Strange Worlds II - Steven Sabat (1994): Recognizing and working with remaining abilities: toward improving the care of Alzheimer’s disease suffers

Overall point: The paper brings out the consequences in Alzheimer’s Disease (AD) patients of being socially misunderstood.

Four subsidiary points:

1.         The behavior of healthy people can have positive effects on the behavior of dementia suffers.

2.         Conversation with AD suffer can be facilitated if AD person is still recognized as someone who has coherent thoughts and feelings to communicate – the self of personal identity can remain intact despite the progress of AD.

3.         Certain personal and social abilities still remain intact and well-being of both suffers and care-givers can be enhanced if care-giver supports these abilities.

4.         Expressions of objection and anger are often misunderstood as disease symptoms, rather than as symptoms of bad communication.

Kitwood, T. and Bredin, K. (1992) Toward a theory of dementia care: Personhood and well-being. Ageing and Society, 12, p.269-287.

12 indicators of relative well-being in dementia:

•          The assertion of desire or will;

•          The ability to experience and express a range of emotions;

•          Initiation of social contact;

•          Affectational warmth;

•          Social sensitivity;

•          Self-respect;

•          Acceptance of other dementia suffers;

•          Humor;

•          Creativity and self-expression;

•          Showing evident pleasure;

•          Helpfulness;

•          Relaxation.

Four global sentient states lie beneath these indicators:

•          sense of personal worth

•          sense of agency

•          social confidence

•          hope

Purposes of the paper:

1)        Two cases in relation to 12 indicators and 4 states - show from their discourses their well-being;

2)        To analyze the effects on both the afflicted and care-givers of social misunderstanding when indicators are ignored;

3)        i) responses of the afflicted to disease, and ii) responses of care-giver to sufferer

Two cases:

1) G.D. (70 yrs) – had a ‘job’ making people at the day center happy;

2) Dr. M. – an ex-Harvard faculty... “I don’t like to be tested... I know what’s wrong with me... I want time with a person who there is a real (gestures back and forth with hands)”

Dementia suffers as persons:

‒          Medicine makes diseases and persons OBJECTS of study.

‒          But for care there are consequences: Persons react, not only to AD, but to how others react to them as a result of AD, and to their surroundings.

References:

Kitwood, T. & Bredin, K. (1992) Towards a theory of dementia care: personhood and well-being. Aging and Society, 12, p..269-287.

Sabat, S.R. (1994) Recognizing and working with remaining abilities: toward improving the care of Alzheimer's disease suffers. The American Journal of Alzheimer's Care and Related Disorders & Research, 9. pp.8-16,