Ellen Langer has been writing about the value of mindfulness for over 35 years. I read her book Mindfulness in the early 1990s. I still have my copy. In it, she points out the tremendous influence context has on our perception of something’s value. She gives the example of heroin, something we consider intrinsically bad, yet can be beneficial when used in the context of pain management at the end of life. As she points out, heroin itself is neither bad nor good. Its value or detriment depends on the context in which it is used.
When I began working with people who have dementia, I chose to avoid existing approaches to dementia care because of what I had seen done in care facilities in the name of professional dementia care. My goal was to learn from my clients directly how to best provide care and support. Wanting to be mindful, I chose to not be influenced by preexisting contexts or notions of dementia care.
Mindlessness is a tool for those experiencing dementia and Alzheimer’s
What my clients taught me was to allow them to use something else that Langer writes about: the tools of mindlessness. We all know the experience of having repeated a task or activity so frequently and often that we lose consciousness of its steps. The task becomes something we do without thinking—mindlessly. Langer identifies “automatic behavior” and muscle memory as tools we can use mindlessly.
Applying her premises, I approached even mindlessness itself without context. What I found is that although automatic thinking and muscle memory may not be helpful to those of us with healthy brains, they are essential and irreplaceable tools for those experiencing dementia.
When someone loses rational thought and memory, being able to perform a task or activity without being conscious of the steps involved is very valuable. As working memory declines (the ability to recall what has just occurred) and memories from the recent past melt away, they can still use automatic thinking to get through daily life if they are in a familiar place. Many of my clients have continued to function safely at home long after they were completely unable to function outside it. When they are performing tasks in an environment that is unchanged, they are successful using automatic behavior and muscle memory—operating mindlessly.
The effects of moving a person with dementia
What is the importance of all this? It means that the most detrimental and unkind thing we can do to people who have dementia is to move them. We take away two of the limited number of cognitive tools that are still available to them.
Even more important, it is economically foolish. Dementia takes away cognitive functioning long before a person’s physical body declines, necessitating long years of costly care. Long-term care in a facility is very expensive. It is bankrupting families and putting a huge strain on Medicare and Medicaid. Enabling people to stay at home longer is not only kind, but economically sensible.
In December 2015 I spoke with two faculty researchers from the Langer Mindfulness Institute. Deborah Phillips, Ph.D., in Boston, is currently doing research on the value of mindfulness in chronic illness. Francesco Pagnini, Ph.D., in Milan, Italy, is focused on research in the areas of MCI and dementia. They were intrigued by my proposal that mindlessness is a valuable tool in dementia care.
I started the conversation with Deborah and Francesco. Research follows theory, but it takes time. So let’s make the conversation public. Let’s put mindlessness into practice in dementia care and see if it helps more people than just my clients. If families across America knew to keep their loved ones in familiar surroundings, they could put off long-term care and avoid its expense. Dementia causes too much emotional pain and too much expense to wait.
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FAQs about moving someone with dementia
In a perfect world we would all be able to age in our own homes with a team on hand to meet our increasing needs as dementia progresses. However, very often this isn’t possible; most of us need to move from our homes into care. When a move will be required, it’s important to plan for the optimum time—either very early in dementia while the person is still able to use memory and rational thinking skills to relearn self care in their new surroundings, or late enough that they are less aware of being moved out of their homes and are in need of full care. Keep in mind that when someone has lived in the same home for some time, they are using automatic thinking scripts and muscle memory to perform tasks and function successfully. Once they are moved out of their familiar surroundings, they lose those tools and their ability to function drops dramatically. This is why so many people must be moved a second time into memory care within weeks of being moved into assisted living for their “safety.”
If you must move someone with dementia, try to arrange their new residence as much like their home as possible. Take photos of the arrangement of their furniture, pictures and even knick knacks to recreate entire walls. Be sure to arrange the furniture so doorways between rooms are in the same location (especially between bedroom and bathroom). Without memory skills or rational thinking skills, people who are experiencing dementia will have been relying on muscle memory and automatic thinking scripts to do many tasks around their house or apartment. Once dementia takes away our ability to learn new steps in a process, we cannot relearn how to make coffee or find the bathroom in the middle of the night in a new location.