The Needs Behind the Disease

“If you could tell her one thing, what would it be?”, I asked. “That I love her very much”, he said, as a tear streamed down his cheek. 

I recently had the opportunity to spend time at a memory care community in Oregon. The day didn’t go as planned–at all. But, the lessons learned were far more valuable than any plan. We were able to get to know these wonderful people with a variety of different types of dementia and help them express themselves in ways they otherwise wouldn’t be able to.

One gentleman (we’ll call him Mr. Brown), was not particularly interested in joining the group for an activity. His dementia is progressed enough that he needs full-time care, but can still carry on a conversation. He has moments of lucidity and you may not otherwise know of his impairments until he is frustrated with a situation and lacks the ability to communicate his frustration except in somewhat aggressive tones or outbursts.

I sat in front of him and crouched down, so his head was just above mine and he could clearly see me. I had read through his history and talked with the staff about where he came from, his family, what he did for a living, etc. so I could step inside his perspective. Using the empathetic communication techniques I’ve learned over the years, I asked him a series of questions such as:

  • Tell me about your wife.
  • What is she like?
  • If you could tell her one thing right now, what would it be?
  • What is the best thing about her?

Through this prompting (you’ll notice I only used open-ended statements and questions), he told me about how wonderful she was and how much he loved her. Then, his deep underlying frustration began to show with the fact that he needed memory care and had to be there–when all he had worked for his entire life was to ensure they could spend the rest of their lives together.  He proceeded to repeat a few times that he never took government assistance–a point of pride. He worked tirelessly to provide for his family (which was a rather large one) and ensure they could live a long life together.

He is heartbroken. Heartbroken that they won’t have that experience because of a disease that requires them to be apart. That is frustrating. That is miserable. It is understandable that he may have outbursts when he can’t thoughtfully express that frustration.

Needs investigation

We, as humans, have needs that must be fulfilled in order to be happy. We have needs that, if not met, can manifest themselves in strange behavior–often aggressive, overtly sexual, “inappropriate” for societal norms, or resulting in damage to our overall mental and physical well-being. Abraham Maslow’s (1908-1970) most lasting contribution to the field of psychology was the study of happiness. He determined that there is a hierarchy of needs that, as each of the needs are met, allows the human psyche to reach a state of happiness or self-actualization, as he calls it.

Individuals with Alzheimer’s or similar dementias still have the need to self-actualize, they just can’t do it on their own. One of the most powerful tools in our caring toolbox is to learn to identify the needs that cannot be expressed. Then, help the elder express that need or care for that need accordingly. Mr. Brown wasn’t an aggressive person, he was simply frustrated at the unfairness of the horrible disease that is keeping him from his wife. He has a need for love and intimacy from his wife. He has a need to feel useful in caring for those around him. There are so many ways that we can improve the quality of life for those with dementia–if we only begin to understand.

Maslow pyramid and circles.png

About the Author: Amira T. Fahoum is the Director of Marketing and Director of Operations, Northwest Region for Compass Senior Living located in Eugene, Oregon. Her path to senior living started when she simply decided to be open to possibilities in life. Possibilities are what led her to what is now a career in serving elders and families. Possibilities also led her into the world of becoming a Certified Eden Associate, Certified Validation Worker, Levels I and II, and a licensed Assisted Living Administrator in Oregon. On her journey with Compass, she has found true reward in working with, and for, the people that care for others.

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