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Your Role in Creating an Inclusive Community

 

Inclusion is a hot topic and a very important one for our elderly population. It emphasizes the importance of inviting the active participation of all citizens, including our elderly population, into our social fabric. 

 

The Canadian Network for the Prevention of Elder Abuse (CNPEA) has reported that:

  • Being socially isolated is a common affliction among older adults. More than 30% of Canadian seniors are at risk of becoming socially isolated.

  • Isolation and loneliness are as bad for your health as smoking 15 cigarettes a day.

  • And, social isolation can put seniors at increased risk for elder abuse.

Inviting the elderly population into social spaces is the first step, the second next step is creating an age-friendly community.

 

What exactly is an age-friendly community?

 

Being age-friendly means that there are no barriers to accessing services in the community, regardless of age or ability. A city that is designed to include and be accessible for its elderly residents is automatically factoring in the needs of its younger population.

 

 

For example, if a community is accessible for someone using a walker or wheelchair, it is also accessible to a parent pushing a stroller. The examples that we think of quickly are usually about physical accommodation such as ramps, wider doorways, longer crosswalk signals, etc. These accessibility features are certainly important, but a truly age-friendly community is about far more than just physical accessibility.

 

Dr. John Lewis, professor at the University of Waterloo, points out that currently, one-quarter of Waterloo Region’s population is age 55 plus. That number is only going to increase in the next few decades. It is not acceptable that there are ageist prejudices towards 1/4 of our population! If we want to have a community that is inclusive to all members, it needs to be designed to suit those who are age 55 and older.

 

Age-friendly communities are about inclusion and a sense of belonging. It is about receiving the respect and dignity that all citizens deserve, regardless of ability or age.

 

Often, these issues relate directly to coping with ageism. Ageism is the stereotyping of and prejudices against someone because of their age. It might include automatically treating someone in a certain way, just because they appear to be a senior.

 

For example, assuming someone is hard of hearing because they have gray hair is an ageist stereotype. Another example is the way that professionals often speak about a senior to their family members, as though the senior is not even in the room! The conversation should be directed to the relevant person, regardless of age.

 

In addition to physical challenges, some people experience cognitive changes. These people deserve the same level of respect and inclusion as all other members of society. Brenda Hounam, dementia advocate and spokesperson, highly advises communicating about dementia itself. Rather than hiding her challenges with dementia, she has decided to be very public and make others aware of her disease.

 

 

Hounam suggests that people “open the doors for communication—just ask”. She feels that it is much better to ask for clarification and to communicate clearly with someone who has dementia; do not just make assumptions. She asks that people do more than just listen; she wants people to truly hear and validate what she is saying. Hounam’s overarching message is that “we are all unique, and we all have something to contribute until the last breath.”

 

Being inclusive and respectful of all citizens—regardless of age, ability, or illness—better allows us to fully acknowledge and appreciate the contributions of all members of society.

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Mealtimes don't have to be difficult - We can help!

 

For many of your residents, meals are the favourite times of the day. They line up in the dining room half an hour early in great anticipation. It is the event to savour!

 

 

Other residents may struggle with meal time. Some require physical assistance with feeding, and some may need constant cueing and reminders to eat their meal.  For those with advanced dementia, the noise and commotion of the dining room can trigger agitation and make mealtime less successful.  There are so many different needs to meet at every meal and it can be tricky for dietary staff to meet all those needs simultaneously.

 

Some residents may benefit from their own dedicated caregiver during mealtime. 

 

Residents such as Lucy, who often became so agitated at meal times that she wouldn’t eat anything at all.  At a quick glance, it appeared that Lucy just wasn’t hungry for her dinner. But when we sat with Lucy through her meals, we discovered that much of the time, she was confused and wasn’t sure what to eat or how.  It was not because she was not hungry.

 

When we provided Lucy with a dedicated caregiver who sat with her throughout dinner, Lucy suddenly began to thrive!  The caregiver would cue Lucy saying “oh, that roast beef looks delicious, would you like a bite?” and Lucy would smile and take a bite. 

 

A minute later, the caregiver would say “you’re a big fan of mashed potatoes, and look what we have here—your favourite! Mashed potatoes!”  By the end of the dinner hour, Lucy had cleaned her entire plate.  With cueing, direction and constant encouragement, Lucy ate her food and was mostly able to feed herself.  By continuing to cue Lucy and not just take over by feeding her, her own dedicated caregiver promoted Lucy’s remaining abilities and independence.

 

Do you have any residents who would benefit from patient, one-on-one constant cueing and encouragement?  Watch your residents thrive when paired with a Warm Embrace caregiver! 

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Exploring Responsive Behaviours

 

Someone who is experiencing dementia may exhibit behaviours that we do not understand.  These behaviours have been labeled ‘difficult’ or ‘disruptive’ or ‘challenging’, but is that really a fair assessment of these behaviours?

 

In caring for people with dementia, the focus often ends up being on the disease itself, rather than on the person who is experiencing the disease.  Thus, their behaviours are often automatically assumed to be associated with the disease. 

 

Sharon Stap, a Psychogeriatric Resource Consultant, contrasts older understandings of dementia with more updated approaches.  In the past, it was understood that dementia was altering someone’s brain, resulting in different behaviour. All behaviour was assumed to be a result of the disease. 

 

 

The newer understanding of dementia is that the changes in someone’s brain results in a different perception of the world around them, creating anxiety, fear and other emotions which then lead to different behaviours.  Understanding that someone with dementia is experiencing a change in perception which causes behaviour should fundamentally alter how we interact with those who have dementia.

 

Dr. Sherry Dupuis, former director of MAREP (the Murray Alzheimer Research Education Project), feels that we need to reframe our view of these behaviours.  Instead of merely seeing the ‘challenge’ or ‘difficulty’ that these behaviours cause for us, or assuming that all behaviour is attributed to disease, we need to reframe these behaviours as a form of communication.  Dr. Dupuis views behaviours as a form of personal expression, a unique way of communicating needs.  We should then seek to understand the meaning behind the personal expression.


We must remember that people who have dementia were all unique individuals prior to the onset of their illness. They continue to be unique individuals with different personalities, communication styles, interests, life histories, etc.  Dr. Dupuis charges us to never lose sight of the fact that a person with dementia is first and foremost a person who requires love, care, and understanding, not just a disease or a ‘case’ that needs to be managed.

 

One of the greatest gifts that we can offer to someone with dementia is the gift of truly relating to that person—validating their personal experiences and feelings.  Someone with dementia is experiencing the world around them differently than they previously experienced the world, and differently than you might be experiencing the world around you. 

 

 

This experience may be frightening, overwhelming, or worrisome, and the feelings that are generated and their emotional response is fully valid. We cannot be dismissive of someone’s feelings or emotional responses just because we do not deem a situation to be frightening to ourselves.  The kindest thing we can do is try to understand the emotional response and validate the feelings that someone else is experiencing.  Only then can we attempt to change someone’s experience into something more positive.
 

If someone is distressed or having a negative experience, distraction can be helpful, but it is not the first step in the process.  Stap emphasizes that you cannot jump immediately to distraction, otherwise you risk being dismissive of someone’s feelings. Stap proposes a four-step process where distraction is the final step, not the first option. 

 
The Four Steps:

 

1. Show you care

 

2. Show you want to help

 

3. Redirect

 

4. Distract

 

For example, Agnes has dementia, and she is upset and focused on wanting to return home. The first step is to acknowledge how Agnes is feeling.  You might say: “You need to get home, Agnes? I can understand why you’re so upset.”  Attempting to inform Agnes that she is already at home—known as reality orientation—is not helpful and only causes more distress; Dupuis and Stap agree that there is rarely, if ever, a good time for reality orientation.

 

 

After acknowledging and validating Agnes’ feelings, you want to show that you want to help.  You might suggest: “let’s go see if we can find someone who can help us, Agnes”.  While on the hunt for someone who can help, you have the opportunity to redirect, the third step.  You could say, “I’m tired. Before we look for someone else who can help, do you mind if we rest here by the piano?”.  After this, you have the opportunity for distraction, the fourth step.  You could then say: “You play the piano, don’t you, Agnes?  Would you play me a tune?” 

 

If you had jumped immediately to distraction via the piano when Agnes first approached you, she likely would have felt even more frustrated that her needs were not being addressed. Acknowledging Agnes’ feelings and needs, then assisting her to focus on something that is more comforting, allows for a positive experience overall.

 

Interpreting all behaviour as a form of personal expression shifts the focus off of the disease of dementia, and refocuses attention on the individual person.  Suddenly, behaviours are imbued with meaning and purpose, a form of communication. It is then our responsibility to enable the best possible form of communication and understanding, setting people up for success, regardless of dementia or other illnesses.

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