Salt Lake City, Utah, March 11, 2001 — “Dignity of Risk” Enhances Quality of Life for Alzheimer’s Patients
Note to the reader: Due to the sensitive nature of this article, some names of individuals have been altered to protect confidentiality.
The elderly woman, thin but not frail-like the limbs of a willow, walked a carpeted hall. She meant to exit the doors of the facility in search of food for her cat. That’s what her voice had said. But her mind had plans of its own.
Two carrot-topped birds chirped lustily in a wire cage. The woman paused for a moment to observe the fluttering. A moment turned into minutes, and the minutes grew. Time passed.
“Do you want to see my cat?” She asked. “She’s sleeping in my room. She’s very sweet natured, but she must be hungry. I am going to go up the street to find some things. Do you think those shops up the road might have something for her?”
Dorothy never arrived at the store. At times, her mind stumbles inside short-term memories. And the songs of a caged bird can be mesmerizing-like songs of the Sirens.
Dorothy suffers from Alzheimer’s disease. She is often disorientated and confused, and is sometimes frightened by the enormity of life. But Dorothy’s body is healthy, her heart is safe and she has her cat, Taffy, to soften those hard-edged days.
“It used to be that people thought f you have dementia, that’s the end of your life,” said Dr. John Bowling, Ph.D. “But there’s still a quality of life for those people. It doesn’t matter if you know what day it is or how to tie your shoes. It’s our job to give life to those people the world has given up on.”
Dr. Bowling is an administrator at Silverado Senior Living Aspen Park, a specialty care community designed to meet the physical and emotional needs of residents of Alzheimer’s disease and other dementia. It’s an environment designed to celebrate life called and “Eden Alternative.”
In a garden setting, residents roam freely through the hall. An elderly man stops to pet Max, a Black Labrador. He smiles, and then wanders on his way. As he goes, he passes a woman sitting in a room filled with birds. The caged birds sing. The woman echoes the tune.
“There’s something about pets that touch our older residents,” said Dr. Bowling. “They create an opportunity for them to feel helpful. Residents here take the dogs out for walks and help feed the birds. This starts to send a message that they have a purpose, they have value."
At Silverado, residents can experience quality of life by feeling productive, loved and needed in a human habitat. The unique facility is formed around a notion that nursing home residents should maintain contact with natural surroundings.
The goal, said Dr. Bowling, is to eliminate the three elements of the long-term care institution: loneliness, helplessness and boredom.
“This is truly their home,” said Dr. Bowling. “If they walk into a business meeting, we don’t stop them and say, ‘hold it.’ They sit in with us.”
Dr. Bowling tells the story of a man who walked into an administrative meeting designed for Silverado staff. The gentleman stood at the head of the table, pulled out some blue prints and started issuing instructions.
“We have to go across the board 15 percent,” he informed staff members, and continued. When satisfied with the presentation, the man left the room. He was later seen wandering the halls, shaking his head and muttering about the meeting.
This man has just experience what Silverado staff calls “Dignity of Risk.” Using common sense precautions, staff members let residents take some risk. This improves their quality of life, said Dr. Bowling.
It also helps family members and staff members understand that people with dementia are valuable members of society.
Memory boxes, small wooden cases located outside the rooms, contain pieces of a resident’s life-from military mementos, family photos and newspaper clippings to artwork and porcelain keepsakes. Not only do they help residents remember their past; they also help them find the way to their room.
“It’s hard when someone you know becomes someone else,” said Dr. Bowling. “With dementia, the world becomes more and more unpredictable.”
That’s why staff members engage residents in activities and exercises that manipulate the healthy parts of the mind. They offer residents some stability-a sense of belonging. And residents seem happy here.
“You know what younger daughter did?” Asked Dorothy. “She called me and said I need to stay here. It’s because I’m a widow and she doesn’t want me on my own. It’s fine with me whatever she does. I do like it here.”
That’s the kind of statement Dean and Emma would like to hear. They moved from Colorado in May when Dean’s brother Albert was diagnosed with Alzheimer’s disease, and are now searching for a long-term care facility.
“When we found out that he had Alzheimer’s it was pretty devastating,” said Dean. “We just know that the guy we see now is not my brother. It’s a grief period.”
Albert, a 67 year-old electrical engineer, needs continual care, and his brother Dean and wife Emma, traveled to Utah to spend time with him before the disease progresses too far.
What they found was disheartening. Albert’s condition was far worse than they had expected, and he was angry at the realization of what he had become.
“He is just so angry all the time,” said Emma. “He is sad and he is angry. He know something is happening, but he doesn’t know what.”
“In your mind, like in our mind, all we see is a beautiful man who was an engineer,” she continued. “But he can’t count backward by seven. He dresses in a suit and tie, but his shoes are not shined. We don’t want to see this beautiful man’s mind disintegrate.”
That’s why Dean and Emma joined a support group led by Daren Buckner, a social services worker. What they’ve learned is that there is no fast and firm way to deal with Alzheimer’s disease. And family members who share their trials and tears are a comfort.
“These groups are just life savers,” said Emma. “They just jolt you into-this is the reality, and this is how life is going to be. In the group you get a picture of what to expect for the future.”
The group held at Murray City’s Heritage Center every fourth Tuesday of the month, educates families about Alzheimer’s disease and provides individuals with a forum for discussion. Buckner teaches group members to uses a technique called “Validation Therapy,” developed by Naomi Feil, to break down Alzheimer’s disease into four stages and validates patient’s emotions.
“We tell families not to try to reality orient the Alzheimer’s patient,” explained Buckner. “Often times, their minds aren’t in the present. And to orient them with reality is confusing and causes frustration.”
“Most people think this disease would never happen to them or their families. A lot of the time there are frustrations,” continued Buckner. “People ask, ‘what can I expect to happen? Unfortunately, there’s not a solid answer.”
When Dorothy became a resident of Silverado Senior Living, she brought along her cat, Taffy. She says Taffy is her joy.
Part of the philosophy at Silverado Senior Living revolves around the beauty of the natural world and the creatures that inhabit it. Nina, a Silverado resident, holds two birds that flutter around the facility.
Jean sits with her puppy, Little Bit, on a couch at Silverado Senior Living. When she brought Little Bit to her new home, her husband Frank adopted another dog-named Two Bit.
Administrator of Silverado Senior Living, Dr. John Bowling, Ph.D. anxiously awaits further facility renovation.
