Life Roles – A Thoughtful Engagement Success Story
By Holly J. Bean, PhD, LCPC, CTRS
Nicole, a Thoughtful Engagement® manager, shares a success story provided by the Thoughtful Engagement® Specialist working with Mrs. X. Mrs. X is a small framed woman who grew up near Coney Island with her family before becoming a pediatric nurse, meeting and marrying her husband and moving to Birmingham, AL. She was a devoted wife and mother of 3 sons while volunteering at Children’s Hospital and other area hospitals. She later had the privilege of becoming “Bubie” to 6 grandchildren, however, all of her grandchildren lived out of state. Mrs. X and her husband visited as often as possible and were a vital part of first baths, first foods, and first steps. Mrs. X gently guided one son and daughter-in-law as they navigated health issues of their first born, as she used her knowledge of her nursing days and her experience raising her own children. Providing helpful information and reassurance that guided them the new parents during this very difficult time.
As Mrs. X’s dementia progressed over the next few years, the two pieces of her past that she had cherished the most but were fading, were her grandchildren and growing up near Coney Island. The Thoughtful Engagement® Specialist helped keep these two very important aspects from slipping away entirely. Payton, the Thoughtful Engagement® Specialist, spent many hours going through pictures of grandbabies and talking about Coney Island. She brought her laptop and showed her pictures of Coney Island from the time when Mrs. X lived there as a young lady. Payton showed pictures of the roller coaster, dance hall, going to the beach or the movies, and how much things cost at that time. Payton who is a Thoughtful Engagement® Specialist made Mrs. X a grandbabies photobook with their names on the pages so that Mrs. X could flip through and see her precious grandbabies and the reminisce on the times she spent with them when they were little. Mrs. X LOVES this book and keeps it on her coffee table so she can show anyone who comes to her room about her grandchildren and her early life at Coney Island, NY.
Payton also found a time period history and pop culture book about Coney Island with many pictures, maps, and information dating back to Mrs. X’s time there. Even though Mrs. X’s memory prevents her from sometimes remembering who she is in pictures on the walls and videos she sees, she always remembers herself with the grandchildren and what she experienced growing up by Coney Island.
These two books have calmed Mrs. X when she appears angry or frustrated. They have provided hours of joy, as Mrs. X pours over them with Payton. They have also helped new caregivers understand what is important to Mrs. X.
When Mrs. X’s son visited to help get her settled into a memory care, the first thing she did was show him the Coney Island book. She asked him with excitement, “Have you seen this yet? It’s all about me!” That soon followed with showing him the book on her grandchildren. These two books went with Mrs. X to her new community. During this transition, the books kept her connected to who she is and what brings her joy. They have helped the staff learn who Mrs. X is and has given them tools to start conversation and build relationships. Some of the first pictures her family shared with the Thoughtful Engagement® Specialist, after the move to memory care, were of Mrs. X showing them her grandchildren’s baby book in her new room at her new facility.
In Blog # 12, we learned how life stories and reminiscing can help with disturbing behaviors that our loved one with cognitive impairment may be experiencing. This success story, submitted from Nicole, supports the importance of this type of programming. Yet, it also provides insight into a developing research focus: emotional remembering for those with cognitive impairment, also documented as amnesia. Feinstein, Duff, and Tranel (2010) report that “A second experiment using a happiness induction procedure yielded similar results, suggesting that both positive and negative emotional experiences can persist independent of explicit memory for the inducing event. These findings provide direct evidence that a feeling of emotion can endure beyond the conscious recollection for the events that initially triggered the emotion” (p. 7674). This research demonstrates the significance of our interactions with those experiencing cognitive impairment and emotional memory. Mrs. X’s emotional memory was intact.
Buettner and Fitzsimmons, in their book NEST Approach: Dementia Practice Guidelines for Disturbing Behaviors (2009) notes the importance of creating programs that focus on the roles our clients filled during their lifetime, because they provide “opportunities to feel productive and useful, promotes self-worth and a sense of accomplishment, and maintain identity” (p. 131).
Whereas Mrs. X moving from one environment to a more restrictive environment (memory care) may have involved negative or disturbing behaviors (frustration, anger, depression, verbal aggression) instead, the artifacts helped create a peaceful transition from one facility to another. The books brought a sense of purpose, meaning, and validation to Mrs. X and allowed for peaceful integration into the new facility. A study on life roles and elders, done by Moral, Terrero, Galan, & Rodriguez (2014) notes that reminiscence “ is associated with the continuity of relationships. Narrative reminiscence serves to maximize opportunities to experience positive affect in social encounters” (p. 241). Moral, et al, in comparing the control group with the experimental group (those who participated in narrative reminiscence) found that “individuals in the treatment sample of older adults in an integrative reminiscence group demonstrated statistically significant reduction in depression symptoms and a significant improvement in self-esteem, integrity, life satisfaction, and psychological well-being” (p. 240).
Programming for life roles with the inclusion of a tangible artifact, in both blog 12 and this blog the artifact is a book, provides our clients with the ability to share that they have lived a meaningful life.
References
Buettner, L. & Fiztsimmons, S. (2009). NEST Approach: Dementia Practice Guidelines for Disturbing Behaviors. State College, PA: Venture Publishing.
Feinstein, J., Duff, M., & Tranel, D. (2010). Sustained experience of emotion after loss of memory in patients with amnesia. Proceedings of the National Academy of the Sciences of the United States of America. Retrieved from https://www.pnas.org/content/107/17/7674
Moral, J., Terrero, F., Galan, A. & Rodriguez, T. (2014). Effects of integrative reminiscence therapy on depression, well-being, integrity, self-esteem, and life-satisfaction in older adults. Journal of Positive Psychology 10(3), p. 240-247.