity. As he draped his gangly arm around my shoulder, he spoke to me in his thick German brogue in a fatherly voice, admonishing,"It's the hard times that make you into somebody." People like the oldest resident of the unit, a Centenarian, whose advice to me about life was: "Just keep busy, kid, and you'll keep outta trouble." And when asked how she was doing she would quip cryptically, "I've got one foot in the grave, and the other on a banana peel!" Each of them, suffering from the debilitating effects of late-stage dementia, all had one quality in common: a particular, and sometimes peculiar beauty about them. Through the mask of their aging bodies, I could still see a glittering soul there, like a buried jewel still vibrant and alive. During individual interviews, I watched sparks in their eyes as they reminisced about their childhoods, adult adventures, and deceased spouses.
These people had LIVED. They had parachuted out of planes, ridden in plane cockpits, traveled internationally, been successful businesspeople, been teachers, and homemakers. They had raised oodles of kids, and grandkids. The most extraordinary thing about them was their indomitable spirit. At the median age of 90, they were still mostly positive about life and had a keen sense of humor. They could and did smile and laugh at their own frailty. What did I learn, you ask? It is said that Alzheimer's is "The Long Goodbye," as the median life expectancy from diagnosis to death is 8 years. These people proved to me that it is not the amount of time we have left, but our attitude that counts. They taught me that we create our own happiness (the German soldier told me that), and we can choose to be happy regardless of our failing bodies and brains. They reminded me that it is the amazingly resilient human spirit which is most important. They reminded me that kindness, patience, and respect are important qualities. They reminded me how to be childlike, and to trust the process. Mostly, they reminded me how to love unconditionally. I believe I received at least as much as I gave from the time we spent together; time I'll always cherish.
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