Saturday, May 25, 2013

what dementia patients can teach us: executive function is not everything

from the article:
... residents as "closer to the higher being.  This is who they are: real, honest, and sometimes raw.  There is no ability to reason, or to cover up who you really are.  And so, for much of the time, you see the loveliness of the soul-- it is bare for everyone to acknowledge."

Valorizing dementia as a higher state of being may strike many people as bizarre, and such sentiments are unlikely to comfort the children or partners of people who must endure living in a state of almost perpetual confusion.  Yet our society does tend to prize cognition and executive function at the expense of other essential human qualities:  sensuality, pleasure, intimacy.   For people who can no longer think clearly, a life of small sensory pleasures is a considerable achievement.

http://www.newyorker.com/reporting/2013/05/20/130520fa_fact_mead

A REPORTER AT LARGE
THE SENSE OF AN ENDING
An Arizona nursing home offers new ways to care for people with dementia.
BY REBECCA MEADMAY 20, 2013

Last summer, Frederick C. Hayes was admitted to the advanced-dementia unit at Jewish Home Lifecare, on West 106th Street. It was not an easy arrival. Hayes, a veteran of the Korean War, had been a trial lawyer for five decades. He was tall, and, though he was in his early eighties, he remained physically imposing, and he had a forceful disposition that had served him well in the courtroom. One of his closest friends liked to say that if things were peaceful Hayes would start a war, but in war he’d be the best friend you could have.

Hayes practiced law until 2010, when he went to the hospital for a knee operation. While there, he was given a diagnosis of Alzheimer’s disease. His combative tendencies had become markedly pronounced, and before arriving at Jewish Home he was shuttled among several institutions. Nobody could manage his behavior, even after Haldol, a powerful antipsychotic drug, was prescribed. In the advanced-dementia unit, he appeared to be in considerable discomfort, but when doctors there asked him to characterize his pain, on a scale of one to ten, he insisted that he was not in pain at all. Still, something was clearly wrong: he lashed out at the nurses’ aides, pushing them away and even kicking them. It took three aides to get him changed.

One day in September, a woman named Tena Alonzo stopped by Hayes’s room. Alonzo, the director of education and research at the Beatitudes Campus, a retirement community in Phoenix, Arizona, found Hayes lying in a hospital bed that had been lowered to within a foot of the floor, to lessen the risk that he would hurt himself by falling out of it. His face was contorted into a grimace, she later recalled, and he writhed and moaned. Alonzo, who is fifty-two, has spent the past twenty-eight years working with dementia patients—or, in her preferred locution, with people who have trouble thinking. She crouched next to the bed, and spoke in a quiet, intimate tone. “I’m here to help you—do you hurt anywhere?” she asked, moving her hand gently over his chest, his abdomen, his arms and legs. With each touch, she asked, “Do you hurt here?” When her hand reached his belly, the moaning ceased and Hayes spoke to her. “I hurt so bad,” he said. “I promise you, we are going to fix this,” Alonzo said, and he thanked her. . . .

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