My 16 year-old cat Andy has been showing the signs of dementia for the last year or so. Her symptoms worsened since the death of her beloved kitty playmate Lucy six months ago. Working with dementia patients in hospice, I have known on some level what helps in caring for them. Andy has been my personal teacher, helping me deepen my understanding of the needs of individuals with dementia, and I have learned so much from her on an emotional and heart level.
1. The need for safety.
Like children, dementia patients need to feel safe and secure in navigating their world. Andy has always been a “talker” – she may be part Siamese with her pretty blue eyes. However, her quiet meows have morphed into loud yowls. She sometimes seems to be in a panic. Talking to her in a soothing tone is helpful.
Andy has her own fleecy bed, which we bought for her after Lucy’s death. She seems to feel more secure when she is in it. The soft texture and rounded walls of her bed really seem to bring her comfort. In contrast, when she roams freely around the house, she appears lost, anxious and confused. This affirms for me that smaller rooms with familiar objects are most helpful for all with dementia.
2. The need for food, touch and motion.
I learned in my Human Development psychology class that what infants need most is food, touch and motion. That’s why we feed babies on a schedule, give them lots of affection, and rock them to calm them and help them sleep. The same applies to elders with dementia – including Andy. She asks for food like clockwork every two hours. So, we feed her on that schedule. Food is definitely comforting to Andy, and I believe the consistency of the schedule helps her too.
It goes without saying that we all need touch – Andy certainly does too. As to motion, I recently learned that picking Andy up and rocking her like a baby really helps soothe her when she is anxious. Similarly, we often see repetitive rocking motions in our hospice patients with dementia, demonstrating that rocking is an innate self-soothing response.
3. The need for caregivers to set boundaries and take care of themselves.
For a while, my husband and I followed the every two hour feeding schedule around the clock. However, we recently stopped doing this because we were becoming dangerously sleep deprived. Andy would be relentless at all hours of the day and night in her quest to be fed. It was difficult for me to stop giving in to Andy, and even more difficult to confine her to one area of our home during sleep hours. Having let go of my resistance to setting this boundary, I must say that it has been a huge help in keeping my husband and me healthy and less stressed out.
Self-care is vital for caregivers. I often remind my caregiver clients, both in my hospice job and in my psychotherapy practice, that if they don’t take care of themselves, they won’t be able to take care of others. It’s crucial to take breaks, set boundaries and get support. As they say in the safety announcement on airplanes, put your own oxygen mask on first before attending to others.
4. The need to acknowledge grief and loss.
After witnessing my cats’ reactions to the death of their buddies, I am clear that animals experience grief. Andy’s grief is expressed in searching behaviors, seeking Lucy in the places where she would hang out before her death. Likewise, people with dementia experience grief and loss. Like young children, they may not be able to express their grief on a verbal level, but they definitely feel that someone important is missing in their lives. In caring for the bereaved with dementia, it is important to validate their feelings of loss and provide comfort and safety.
5. The need for validation, dignity and respect.
The need for validation, dignity and respect is universal. There is a tendency to treat the old and infirm like helpless beings who no longer have any worth. That is a mistake. We all want to remain independent and in control, to the extent possible, throughout our lifespan, as well as to be treated with dignity and respect, no matter what the circumstances.
The hospice staff does whatever we can to give all of our patients a sense of autonomy and dignity. This is also an instinctual need for cats, who retain the imprint of their past lives as predators in the wild. Accordingly, cats do what they can not to show weakness, to prevent becoming prey to stronger animals. With Andy, this is expressed as a need to assert herself and get her way – which we accede to within healthy boundaries.
Our elders deserve our respect, and not be abused or put down for their frailties. The same applies to cats – they are proud animals. (I guess that’s why they call a related group of lions a pride!). I do what I can to give Andy the dignity and respect she deserves.
6. The need for gratitude and acknowledgement.
We all want to be acknowledged for what we have accomplished in our lives, and to feel that sense of accomplishment. Humans do this by telling our life stories, as a way to create meaning and validate that our lives have had purpose. This is called “life review.” One way we engage in life review with our nonverbal hospice patients is to look at old photo albums together, or look at magazines about their interests and hobbies.
I intentionally take time to thank Andy for all the joy and comfort she has given me throughout the years, and for all of the richness she has contributed to my life. I don’t know if she understands my words, but I believe that she understands the loving energy that accompanies the words. So, thank you, Andy, for all of your gifts, and for this new gift as my teacher in your waning years.