Recall that at the psychiatric hospital, I worked with two groups of patients:
Adult patients with a mental health diagnosis (usually schizophrenia)
Geriatric patients with cognitive or physical declines due to aging
What worked for the adult patients, didn’t always work for the older adults. I had to find a different approach to working with the geriatric patients because so many of them had severe cognitive or physical impairments due to aging (i.e. dementia, Parkinson’s, etc.) that prevented them from participating in activities that demanded a high level of functioning.
Although I incorporated some mindfulness techniques, I really had to drawn from my cognitive psychology background. At Whitman College, I wrote my senior thesis on memory and aging, so I had some terrific scientific resources to draw from. I also took a class at Whitman called, “The Psychology of Aging.” In this course, I studied the physical, social and cognitive impact of aging, and how certain forms of decline can be prevented or postponed with activity. Luckily, I found most of my notes summarized on my hard drive. I reviewed studies that demonstrated support for the mental exercise hypothesis, which suggests that by using your cognitive “muscles,” one may better preserve cognitive ability.
To illustrate, one study investigated whether older university professors showed less cognitive decline than older adults from the community. Professors were studied because they use cognitive abilities on a daily basis, therefore, they might have better cognitive functioning in old age. The researchers tested fluid intelligence (e.g. reasoning, memory, speed, etc.) in young adults, young professors, older adults and older professors. Older professors scored just as highly as the younger professors and young adults. However, the older adults from the community showed significantly more impairment than the older professors. This study demonstrated that some leisure activities could slow the normal age-related decline of fluid intelligence.
The only problem was that this research studied healthy older adults. In healthy adults, crystallized intelligence, which is acquired or accumulated knowledge, (e.g. language) tends not to decline with age. However, I would be working with older adults suffering from dementia or another mental health disorder. In dementia patients, crystallized intelligence does decline (source).
Can cognitive training for dementia patients help prevent the onset of cognitive decline the same way it helps healthy adults? The science is out on this one. Studies are inconclusive as to whether cognitive interventions lead to significant improvement in dementia patients. However, these types of activities do show increased satisfaction. This was the angle I needed to develop my program for the geriatric patients.
I created a set of cognitively/sensory stimulating activities that would benefit geriatric patients with or without dementia. The activities varied from something as simple as table ball (a response-timing game that involves rolling a ball across a table in one fluid motion, while working as a team to keep the ball from falling off the table) to something as challenging as the game of Memory (the cognitively challenging card game where pictures are arranged in a grid, face down. Players flip over two cards at a time in order to find a matching pair.).
Again, I always worked with a Moroccan nurse to help with translating since very few of the older patients spoke French or English. But the language barrier was not the biggest challenge I had to face. I was constantly surprised by cultural and generational differences. Unlike some of the more obvious cultural differences between Morocco and the United States, these were subtle differences, made more apparent by the older generation of patients. Each time, I had to ask nurse Sara to explain these differences to me, which she did with amazing insight.
For instance, one patient who suffered from dementia experienced a drastic change in mood every day like clockwork. A warm and friendly woman in the morning, this patient became aggressive and hostile after lunch. She would try to secretly slip out of the clinic, and when that didn’t work, she would bang furiously on the glass doors. What happened between the morning and afternoon to make her want to leave so badly? As Sara explained to me, she had cultural concepts of hospitality deeply rooted to her sense of identity. As I’ve alluded to in previous posts, Moroccans take hospitality seriously. The guest is treated as a king and the host will never ask the guest to leave. As such, a social event could last three, four hours. It is up to the guest to determine an appropriate amount of time to stay. In the mind of this patient, she was a guest at the clinic. After spending the morning socializing and sharing a meal, she felt adamant that she needed to leave. What might have been a heartbreaking ordeal to witness usually turned into a hilarious e scapade because the old woman was sly as a fox. She couldn't remember when and where she was, but she had an amazing ability to figure out escape routes.
Another example that shook my cultural beliefs occurred during a collaging exercise. I presented the geriatric patients with a white piece of printer paper. The assignment involved cutting out images that appealed to the individual and pasting them onto the piece of paper. Instead of starting the relatively simple assignment (or so I thought), about half the patients stared blankly down at the white paper. With some coaxing, I was eventually able to get a few patients to point to magazine images they liked, which I then cut and pasted on to the paper for them. But I couldn't shake the feeling that I was missing somet
hing important.
The next day, Sara had the same patients paint within stenciled pictures of fruit. Most of the patients started painting right away without any hesitation. So why was my activity met with so much more mistrust? Sara explained that the majority of the geriatric patients were illiterate women. Although my activity didn't require any reading or writing, these patients had a blanket mistrust for the white page. To them, it represented the unknown--a frontier that had always been forbidden.
I was taken aback by this revelation. To me, the white page represented innovativeness and self-expression. But to these women, the white page was a terrifying experience. Consequently, I adjusted the rest of my assignments so that they were more approachable, but the experience rattled my cultural competencies.