Denial and Isolation

Well, I humbly come to you no longer from the sidelines but from the field. Dr. Cate, Dementia Coach has been forced to put on a helmet and uniform. Yet even as I write this I question if indeed I am exaggerating. Just because my spouse has said for the past three years that he is having processing problems. Just because he emits off the scale anxiety around any new process, including opening a new piece of equipment . . .
I do not have a diagnosis. Maybe it is all in our heads. Maybe he is just crying wolf . . . and I have come to believe him.

I believe him more than he believes him. I believe because I remember the times he has had a meltdown. He does not. I am the one taking the verbal assaults when he is melting. I forget my helmet and find myself pummeled and bruised an hour later . . . while he is resting on the bench joking with the water boy.

Of course the game is even more challenging in that it is taking place on a 41 foot sailboat in the Caribbean surrounded by Heston-like individualists who reject the US, the locals, and most things I value.

So the Dementia Coach regroups. I think of my caregiver advice. I took up Zumba in town. The walk to and from has given me necessary space to reach out to experts, counselors I have worked beside. The Zumba feeds my physical and emotional strength.

We have discussed the need to return to the US. Dreamkiller is a name I have chanting in my subconscious. Though my spouse never says it quite that way.

As we sink back into denial between incidents I hear how the hard part of sailing the Caribbean is over. It’s all downhill from here. It is a cake-walk from here. Others saying, you can’t go home without going down island, you are so close. And the Puerto Rican Zumba ladies, stay—we have all that you need. Yet the Alzheimer’s Association helpline voice recordings were in Spanish and never called back. Even though I stated I was a spouse looking for support.

I am amazed and thrilled to experience the magnificence of a Caribbean sunrise or sunset. I am honored to become acquainted with Puerto Rican women who seem more grateful for life than my local boaters. I understand also that my language deficits adds to my naivety.  It protects me from knowing much of what is driving them.

Little does my spouse know, I do not see “downhill from here” as positive. I see fraying line and fear the emergency replacement needed during an assault by the gentle Caribbean. I hear how his arthritis is making everyday chores difficult and I project how that will play out trying to clip a harness to a safety line. Biggest of all . . . I see a mechanical or electrical incident, minor or major that will require split second processing and fear neither of us will be up to the task.

But as I step out of my caregiver anxiety and look at the game’s history, I see that most spouses have had to be the bad guy not just once, but many times. Whether it is getting the diagnosis, removing the keys, distributing medication, placement in memory care . . . life as a caregiver requires the ability to be the bad guy.

Which circles me right back to enjoying the moments here today. Waiting for any critical decision until we have a memory assessment in December. Practicing self-care.

Posted in Caregiver, dementia denial, Travel Truths | 2 Comments

Not All Specialists Are Special

We were recently referred to a neurologist based on my husband’s feeling that he was losing his memory. At the age of 64, his general practitioner agreed that it was an issue worth investigating. This is a life curve that provides me with an insider view resulting in quandary and possibly denial. It is like walking through steady fog, I think I see clearly but maybe I do not.
So the dementia coach in me was in absentia when I scheduled the second neurology appointment in three years. Despite the many family caregivers who had expressed that the best evaluation they ever had was from a more intensive Gero-psychology based evaluation, we went to a referred neurologist.
Despite the specialist fee charged, our experience was far from special. The visit lasted less than 15 minutes, involved a cursory physical assessment, the traditional three question quiz and a brief discussion with my husband as to what he felt his symptoms were.
The thing that was most appalling to experience was the complete disregard of the spouse’s perspective. Never once did the doctor direct a question or even eye contact to me during the visit. Of course I had no expectation that the doctor would be attuned to my training or professional experience. Let’s face it, most medical doctors would not see a doctorate based in psychosocial dementia interventions as an expertise. But I did expect he would be astute enough to value input from the spouse.
At the end of his brief assessment, he told my husband “probably mild cognitive impairment, nothing to worry about.” At which point my inner researcher went ballistic. In my best patient advocate voice I stated, “We live on a boat, is this a problem? I am worried.” To which he stated, “You have auto-pilot, no need to worry.”
So as we leave my inner researcher is still screaming while inner wife of a 64 year old man is happy to have dodged the bullet. Just a little MCI. Like just a little pregnant. No need to worry. We have instruments. . .
So it is after some time away from the ordeal, we have agreed to have a more thorough clinical assessment. Hopefully one that will result in silencing the raging researcher with truly specialized testing. We have, of course, postponed this assessment until winter because . . . well either wisdom or denial. To be cont’d.

Posted in Care Options, Caregiver, Specialist | Tagged | 1 Comment

“You’ve Got This”

We recently had the honor of witnessing the birth of our grand-daughter. It was a long labor. I found the difference in perspective enlightening. Let me simply state, the view is drastically different from the receiving end of natural birth.  In the final hours of my daughter’s labor, I definitely wanted to intercede. It was more difficult than I had remembered. I realized that it is all in your perspective.

The same perspective shift that I am experiencing as a spouse of someone reporting memory decline. As I, Dr. Cate, Dementia Coach, try to practice what I preach. As I try to be pro-active in assessment, in long-term planning, it surprises me how difficult it is as a spouse. Yes, I am embarrassed by that last statement. It is a world of difference when it is your husband. So far we have a neurologist’s decree of possibly Mild Cognitive Impairment. My training prods me to not settle. We will be seeking a more thorough assessment. But for now, we are enjoying each day. My husband has been overwhelmed with my pro-activity, unhappy with others’ knowing. And so it goes. A world of difference from a different perspective.
Research shows that caregivers who manage to sustain self, first reflect on past experience. In my tough times since my 20’s, I always have used the birth of my children as my touchstone. When things get difficult, I remember I labored three times with three amazing children as the result. Mike and I jointly labored through the grueling dissertation process, through the wind-on-the-nose Caribbean process. If we got through those successfully, we can get through this “near and present danger”.
My daughter says that every time she looked at me during labor, I was crying. They were tears of amazement and of love. Throughout her labor, she and her partner/spouse were incredibly engaged. It was a partnership to rival all. He was awake and responsive to her every need. I was moved to tears by their teamwork. This was so far from my personal birth experiences.
When my grand-daughter’s entrance to the world was seemingly imminent, twenty-three or so hours later, my daughter’s energy was low. my son-in-law’s role as coach became all that more vital even though he too had had no food, little hydration, no sleep. “You’ve got this,” was his repeated encouragement, just one more push, “Almost there.”
So in a recent tour of seminars and marketing with dear friends and eldercare peers, I too benefited from partnership. As I pro-actively checked into our affairs, I felt partnership as powerful as that of my daughter and son-in-law. Partnerships for the journey. The coaches for the coach.
No matter what is ahead of Mike and me; regardless of the assessment results; I will need the premier partners and coaches so evident in friends and colleagues. And as we look to sustain self, we reflect back on dissertation, miles traveled upwind . . . and I will know “We’ve got this!”

Posted in Uncategorized | 3 Comments

Sorting Shells

As I sat in the plane flying back to our boat, I thought back on the last five days.  Five days spent at the Homestead with my youngest daughter and son-in-law prepping for my first grandchild.  It had been a great visit, as they always are.  I reviewed the time, much like a shell collector, sorting the best, turning them to see each facet and marvel at their beauty, rejecting the damaged or incomplete.  Classifying memories.

It occurred to me how universal this process is.  Probably each individual on the plane was going through the same process in some manner.  Maybe some were prepping business reports highlighting accomplishments, maybe some were quicker to discard, less likely to analyze thoroughly.  But at some level there was or would be a recap.

As I looked at the best moments of my visit, I saw that they were centered on time with my immediate family.  The time spent exercising with my two daughters, the laughter, the camaraderie, and the memory of previous sessions.  The moment I saw my son-in-law, beaming with happiness.  The tender moment of seeing mother and father marveling at the baby’s foot through mother’s stomach.  Seeing my oldest daughter totally self-assured, beautifully turned-out, placidly supportive and in charge as needed.  Fondling these memories was like fondling prayer beads.

I have returned to these recent memories several times in the re-telling of my trip. In the middle of the night when I become anxious about the weather or missing the birth.  When I worry that I am not seeing enough of my other children, I find myself returning to these positive memories and fingering them just like a devout fondles and reviews their prayer beads.

These memories frame who I am, what I value, and how I will one day respond if my memories are washed away by the tide of dementia.

With dementia, I may have no memory of my children’s names, but I will marvel at their pictures in a scrapbook.  I will always marvel at a pregnant woman.  I will be positively influenced by a self-assured, placidly supportive and in-charge woman. I will gravitate to the artistic beaming face as familiar.  I will feel a certain awe in the presence of youthful joy and enthusiasm.

In dementia, I would prefer that my caretakers know my values, my preferences.  I would prefer that my care is not a random shotgun approach to determine what defines and moves me.

How can we as caregivers best capture the essence of an individual? A simple biography is a start.  But how do we zoom in beyond ”values family”, “has two daughters and a son”?

A good starting point is to look within.  Take a moment and ask what memories best frame your essence.  What are your precious shells?  What are the prayer beads that get you through anxious and difficult situations?  Savor these.

Meanwhile collect more shells and show them to those you love.

Caribbean Rainbow

Caribbean Rainbow

Posted in Care Options, Person-Centered Care, Travel Truths | 4 Comments

De Nada

Responses to thank you. We say, if we are being polite, ‘You are welcome.” Here in Puerto Rico, they say “De Nada”. It’s nothing. That is somehow heartwarming to hear. It’s not a big deal. You can ask for more, I will do it, all those things seem to be said with “De nada”.

As I have journeyed, so has the Alzheimer’s community. Today I see a much more positive side of Alzheimer’s being presented. Sites like Living with Jim and Mom with Alzheimer’s focus on what is happening in the midst of the disease. There is much more of a feeling of life goes on, and this is how it changes. Rather than life stops and it sucks. I see more of the glass half full, A feeling of “De nada’, It’s all part of life, it is not the end. I can deal. Together we can.

A new book, The Long Hello offers this same perspective. The 36 Hour Day is still a good resource, but it has been rounded out. Perhaps Still Alice in the theaters will be a call to more funding and more action to maximize life with the disease as well as end the disease.

Posted in Psychosocial health, Stigma, Uncategorized | 1 Comment

Sea-batical

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Rincon, Puerto Rico

 

Dr. Cate, Dementia Coach has been on a bit of a sabbatical, in the Caribbean. It has been life-changing in many ways. The deficit of internet, the influx of foreign culture, new languages, and the rigors of some tough sailing days have taken precedence. It has, in many ways, been an out-of-my-world experience with a total immersion in living moment by moment. After six years in the academic environment coupled with four years in a fast-based memory care admissions role, I have been thrust into a very physical and survival-based present. One that has been far from any idea of my personal comfort zone.

In reality, my day is often exactly like the day of an individual with dementia. I have limited sailing experience, the guide books are often out of date, and I am constantly feeling uncomfortable. Just about the time I start feeling comfortable, we move to a new place. Sometimes this place is pleasant, sometimes it is not.

There are several glaring examples of how this life magnifies my dementia experience and commitment to quality care. This past May we journeyed from the slightly familiar and friendly environs of the Bahamas through the Windward Passage to Ile a Vache, Haiti. Here my French language education was put to the test in understanding the local Creole. Many times my French was sufficient for understanding and communicating. In those times when I could not understand what was being asked, I felt much like our loved ones and clients with dementia. The advantage I have is my ability to revert to basic validation techniques. Because of my years of work in long- term care, my go-to response is a positive affirmation, in the case of Haiti, it was “Oui, oui.” Keep in mind that this response doesn’t necessarily mean I understand, but it does communicate willingness and buys me some time to hear a word or see an expression that I can utilize.

As those of us in eldercare know, body language and expression are key to communication. In the case of the Ile a Vache boat attendants, I soon learned that “No, no,” was often more appropriate since their boat-side visits were always requests for goods or work. We employed one “volunteer”, Pepe, to lead us to Madame Bernard’s market, a four mile journey through Haitian culture. We were very grateful for his English skills and cultural aptitude when we reached the market. From neighing goats, live chickens held upside down, piles of unknown fruits and nuts, people who looked, walked, and behaved differently—there was severe sensory overload. I wished I could have been invisible so I could simply stop and take it all in and try to process the input. Some sights were astonishing. I had to consciously remind myself to maintain a poker face so that my foreign face did not judge.

My response was similar to the instinct of an individual with dementia who stops in the center of an environment, refusing to move. “Let me try to make sense of this.” Often, they too have inappropriate affect. We hung onto Pepe’s heels tightly, much as our loved ones or clients hang onto our steps. “If I lose sight of you, I don’t know if I can cope. Please stay close.”

This same validation strategy was re-enforced when we reached the Spanish-speaking regions of Dominican Republic and Puerto Rico. My Spanish is very newly learned, and elementary, so I often feel overwhelmed by the language demands. In the Dominican Republic (DR), we usually had a bi-lingual guide who mitigated the stress. As Fernando and Ricco negotiated prices I listened with the same astonishment and confusion as an individual with dementia. If we were in the central open-air market, the sensory input was over-powering. No goats or upside down chickens here, but many uniformed men with automatic weapons surrounding the market which created a level of tension.Perhaps the same level of tension we would see when a school of medical students in white coats would tour a memory community.

The DR market was abundant with amazing colors and scents of produce, spices, coffee, nuts. It made us salivate and crave and marvel. We were intrigued and had a tendency to linger with our guide encouraging us along. The same response our memory clients had when we expose them to children, a local farmer’s market, a restaurant experience.

Rosetta Stone™ had not yet prepared me for market day. I could not imagine negotiating the sights and sounds without a guide. In purchasing produce, I needed Fernando to identify the vegetable, obtain the price, and communicate the amount. As caregivers we translate peculiarities of the world for our loved ones. Over time, the translations are more advanced as the vocabulary of life slips away.

As we walked back to the harbor with Fernando, a few locals said something to me. Fernando was a bit ahead, so I simply responded with a “Buenos Dias”. Hearing me, Fernando said I might want to ignore them as they had been propositioning me!

How often do we encounter an inappropriate response in providing memory care? I comfort myself that if I have memory loss, I probably will always err on the side of a positive response as opposed to a negative one despite how inappropriate the response may be. As caregivers we protect our clients and loved ones from dangers, we are the guides that know the culture. We accept their response as part of their state of mind.

Leaving the DR we traversed the Mona Passage, a notorious body of water that I had heard about via a family member of one of my memory care communities. Her husband’s past was as a boat captain and many fine memories included the cruising life. One of her favorite sailing memories of Captain was of his consideration of her seasickness in the Mona Passage. I had tucked this memory away for our future, having great respect and some trepidation of the Mona . . . We waited for an ideal weather window before making the crossing from the DR to Puerto Rico. It was uneventful but it was full of acknowledgment of the Captain’s legacy of generosity.

As we went ashore at Boqueron, Puerto Rico, we had a visceral response of relief. We immediately saw US influence affirmed. It was a relief to see dogs on leashes who were well-fed, a phenomenon not present in the Bahamas, Haiti or the DR. It was humorous and a bit embarrassing to see obese people. Clearly we did not land looking for either perspective. But these two images struck us right away.

How often does a person with dementia emote a visceral response to an environment or situation that seems common and unremarkable to us?

Unless you have walked on the wild side, you cannot see the mundane as phenomenal.

Coming from the countries west and north, these things were stop-in-your-tracks notable. From a person with dementia’s cognitive space, many environments and situations seem profound.

On our first trips to Walmart and real grocery stores I had reinforcement on the power of basic validation. As I shopped for clothing staples I was considering price and value as a Spanish speaking woman joined me at the same rack. She began to speak in rapid Spanish, expressing some facial angst, gesturing. For an instant I was torn between telling her “No hablo espanol”, and interrupting her. Instead I matched her expression, mimicked her gestures just as we learned from Validation™ training, and empathized with “Si, si”. Which seemed acceptable. Then I departed quickly for fear she would ask a question, and I would have to admit my Spanish language ignorance. It was a moment or two of empathic validation. Whether I understood completely was irrelevant. What was important was the sharing of the moment. That is the key to quality memory care. Reinforced in a Puerto Rican Walmart.

On this same trip, I needed to “use the loo,” which was surely not the phrase to produce directions in Mayaguez :}. But then I remembered, “Donde esta quata de banos?” This was not Rosetta knowledge. This came from years ago working with an adult day client named Rosa, who was Puerto Rican. She remembered very little English. So, as staff, we used our limited Spanish to work with Rosa. Rosa taught us key phrases and questions like “where is the rest room?” Rosa was a happy and totally engaged client who would correct our Spanish and laugh at our humble attempts. It was the empathy and validation that carried our relationship.

Years later I worked in Rosa’s care home as a recreation leader. Here the staff spoke mainly Hindi. Rosa and I produced a communication board to assist them in those key phrase and words vital to her quality of life. Working in her home reinforced the value of the adult day center in maintaining quality of life.

Cruising in cultures that differ greatly from my US culture has allowed me to spend a bit of time walking in the shoes of an individual with dementia. All of my research and hands-on experience of dementia has been better defined in this journey.

One take-home message for U.S. care providers, memory care excels in the U.S. compared to the Caribbean. Even Puerto Rico has very limited eldercare options, with little to no memory care component. The rate of dementia is not significantly lower, just the response.

As Dr. Cate, Dementia Coach I continue to cruise the Caribbean immersing myself in culture, translating experience and research to improve quality of life for those with memory loss. I happily return to the US for speaking and training. I can be reached at catemccarty@gmail.com.

Posted in Dementia Behavior, Empathic Validation, Person-Centered Care, Sensory Memory | 1 Comment

Deal or Deal Breaker?

Dandelions, daffodils and dreary days.  Each of these images recalls a sensory experience recorded in my primal memory.  Each impacted my life in a particular way from early childhood.  As a child growing up in the suburbs of Baltimore, dandelions were summer flowers that played at my feet as I swung high in the sky on my rope and board swing.  I picked them for my mother, and made them into chains.   They remind me of good simple warm times . . . even when my mind is not really at work.  It’s a primal sensory memory.

Likewise daffodils are harbingers of spring.  They arrive after the worst of winter has passed.  Sunny yellow little trumpets.  Both of these yellow flowers are responsible for yellow being a favorite color.  Bright, warm, promising. 

Both dispel the negative drop of a dreary day.  Gray skies signal doom for me. Add rain and it’s a cool day in a MD autumn.  Add sleet and it is a cold day in a MD winter.

Even though I may be in FL where dreary days are “once in a blue moon”, my reaction will be one of a native MD’er who knows it will be dreary “forever”.   If my cognitive abilities are diminished, my sensory preferences coupled with my personality will dominate. As an individual whose personality is stronger on the feeling side, dreary feels depressing.  My actions may illustrate this more vividly than someone who has a personality that was less feeling-based. 

          For years in healthcare we were trained to recognize the “3 D’s”, Delirium, Dementia and Dehydration.  Symptoms like dementia and delirium are common in older adults suffering from dehydration.  Couple that with a propensity to be dehydrated . . .  many older people are hospitalized for dehydration and resulting Urinary Tract Infections.   Quality elder care providers know the value of offering frequent hydration opportunities. 

How much more effective would it be to offer beverages preferred by the individual?   Are cold or hot beverages preferred? 

Person-centered care focuses on the individual and responds to his/her sensory preferences.Each of the “Three D’s” can be addressed through the individual’s sensory preferences.  Re-directing an irate individual struggling with delirium requires a gentle and intuitive understanding of the individual’s preferences.  Sensory preferences are a big deal.  Offer the wrong solution to a person with delirium:  Deal Breaker.

 If you are caring for a loved one, how are you representing their sensory choices?

As a caregiver, how are you honoring your sensory preferences?  What action or item would make the day less dreary?

Posted in Care Options, Dementia Behavior, Person-Centered Care, Psychosocial health, Sensory Memory, Sensory Satisfaction | 2 Comments

Creosote and Calico?

Sensory pleasures are individual and based in our history and heritage.  It is sensory pleasures that enrich our offices, homes, sick rooms.  As we encounter illness, it is often the sensory pleasures that define “comfort”.  In the continuing exploration of the power of the senses, C is for comfort.

 For me personally, sensory comforts come in the taste and smell of corned beef and cabbage; the smells of coffee and creosote; the beauty of cruising and calico. 

Quite an eclectic list, right?  Taking it one comfort at a time: 

Corned beef and cabbage plays a key role in my adult life while married into the Fitzpatrick clan.  Though a McCarty all my life, Irish heritage was not a point of pride in my childhood but was very much one for my in-laws.  Every March 17th was a high holiday not only as the national day for Irish recognition but as the birthday of our patriarch, Thomas M. Fitzpatrick, III.  The Fitzpatrick clan would gather to share the tangy taste of corned beef and cabbage, the lilt of Irish music and the rare camaraderie of 50+ “close” relatives.  The sensory pleasure of corned beef and cabbage engenders memories of Tom, a gentle man whose experience with Alzheimer’s was life-changing.  His Irish eyes were shining when his family was gathered.

Sharing corned beef and cabbage with two of my adult children recently was a tribute to the spirit of family and heritage.  That my son has cooked it for me several times, each with a lot of love and attention to taste and consistency warms my heart. 

Which leads me to children.  Yes,  my children are all in their thirties, but the memories they have given me are the best I have.   In the words of a favorite poet, Kahlil Gibran, “They are the sons and daughters of life’s longing for itself.”  How beautifully stated, and how grand life is.

The whiff of baby powder, the sound of a crying newborn, the delightful innocence of a four year old’s enthusiastic “speech” are each pleasurable for me and many individuals.  I still find myself unconsciously rocking back and forth when a child cries in a setting calling for quiet. 

However there are some folks who were not able to have children, who did not want children, or who have lost children.  My sensory pleasure is not necessarily theirs.  As caregivers it is important to know the individual’s history.

Coffee and Creosote?  My primary sense is smell . . . both of these smell good to me. This is why:

Coffee is a delight to smell but not to taste in my world.  I awake happy with the smell of coffee.  I drink tea.   Sensory pleasures that may appear universal are individual.  Coffee was a morning smell for the first seventeen years of my life.  It does engender a sense of home.  But only its smell, not its taste. 

Creosote is all about the smell too.  As a child, we went to the beach for a vacation every summer. In our walks to the beach from our rental, the hot sun would bring the smell of creosote out of the boardwalk pylons.  The smell is connected with a positive life experience.  Consequently I always think of the beach when I smell creosote, a distillate of tar that preserves wood from water.

C is for cruising and calico.  I am living aboard our sailboat, Horizon, cruising the Caribbean.  The color blue will always hold a special place in my environment.  As will sunset oranges, gentle breezes and warmth.  I shiver at 68 degrees.  I find the ground very still when I visit my children. Nonetheless I have a Pinterest board or two with home touches that do not fit on a sailboat because I do still have a huge fondness for chickens and calico. They are roots that run deeper than the Caribbean  and hopefully will play a role in my future. 

When and if you or I have no language, when and if our minds cannot logically determine friend or foe, it is the sensory cues that will make our life worth living and our death a pleasant passage.

Why not feather your nest? Record your sensory preferences in Feathering Your Nest, a Blueprint for Comfort  available through Amazon or Old Line Publishing.

What sensory pleasures have gotten you through this day? 

Which ones might lighten your loved one’s day?

Posted in End-of-life, Life Truths, Person-Centered Care, Psychosocial health, Sensory Memory, Sensory Satisfaction | Leave a comment

B is for . . .

“You are not going to do all 26 letters of the alphabet are you?”  my husband asks as I write this post.  I was annoyed, here is Mr. Metric nay saying a rational outline to explore sensory preferences.  I considered dropping him from my email list . . . but of course, I am going to continue to use the alphabet as my foundation for exploring the value of knowing one another’s sensory preferences.

 “Why,” you and he might ask?  In the words of Sherlock Holmes, “It’s elementary, my dear Watson”.  When things are going poorly, whether it be in a relationship, with our health, or our environment—our sensory preferences matter.  A toxic day with my boss can be ameliorated with my favorite potpourri or music.  A bouquet of my favorite flowers goes far in making up for a spousal argument.  My agitation is softened if I can moderate the temperature of my surroundings. 

Our sensory preferences are basic, foundational and elementary.  They are formed from our earliest days and develop over a lifetime.  So join me for a calculated review of sensory stimuli.

B is for beach, baking bread and the B-52’s. 

One of my favorite all-senses place is the beach.  Now as I travel the Caribbean I can capitalize the term . . . The Beach.  It can be any sandy shore.  It does not have to have a particular color of water—blue is ideal but because my history is in North East US, greenish brown is also visually satisfactory.   Throughout childhood I spent one summer a week at a MD/DE beach basking, reading, people watching. The subtle blue tones of the Bahamian beaches are stunning but should my memory regress with dementia symptoms—a picture of a North East beach will be most recognizable.  Sand and shells will be both visually and tactually pleasing providing me with memories of quiet sea breeze day of reading and people watching.  Sifting sand with my hands or my feet would be calming.  An audio of gentle surf would be soothing for me as well.  

Baking bread was a young mother’s weekly event often accompanied by young children.  It was a gratifying hands-on experience with the tactility of kneading.  It was often a satisfying venue for frustration.  The smell of baked bread engenders thoughts of happy home.  As the bread went into the oven, the butter and jelly came out of the refrigerator.  Fresh baked bread was an olfactory and a  taste sensation.

Bake day at the Bixby’s was our name for baking day.  The name reminded us of our one multi-state vacation that included Sturbridge Village, MA, an historic re-enactment of village life in the pre-industrial era.  A whimsical name for a labor-intensive day.

Imagine you are caring for someone and you want to give them a moment of pleasure but you know little about their history or sensory preferences.  A person who had positive beach memories would experience a sand bin with shells as a positive sensory experience.  A person with no beach memories would probably avoid the whole experience. 

Baking bread is an olfactory pleasure almost universal in reach.  Musical memories can be guessed at, based on an individual’s age and the music’s overall appeal.  Benny Goodman and Big Band are satisfying to most adults who were young adults in the 40’s. Those in the 1960’s would resonate more with the Beatles and the late 70’s– the B 52’s. 

Take a moment and think of a pleasant smell, taste, sound . . .

Posted in Person-Centered Care, Psychosocial health, Sensory Memory, Sensory Satisfaction | 2 Comments

The ABC’s of Sensory Preferences

Each of us has our own unique fingerprint as well as our own unique sensory preferences.  With our fingerprint, we can be universally identified often for less than positive reasons.  With our unique sensory preferences we can be universally pleased with an experience or universally displeased.  The range of response is based on our ability to communicate due to illness, dementia.  Regardless of health, our sensory preferences remain. If it is an unpleasant sensory stimulant, we will “communicate” our distaste by some type of negative behavior.  

Those closest to us are more likely to know what sensory stimulant triggers our behavior.  Yet even long-time spouses cannot pinpoint a loved one’s sensory preferences beyond a favorite dessert or color.  Feathering Your Nest, A Blueprint for Creating Comfort is a workbook I have written to build relationships through the sharing of sensory preferences.  When health is challenged, true relationship-centered care requires a foundational understanding of the individual’s sensory preferences. 

Over the next weeks I will be writing my personal primer for sensory preferences.  Using my own sensory memories and preferences I will illustrate the value of knowing an individual’s sensory preferences.

 

 

 

 

A is for apple. 

When I slice and core an apple my memory flashes back to late summer or early fall evenings in the second floor bedroom of our home in MD. The room was surrounded by windows open to the evening breeze.  I called it our “tree-house”.  There were two apple trees near our windows whose over ripe fruit covered the ground.  The apple scent was sweet and heady on the light breeze.  There was a sense of satisfaction . . . long summer nights were mostly passed.  On these aromatic nights, the white tail deer would often wake me as they gathered under the apple trees to munch the fallen fruit.  I can still hear the sound of their chomping and their hoofs scuffing the ground.  I can hear the quick forceful snuff of air from their noses as they sensed danger.  Through these senses, I became part of the night world, unbidden but magical.  There was a sense of calm that descended even if a nightmare had just past. 

All this from the slicing of an apple?  Absolutely!  Smell is my primary sense, hearing a close second.  The slicing of an apple brings back a rush of other senses, all positive for me.

That same apple smell could bring a totally negative sensory memory to another individual.  Suppose the smell of apples brings back the memory of a job at a farm picking, sorting, smashing, juicing apples in the fall.  The work was hot, the bees vicious, the pay low.  The smell of sliced apples might bring back a feeling of fatigue, discouragement, a virtual shudder of reminiscence. 

For me, apple slicing would be a positive daily activity that produces pleasant memories, reduced anxiety and increased cooperation. For another individual, the slicing of apples might be repugnant, causing withdrawal and maybe even aggression.

What sensory memories are triggered today in your world?

Consider this:  If we knew the sensory preferences of the individuals in our life, how much more effective would our care be?

Posted in End-of-life, Person-Centered Care, Psychosocial health, Sensory Memory, Sensory Satisfaction, Uncategorized | Leave a comment