"Give a man a fish you feed him for a day. Teach him how to fish and you feed him for a lifetime." - Lao Tzu (but if he is starving, please just give him a fish.)

Several years ago I was managing a summer camp in San Francisco and was conducting an assessment with a young boy on the autism spectrum. He was excited to be coming to camp, and I needed to understand how he best communicated, his interests and his strengths to create a successful inclusion plan. 

His mom was sitting with us at the table and suddenly he jumped out of his chair and placed his hands firmly over his ears and began to move around. It is not usual for a child or an adult with autism to have hyper-sensitivity to sounds, but I heard nothing. I look to his mom to understand the cause of this abrupt change in her son's behavior and she placed her fingers to her lips as if we should remain quiet and said just one word to me. "Listen." So we both "listened" intensely and could barely hear the faint hum of a lawn mower in the very far distance. 

His mother reported that he hears sounds before others can, and some sounds such as a mower is painful to his ears. But unlike people with dementia who have lost their abilities to problem solve or use strategies from the past to manage emotions and stress, this little boy knew how to let us know that he was beginning to feel something painful and protected himself by covering his ears.

This mom and her son taught me the importance of listening. It is our responsibility to practice active listening for the sounds and the silences, and by being pro-active, we can avert possible stressful events and help our family member to feel safe.

"The word 'listen' contains the same letters as the word 'silent'. 

-Alfred Brendel

Along with developing active listening skills, observation skills are necessary to practice your awareness of all five senses so you can recognize, understand and process your loved ones environment.  By becoming more skilled at being mindful and staying present, you will learn to become aware of your emotions and to able to use empathy and compassion to communicate effectively.  Observing your family members emotions, reactions, and body language, is crucial. Being able to identify and regulate your own emotions will improve your relationships with your loved one, and ensure more meaningful connections and positive interactions. 

Gaining insight of your own body language and how it is interpreted by your family member or friend will become easier with practice. Observing their facial expressions, their body language and focusing on their emotional response will let you know if they are feeling understood and validated. Effective communication skill helps you connect with your family member and build meaningful relationships. When you are able to recognize your family members emotional state you can adjust your emotions and communicate without conflict. All behaviors are communication and we must understand what a behavior is telling us.

Our social-emotional effect on others can result in a person with dementia  feeling judged, devalued and emotionally unsafe, or we can honor their refusal to do something as a choice rather than characterizing the person as "non-cooperative." By using a strength base approach of support you will recognize what the person is still capable of and what they have to offer us.

"You can observe a lot by just watching." 

-Yogi Berra

It just feels good to be validated. When your thoughts or feelings are  affirmed by others, there is a feeling of acceptance and understanding. When our feelings or thoughts are discounted or we are even corrected on our thoughts, a sudden need to defend ourselves arises, and the instinct to lash out may occur. No one likes to be invalidated.

When I started working in healthcare after graduation from college in the 1970's, my first job was working with persons with dementia in the  "nursing home." At that time little was known how to treat dementia so "Reality Therapy" was thought best.  Trying to make the person remember and force them to be in our reality,  just didn't work. Attempts to ground a person with severe dementia into our reality was not only ineffective, it was just plain cruel. Trying to convince a person living with memory loss that it was July when they thought it was Christmas day creates arguments and behavioral symptoms of dementia. The lack of understanding by healthcare professionals at that time thought that by drilling "reality" into their brains would make them remember. 

 By the 1980's "Validation Therapy" was introduced to help a person, who was living in a world they could not understand, to manage emotions and feelings and reduce the confusion and disorientation. By using this new way to communicate with a person with dementia, anxiety decreased, stress was reduced for both the person and the healthcare staff, and more positive interactions with others evolved.   

"Validation Therapy" is simply validating what the person with dementia says or feels. Feelings, not facts is what is important. Often, when a person talks about events or situations that are not accurate, they are really trying to resolve some unfinished business in their life. By agreeing, nodding, reaching a hand out or simply asking them to  "tell me more," the person will feel understood and have a much more joyful interaction. Helping your family member manage emotions is key, but learning how to manage your own emotions without becoming overwhelmed is the first step. 

"Nothing brings down walls as surely as acceptance." 

-Deepak Chopra

When we can help a person with dementia to feel heard, understood, and validated, a sense of safety and trust will lead to a social-emotional connection. Once this connection is established, engagement is possible. Engaging with someone is being listened to as an equal. 

Whether the person with dementia is engaged in a conversation, participating in a solitary activity, or enjoying a shared interest, the benefits of being "lost in the moment" can re-create a anew, or re-create (from the word recreation) a feeling of a restored body and mind.

Staying socially, physically and cognitively stimulated can slow the progression of cognitive decline and promote independence.  Activities of daly living, such as dressing, and eating can be maintained longer.

When activities are meaningful, the shared engagement creates social bonding and a positive emotional experience. Often family members or friends assume the person with dementia can no longer participate in past hobbies and once a diagnosis of cognitive decline, the person is no longer offered familiar activities such as golf, or gardening. 

The skill levels will not be as accomplished as before, but simple adaptations can easily be done to ensure success. The former golfer may not be able to drive the cart safely and play 18 holes, but studies show that the muscle memory of golf skills will remain a long time, and a trip to the driving range or putting green can bring great joy. It is believed the feeling of being outdoors and the social atmosphere is the reason.

Engaging in meaningful activities to the person, can encourage creativity and a sense of accomplishment, enhance pleasure, reduce anxiety, and create more life satisfaction. Initiation skills decline with dementia, so it is important to set up the activities and provide an inviting environment with good lighting. Playing familiar music can encourage reminiscing.

Be mindful of not talking slow when engaging, as it can be interpreted as condescending or demeaning.

"Surround yourself with what you love, whether it’s family, pets, keepsakes, music, plants, hobbies, whatever. "

– George Carlin

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