Dementia consists of a global impairment of so-called cortical (or higher nervous) functions, including memory, the ability to cope with daily demands and perform previously acquired perceptual and motor skills, maintaining socially appropriate behaviour according to circumstances, and controlling emotional reactions, all in the absence of impairment of the state of vigilance. The condition is often irreversible and progressive, as defined by the Committee of Geriatrics of the Royal College of Physicians in Britain in 1982.
A person with dementia retains the capacity to experience emotions, both positive and negative, to have desires, and to have psychological needs. What they lose, however, is the ability to fulfil these desires and needs independently.
Kitwood (1997) explained that “malignant social psychology” arises because people with dementia are seldom visible or acknowledged in society, which undermines the personhood of these individuals. Therefore, these people are treated as less-than-human as a result of this depersonalisation.
There is a list of words indicating many wrong strategies to cope with persons with dementia: intimidate, withdraw, hasten (not accommodating the pace), infantilise, label, denigrate, accuse, deceive, invalidate, disempower (preventing the person from using their remaining abilities), impose, intrusion, treat as an object, stigmatise, ignore, exclude, mock. On the opposite, the right mood to stay in contact and work with persons with dementia is described by this second list of words: provide warmth, be comforting, accommodate the pace, respect, accept, celebrate, recognise, be genuine, validate, elevate, facilitate, create appropriate conditions, collaborate, appreciate, include, welcome, have fun with.
Examples of good practices of the work with the elderly with dementia
Using life stories with the elderly – a storytelling laboratory
The strategy involves addressing a different theme concerning life stories and related past events each week. The chronological order of memories is followed to trace each individual’s life journey of. Operators propose different themes: introduction, the family of origin, war, marriage, school, past occupation, children, grandchildren, food from the past, nursery rhymes and proverbs from the past, songs from the past, games from the past, works from the past, transportation from the past, lifestyle from the past, “timeless effervescence”, comparison between youth today and in the past, present and future.
This activity aims to reach goals working on reminiscence, both cognitive and emotional. The elderly are asked to recall their experience with autobiographical memory, the cognitive function of maintenance, the emotional function of integration of the self, and instrumental and procedural functions.
Emotions Project – Training on social skills
It consists of training in the skills that allow individuals to interact with others satisfactorily. It represents concrete and targeted assistance in establishing or integrating into a network of interpersonal relationships. With this objective in mind, the operator aims to intervene in the affective and relational spheres of the participants. Its goal is to enhance the social capabilities of the participants to improve the quality of their interpersonal relationships. It aims to create a supportive and stimulating social network from which each individual can draw support. Lastly, it seeks to uplift the participants’ mood as a direct consequence of the factors above, as well as through the promotion of strategies for adapting to ongoing social changes and the difficulties encountered in the new community. It addresses topics related to social skills, such as recognising and expressing emotions and functional strategies for adapting to encountered problems.
The adopted tools involve group discussions, which are fundamental for creating a sense of belonging to this micro-community, increasing dialectical and relational skills, and generating new solutions through peer discussion. Various techniques are used, such as playful situations, miming, riddles, brainstorming, sharing autobiographical events with the group, and discussing predetermined topics. The proposed topics are designed to highlight the typical difficulties faced by institutionalised elderly individuals, such as ageing, longing for family, physical and cognitive impairments, loss of routines, etc.