Improving Alzheimer’s and Dementia Care: Emotions Rule
Habilitation Therapy (HT), a comprehensive behavioral approach to caring for people with Alzheimer’s Disease and related dementias (ADRD), is considered to be a best practice by the Alzheimer’s Association (Alzheimer’s Association, 2012). HT is best used for every interaction a person with ADRD has with their care partners, from the moment they rise until they fall asleep at night.
One of Habilitation Therapy’s primary goals is to create day-long positive emotional states for dementia patients (Alzheimer’s Association). His or her capabilities, independence and morale are thoughtfully and ongoingly engaged to produce a state of psychological well-being.
Why such an enormous focus on emotions? Given all the many deteriorating capabilities of dementia, why not instead focus on helping memory, reasoning, language, and other functionality that adults need in order to cope in the world?
It’s vital to remember that Habilitation Therapy is not Rehabilitation Therapy. Rehabilitation returns people to earlier, higher levels of functioning; such recovery simply is not possible with ADRD. Habilitation helps dementia patients use what functioning they still have at a more optimized level.
So, what do dementia patients have left, especially as their disease progresses? The ability to experience and maintain emotions, as well as to accurately perceive others’ emotions, remains intact right up until nearly the end. They can also consistently associate positive or negative emotional states with certain people, places or things.
Since HT works only with functionality that is still present, the emotional world is the strongest channel through which to impact a dementia patient. Taking the time to consistently create positive emotional states can reduce difficult behaviors, allow enjoyment – or at least better toleration – of care tasks. In this way, Habilitation Therapy can trigger states of calm, happiness, pleasure and self-esteem.
While it may be difficult or impossible for a person with dementia to understand a broader context for what triggers their feelings, they will consistently know that it feels bad to be scared, and good to laugh. They can also retain a feeling over time, though they may not recall what that feeling was originally about. In this way, a positive feeling can persist and help set the stage for “a good day.” The converse is also true; a negative feeling can be the precursor to “a bad day.”
Trying hard to figure their way through an increasingly bewildering world, people with dementia often become amazingly good at reading and responding to others’ emotional states. Care partners’ body language, facial expressions, and tone of voice add up to a strong message clearly received — often despite what is said in words. This is especially true as the patient’s spoken language capabilities deteriorate. Presented with subtle indications that something is positive, the dementia patient’s emotional radar tells them all is well. If they pick up something that says the contrary, they can become quite upset, though having no clue about what is actually going on.