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Rehabilitation for Dementia - A Counsellor’s View

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Written by Bharat Hegde

“What is your name?” Uncle asks me again. I smile at him as I reply. He asks me this question each day. Some days he gets my name almost right, some days he doesn’t. But it’s weirdly fascinating to watch him try to recall it. It’s the joy in his face when he gets my name right that makes working as a counselor at a dementia care center worth it. Dementia. It’s a dreaded word for people and their families. That’s because humans have no defense against dementia. We can probably slow it down with medicines, but that’s pretty much it. So, my role at a care center is more about preserving the cognitive abilities they have and keeping them engaged. It’s simple and fun sometimes, but not so much the other times. Let me explain why.

Rehabilitation for Dementia: What is it?

Rehabilitation is such a scary word. Let me just put it out there: Rehab is not an Asylum. It is not a place to contain the mentally ill. Rehabilitation is something entirely different. At rehab, the aim is to keep the individuals engaged and functioning. Beyond that, it has been a revelatory experience to work with these individuals. It is in equal parts challenging and enjoyable. So, let me just go ahead and explain the day. 

The individuals fighting dementia wake up at around 6:30. They have a session of exercise post which they have breakfast. Sometimes, they don’t feel like following the routine, that’s when you have to negotiate with them. They then move on to activities. These activities are aimed at keeping them cognitively stimulated. The activities include matching colors, sorting pulses, sorting shapes, and more. The elderly especially find Ludo and Carrom very stimulating and interesting. 

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Rehabilitation Programmes for Dementia - The Activities

What are the activities that are conducted? Largely, they can be split into 3 different categories. The first ones are the activities to stimulate memory and cognition. This includes validation therapy, reality orientation, and reminiscence therapy. It helps them remember different parts of their life and keeps their minds fresh.

Reminiscence therapy is also a way to help elderly dementia patients keep their families in memory. It breaks my heart a little when families ask “Have they forgotten us?”. We show photos of the family, arrange calls with the members, and ensure that the elderly can remember their families and keep in regular touch with them. 

The second set of activities is aimed at keeping them physically active. We need to keep them active so that they remain physically healthy. It is very important as old age brings with it a host of physical problems. The third set of activities includes behavioral training. Training a routine is very important. All these activities together create a rehabilitative experience that helps the elderly.

How is it to work with individuals with Dementia?

Beneath all the explanations I have given about a rehabilitation center for dementia patients, there is a profound experience that I may not be able to do justice to with words. For example, what gets to me is a few things that we take for granted, that are very difficult for individuals with dementia. 

The other day, I entered the dementia care unit and one of the gentlemen was having their tea. He asked me for one extra biscuit, and I said I would give it to him if he was able to tell me my name. I could see that he was straining to remember my name. He got it almost right, and I gave him the extra biscuit. The joy on his face was akin to that of a toddler finally learning how to do something new. 

Sometimes, the individuals forget that they have had a meal. I was working with a lady who fought dementia, and she would often forget that she had had a meal. She would complain, let’s say 10 minutes after breakfast, that she was hungry and needed food. Eventually, we would relent and give her some more food. But, it was still unsettling.

I have understood that a lot of patience is necessary while working with someone fighting dementia. Sometimes, they lose threads of a conversation or have difficulty recalling simple things. However, given time they will eventually get there and the satisfaction on their faces once they achieve this is worth the wait.

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The emotional toll of Dementia

As a counselor, I liaise with individuals and their families. I have seen the emotional toll that the disorder takes on the family. Family members are constantly in the fear that their loved ones might forget them. The individuals at the rehab are always waiting, for their families. One of the individuals waits every day for their daughter. They confuse each day for a Thursday and say, “Today is Thursday right? My daughter will come today.”

The daughter does visit regularly, but her father does feel the emotional strain caused by Dementia. Families visit regularly, but it is difficult for them as well. Especially with the pandemic, it was very difficult. But, through video calls, voice calls, letters, and more, we have been able to bridge the gap a little. 

But, there are moments of pure joy as well. Especially when the individuals are engaged in activities. They like being competitive and enjoy games like ludo and carrom. You can even encourage them by igniting their competitive spirit as well. Even during festival celebrations, they get excited. You can see it in their eyes. They might not be all there, but they still make an effort. Eventually, it’s their innocence, their smiles, and the sheer joy they find in the simple things of life that keeps me going each day.

Of course, there is pain. Sometimes, elderly individuals with dementia may pass away due to physical health issues, or they might go back home for various reasons. That hurts. To meet a person every day, and then suddenly to not see them the next. But, professionalism comes first, and I feel incredibly lucky that I have the opportunity to work with these wonderful individuals and make their life easier!

Eventually, what keeps me going is the realization that even in our weakest moments, we are undeniably human. Dementia shows that regardless of the deterioration in memory or cognition, the innate nature of us being human remains the same. Ok, that’s enough for now, I shall go back to work! Maybe the gentleman will remember my name correctly today!

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