Change: How to Delay Cognitive and Emotional Decline

Changing the setting

I was recently in New York City and visited one of my favorite museums: The Metropolitan Museum of Art. In the past when I visited with my wife I would arrange to meet her at a specific spot in a few hours since our tastes in art are different.

I stopped to listen to an older couple on my way to the African mask collection. The gentleman was in a wheelchair, and the woman who was pushing them through a gallery appeared to be his wife and caregiver.

The conversation was vibrant and filled with positive emotions related to what he was experiencing.

Different Types of Conversations

I never got to the African mask collection. Instead, I spent two hours listening to them and other older couples, some of whom I thought were in a caregiver/loved one relationship. The conversations were so different from those I often hear from people confined to their homes because of health issues. In a home setting the conversations I hear are dominated by talk of physical and psychological problems.

Was the level of conversation related to the sophistication of New Yorkers? I don’t think so. I believe context—the setting in which people find themselves—creates the dramatic difference.

Going Outside of the Home to Change Context

We often do much of our caregiving at home because of necessity or convenience. Moving out of the home, even if it’s sporadic, is stimulating, and I would suggest can delay or slow down cognitive and emotional decline for people those world has shrunk.

A patient with ALS (Lou Gehrig’s Disease) was confined to his apartment because of mobility issues. After having a ramp built from his apartment to the street level, we began visiting Golden Gate Park in San Francisco once or twice a week. His attitude following each visit was jubilant, despite realizing he had a limited amount of time left.

Similar changes occurred with a client dying from sclerosis of the liver when we aimlessly drove along the coast and someone with AIDs when we walked on the beach. The changes in their attitudes lasted well into the week.

Sensory Deprivation

Being confined to a small area reduces stimulation. Experiments on sensory deprivation in the 1960’s and 1970’s showed a reduction in sensory input could lead to various psychoses. Although the severe conditions imposed in the experiments don’t come close to the limited setting many people who are being cared for experience, they do offer an important lesson: when possible, find various settings outside of the home that can stimulate your loved one. It doesn’t need to be anything complicated. A visit to a local park or even a wheelchair stroll around the block is sufficient.

Changing Contexts Within the Home

We can’t always take our loved ones out of the home for stimulation. It may be impossible for people who are bedridden to visit a museum, a park or something stimulating.

Their world is confined to what they see, smell, touch, and hear within a limited space.

Contexts can be changed even if a person is confined to her home. For example, different types of fresh flowers can be placed in the bedroom every few days. Pictures can be rotated with each group expressing a theme (e.g., our life in the 1940's, etc.) You can devote each day to listening to one of your loved one’s favorite singers. Even something as minor as changing the bedspread increases stimulation. You can also theme the food for each week by country or geographical region.

The types of changes you make are of less importance than what happens when stimuli are altered. There are few caregiving strategies that can produce as dramatic an effect as a simple change of environment.

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