"The real voyage of discovery consists not in seeking new landscapes but in having new eyes."
Thursday afternoon, June 6, 2019, Al Powers, MD, board certified internist and geriatrician, invited an Elder Ashram packed room of elder community and family members, staff, and related professionals, to view dementia in a different way from the commonly accepted medical definition.
Living with a Changing Ability
Powers replaced the medical definition of dementia, which focuses on loss of memory and other limitations, with the following more accepting definition: “Dementia is a shift in the way people experience the world around them,” he asserted. He gave as an example his colleague Richard Taylor’s definition towards the end of his life: “I’m not dying with a fatal disease. I am living with a changing ability.”
“For medical purposes,” Powers said, “We need to use certain terminology.” “However,” he continued, “a more experiential definition of dementia allows us to relate to the world with a focus on well-being, rather than a focus on drugs and disease.”
Powers noted that we expect more perfection from people with an illness than we do for ourselves. “We shop in bulk at COSCO, yet we call seniors hoarders,” he said. Instead of measuring how many falls we have had or words we have forgotten, Powers suggested that we reflect on what makes a life worth living.
Perfectionist related experiences that come to mind are as follows: Do we focus on how many falls a toddler makes when he is learning to walk or how excited he is to be able to balance and move forward on his own? How many mistakes a new teacher makes with her first classroom experience or her evolving teaching skills? How many mistakes we make learning a new computer application or our ability to master the technology? Maybe we can be more compassionate with those with an illness if we are more aware of our own perfectionist tendencies.
Seven Domains of Well-Being
Powers outlined seven domains of well-being that he describes more fully in his books Dementia Beyond Drugs and Dementia Beyond Disease. The first four domains form the basis of well-being: Identity, Connectedness, Security (emotions, trust, dignity, modesty, respect), Autonomy (independence, freedom to take risks). The higher level domains, Meaning, Growth, and Joy, demonstrate that people living with dementia are moving from cognition, through emotion, and into spirit. What a journey!
To implement these concepts, Powers advocates paying more attention to care of, communication with, and education of care partners. For example, he noted that “sundowning” often comes around with change of shift. “In one community,” he recalled, “they changed how care partners left the community, making sure staff departed out a back door, without commotion.” He noted that changing the experience of community members during staff shift changes dispelled their sundowning behavior.
“How often do we engage people only when we have something we want them to do?” Powers asked. He asked participants if we’d like to be given a shower by another person? By how many different people? To prevent negative shower experiences in assisted living, he suggested that one’s naked body be exposed to as few people as possible. Powers’ advice: SEE (Slow down, Engage, Empower).
Nader Shabahangi, host of the presentation, joined Al Powers as the conversation moved to a focus on service. When asked how we view service, participants responded: “respect for one’s uniqueness,” “access to the outdoors,” “small groups and one-on-one activities to accommodate the needs of introverts, as well as extroverts,” and “involving elders in decision-making.” Both community members and related professionals emphasized the importance of self-care. “If you can’t give to yourself, you can’t give to others,” noted an elder.
What were the takeaways from Dr. Powers’ presentation? Feedback from participants included moving away from medical categorizing of people to a well-being approach, in which each person is valued for who he/she is now, as well as for his/her past experiences, care for self, as well as care for others, and opening oneself up to seeing through the eyes of others. Participants appreciated the interaction with the speaker and with each other, both during his presentation and after the presentation.
As Dr. Powers noted, “The joy of discovery is to see through other people’s eyes.” The afternoon get-together provided an opportunity for participants to both listen to others and to share their own perceptions of illness and well-being.
Powers’ presentation exemplified the vision of the Elder Ashram community. “Elder Ashram: The Art of Aging,” is an assisted living community, located at 3121 Fruitvale Ave, Oakland, serving our elders and teachers.
The elder ashram is a place of learning and being with, where elders and their way of being are exactly what we younger ones, we children and adults, need to learn. Not only will it satisfy our search for inner and outer peace, but an elder view of life might be the sole way we humans can sustain living on our planet.
Sally Gelardin, EdD, is an educator/trainer and former Regional Engagement and Education Director of the communities upon which Elder Ashram is founded. Totally aligned with its vision, she puts into action the concepts upon which the Elder Ashram is based.