“In order to empathize with old-old people, we need to understand the complex interweaving of physical deterioration and developmental needs,” writes Naomi Feil in The Validation Breakthrough.
Like Feil, who has more than 30 years experience working with the elderly, I’ve found that “old disoriented people have an intuitive wisdom, a basic humanity that we all share. Behind their disorientation lies a human knowing. I have witnessed this “human knowing” in people with dementia, even when they find it difficult to articulate their thoughts. I call it “intuitive clairvoyance.”
It shouldn’t come as a surprise that old people have the same needs all of us do. But somehow we lose sight of their humanity and their right to dignity. We treat them like children. We talk about them like they are invisible even when they’re right beside us. We tell them what to do. We restrain them physically and chemically. We ignore and isolate them. We fail to provide them the things they need to live full and productive lives to the end. What a shame!
We must use our failures (as Feil herself has) to develop a deeper understanding as well as better tools, techniques, and ways of caring for the elderly and people with dementia. I believe we must change the way we see and support the elderly, in particular people who have dementia. As they become less able to do so themselves, it’s our responsibility to help them get their needs met in the final part of their journey.
Fell suggests “old-old” people and people with dementia have psychological and social needs just like the rest of us. I would go further and say these are rights, not just needs. Everyone has the right to the needs Feil’s describes:
- Resolve unfinished issues, in order to die in peace.
- Live in peace.
- Restore a sense of equilibrium when aspects of self fail (e.g. sight, hearing, mobility, and memory).
- Make sense out of unbearable reality: find a place that feels comfortable, where one feels in order or in harmony and where relationships are familiar.
- Be recognized and have status identity and self-worth.
- Be useful and productive.
- Be listened to and respected.
- Express feelings and be heard
- Be loved and feel a sense of belonging; have human contact.
- Be nurtured, feel safe and secure, rather than immobilized and restrained.
- Have all five senses stimulated touch, sight, sound, smell, taste, and be allowed to express one’s sexuality.
- Reduce pain and discomfort.
I would add:
13. live joyfully, surrounded by laughter, love, music, fun and opportunities to connect with others in a meaningful way.
Most important Feil says, is that despite disorientation, the old-old and people with dementia must be given the opportunity to fulfill the “universal need to belong, to find identity, and to express themselves.”
Plus, says Marcy MacPherson, BA, BSW, as critical as all of the above is “to have purpose in life.” I couldn’t agree more, and it’s our job as care partners to ensure that happens.