Losing and retrieving

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• Priscilla Ebersole, PhD, RN, FAAN

When I was young I didn't dream there would be a day when the tip of one finger could control a vast amount of information. Yesterday I deleted 72 e-mail messages by selecting all messages rather than just junk. Later in the day, I retrieved a history of dementia with a few finger taps on google.com (search: History of Dementia, www.sciencedirect.com/science). But how did I recover from that earlier blunder? I have a backup system—our wonderful managing editor, Leslie Flatt, who receives almost everything that is of importance to GN. What possible relevance does this have to dementia? A great deal.

First, and most important in my mind, is forgetfulness panic. “Oh, dear! What have I lost?” Age-associated memory impairment (AAMI) exists and is normal for most people after age 80, although some 40-year-old gerontologists may quibble about this. The average (as if there is such a person) older person will forget details that are unimportant—and maybe a few important ones—and often will not register automatic actions or insignificant events that occur each day, such as, “Did I take my eyedrops this morning?” or “Where did I put my glasses?” Adaptive mechanisms have also developed automatically for most of these people, however. Ordinarily, elders develop backup systems that work beautifully for them. The vial of eyedrops is placed differently in the medicine cabinet after the morning dose than before. Several pairs of glasses are placed at strategic points. Everything that is important is written down. Grandchildren can be tapped for their more exacting, although often misinterpreted, memory of whatever happened last week. When one walks downstairs and forgets why, one simply turns around and goes back up; exercise is a wonderful mental and physical restorative.

The fear of dementia is overactive, and many elders live in dread of developing Alzheimer's disease or a related disorder. Each little lapse of memory triggers an anxiety reaction that blocks clear thought. The fear of an irreversible dementia is serious because if we lose our memory, we lose our personhood. We “lose it.” We lose “I.”

My 4-year-old granddaughter often wants to talk about when she was a baby. Initially, I thought her focus on that was a trifle unusual, but now I see it as filling in the amnesia of babyhood. She wants to know who she was and what she did, and especially how “adorable” she was. So yesterday we retrieved a dozen or so photos of her babyhood and talked about each one of them—why, when, and where they were taken, and so forth.

These ideas can just as easily be transferred to working with an elder who has mild to moderate dementia; maybe even beyond that. Whatever threads of memory may be awakened will make life a little bit more worth living, and even if none are stirred, the special attention will feel good. So who has time to do that?

Visual images, foods, objects, fragrances, memorable music—all can be tools of stimulation, used carefully to avoid overload and to enrich daily existence. How about assigning group leadership to select aides?

When dealing with individuals in the home, nurses are detectives, seeking small clues in the environment that may activate thought-provoking comments to an elder or a family member. Irreversible dementias, particularly Alzheimer's disease, have been the subject of a great deal of geriatric research. Nurses and family members are the people who must deal with the manifestations on a daily basis. We are pivotal in identifying the reality of loss, preventing unnecessary loss, and activating methods of personhood retrieval. We are the “backup system.”