Holistic care is way to view a person and her health challenges in a way that recognizes the whole person- body, mind and spirit. There is an increasing emphasis on assessing and treating people holistically, and this needs to be extended to those with Alzheimer's and related dementias as well.
In mainstream society, we're pretty good at addressing the body perspective. For example, we may look at the physical changes someone experiences, or the benefits of physical exercise for people with dementia. We might identify different declines in physical functioning based on which stage of Alzheimer's the person is in: early, middle or late. There are also lots of resources available to assess pain in people with dementia, and traditional medicine offers many options to treat that discomfort.
We also generally do an adequate job of addressing the mind perspective, especially in Alzheimer's. There are many screening tests that assess cognitive functioning such as the verbal fluency test, Stroop test, the Mini Mental State Exam, and more. We place a lot of emphasis on memory functioning, and are doing a better job overall with offering education about dementia to patients and their families so they know what to expect.
What we're not always so thorough with is assessing, addressing and understanding the spiritual aspect of people with dementia. For many people, the spiritual and religious aspect of the their lives are extremely important; yet, minimal attention might paid to these areas.
Hospitals and other organizations have, however, made small gains in this area in the last several years. For example, organizations like The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)) requires a spiritual assessment upon admission to a nursing home. That spiritual assessment may be minimal, such as asking if there is a faith background patients would like to specify in their medical chart, or it may consist of more in-depth questions. Some healthcare organizations such as hospitals or nursing homes employ a chaplain to spend time with patients or families who request those services.
Barriers to Addressing Spiritual Needs in Dementia
- A Desire to Not Offend
Some caregivers avoid asking any spiritually-related questions because they want to avoid offending the person or her family members. They might be concerned that the patient would view this topic as a very personal aspect that they might not want to share with others, although the opposite may also be the case.
- Uncertainty of What to Ask
Others might desire to address the area, but have no idea where to start this type of conversation. It's not quite as easy as saying, "Do you have any pain today?" or looking at a lab report and noticing a value that's outside of the normal limits.
- Lack of Training
Similar to the uncertainty noted above, very little if any training on addressing the spiritual needs of people with dementia is offered. If you're a professional in the field, it might be easy for you to recall a recent training on infection control practices or addressing challenging behaviors in Alzheimer's, but when's the last time you had any type of training in this area?
- Discomfort or Incongruence with Your Patient's Faith
You might avoid this topic altogether because you believe differently than your patient does. It's important to remember that whether you are completely comfortable with faith and spirituality or adamantly opposed and distinctly uncomfortable, this is about the person with Alzheimer's, not you. You're not there to push your own faith on that person, and you're not there to deny them the encouragement and comfort it provides for them.
Alzheimer's Association. End of Life. Accessed November 29, 2012. http://www.alz.org/documents/ct/B3_End_of_Life.pdf
Alzheimer Scotland. Palliative care needs of people with dementia. Accessed November 29, 2012. http://www.alzscot.org/pages/policy/palliativecare.htm
Catholic Medical Quarterly. The Journal of the Catholic Medical Association (UK). Accessed November 29, 2012. http://www.cmq.org.uk/CMQ/2011/04-spiritual-needs-dementia.html
Social Care Institute for Excellence. Dementia Gateway: Getting to know the person with dementia. Exploring spiritual needs. Accessed November 29, 2012. http://www.scie.org.uk/publications/dementia/know/spiritual.asp