The Mind ... is not the heart
I may yet live, as I know others live,
To wish in vain to let go with the mind -
Of cares, at night, to sleep; but nothing tells me
That I need to let go with the heart.
— Robert Frost
As expressed in the above poem, the persisting capacity and need for emotional
expression, for giving and receiving affection, is common in literature.
The clinical literature also emphasizes the capacity for, and the importance
of, emotional expression. Moreover, throughout much of the course of the
illness those with Alzheimer's Disease remain very capable of giving and
receiving love, of sharing warm interpersonal relationships, and of participating
in a variety of meaningful activities with family and friends.
In many ways the dampened rationality of the person with Alzheimer's Disease enhances emotional sensitivity and means that the person tends to communicate more on an emotional level. The person is very aware of the emotions and moods of others, and often is very susceptible to picking up these moods. If a happy and lighthearted mood is set by the caregiver, this spreads to the person. Conversely, in long-term care, if one resident on a dementia unit becomes upset, it doesn't take long to spread to others. When we are angry or frustrated they will feel it and may also become upset. Be aware of facial expression, voice tone and language, so as not to convey any negative personal emotion to the person with Alzheimer's Disease.
Another dimension of emotional awareness is an apparent heightened spiritual intuitiveness, making the continuation of life-long spiritual practices especially important.
Even though emotions are felt, it becomes more difficult to express them, particularly verbally. It also becomes harder to interpret the environment and make an appropriate emotional response. The onus is on caregivers to facilitate the expression of emotion, especially through non-verbal methods. Simplifying and clarifying the environment helps to facilitate appropriate emotional expression.
There are many activities that encourage non-verbal emotional expression.
For example:
- Caring for plants or pets (express feelings of caring, affection, satisfaction, responsiveness from living things);
- Listening to favourite music or singing (recalls the feelings associated with the music);
- Repetitive, physical activity such as walking, digging the garden, or shredding papers for recycling (provide a release for feelings of frustration);
- Holding hands, hugging, brushing hair, rubbing on hand cream or other adult uses of touch (acceptable, adult expressions of caring and concern);
- Simple household chores, such as dusting, drying dishes, or preparing vegetables (enhances feelings of usefulness and self-worth).
It is important to let people know that you are aware of their feelings. Read non-verbal cues (e.g. facial expressions) and the tone of the voice to determine the nature of the feelings, then check it out with them by saying something like, "John, you seem to be very upset. Is that… true?" Then, "Are you upset because… ?" Even if you can't determine the source of the upset, letting the person know that you realize how they are feeling often helps reduce distress.
Excerpt from: Living at home with Alzheimer's disease and related dementias, published by the Canadian Association of Occupational Therapists and Alzheimer Society of Canada, coordinated by occupational therapist Carole Bowlby, Available from CAOT Publications ACE at 1 (800) 434-2268, ext. 242.
January / February 2001 Table of Contents
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