Emotions, feelings, activities

There is a distinction between emotions and feelings. And there is a confused belief doing activities will upgrade a loved one’s mood-state, regardless of their emotions and feelings. In other words, getting the loved one involved in enough activities will automatically cause them to be “content.” In fact, it is believed, all “unwanted” behaviors will subside.

This train of thought works sometimes. But the loved one gets mislabeled as “highly agitated, restless, anxious, or aggressive” when it doesn’t. To quell these unwanted behaviors one of two things will happen:

They will be given an antipsychotic-type medication that will knock them out for a few hours. The most common being Risperdal, Seroquel, Zyprexa, Abilify, and clozapine (Clozaril). Or
The loved one will be urged to partake in an activity. Of course this is with the idea it will redirect their thinking process to “happier” thoughts. And of course this should then lead to their forgetting about acting out using “dementia-induced unwanted” behaviors.

Dementia does not make a person agitated or aggressive. Having unmet psychosocial needs do.

Emotions + feelings = 66% quality of life

“Emotions are physical and instinctive, instantly prompting bodily reactions to threat, reward, and everything in between. While emotions are associated with bodily reactions, feelings are the conscious experience of emotional reactions. Feelings are sparked by emotions and shaped by personal experiences, beliefs, memories, and thoughts. Strictly speaking, a feeling is the side product of your brain perceiving an emotion and assigning a certain meaning to it,” explains Bryn Farnsworth, Ph.D.

Quality of life perpetually hangs in the balance for those with dementia. Unlike any other population at any age, better than 95% of the time a loved one’s needs go unmet.

Ironically their medical needs are met nearly 100% of the time. Physical needs too. But little if any care is given to their psychosocial needs.

They need and want attention in a less “obvious” way. Still, grasping the psychosocial concept is difficult for many to understand. How do I do it? When do I do it? What do I do? Sadly, this lack of understanding translates into roughly one third of their care needs ignored every single day.

With psychosocial needs neglected, “unwanted” behaviors begin cropping up. In fact behaviors will continue to escalate until some kind of intervention occurs. Either their need will be discovered and met or depression will set in. The loved one has just come face to face with learned helplessness.

Feelings and emotions need to be fed or they wither and die

To understand the significance of this, let’s look at the life of an infant for a minute. An infant cannot speak nor can they understand the language. Likewise, they cannot articulate their urges or needs. The first learning curve parents need to perfect is the meaning behind the different noises their newborn makes.

Now, imagine omitting one third of their daily care. Yes, you change them, you feed them, even adjust their sleeping position for safety sake. But you don’t talk to them the way they need to be talked to.

Infants need and want specific vocal intonations from their caregiver. Nurturing sometimes, playful or reassuring other times. They like and need non-clinical touching, holding, stroking.

Instinctively they are pushed to confirm you are the one who will tend to their physical, medical, and psychosocial needs. You indeed are the one that loves them, values them and are vested in their survival.

Their mood state and their sense of security is hugely affected by vocal interactions and/or consequently, the lack thereof. This being amazingly true even though they cannot understand a word you are saying.

Failure to thrive is the only alternative

So how will an infant survive in the absence of little or no psychosocial interaction? Not very well actually. In fact without psychosocial interactions, many will die before becoming a toddler. Psychosocial interactions are as necessary to sustaining life as are food and water.

The infant’s mood state will remain guarded. They will repeatedly attempt to elicit psychosocial interactions from you. Each time adding more desperation to their cries for assurance if their needs continue to go unmet. If it continuously goes unmet, they develop “Failure to Thrive Syndrome” and die. Die like wither away. All their body functions are still functioning perfectly. Instinctively the spark of life goes out and they conclude there is no logical reason to continue existing.

The mystery of psychosocial needs

Remember, dementia mimics the cognitive maturation process, but in reverse order. In other words, the loved one is cognitively becoming more childlike with each passing day. Now loved ones and infants have many of the same psychosocial needs. Unmet needs will produce the same Failure to Thrive result in your loved one as it does in the infant.

Psychosocial needs are not understood at all. Not in the industry, not by family members. You will even be hard-pressed to find a physician who is able to properly define them.

People instantly back off just at hearing the word “psychosocial.” Eyes begin to glaze over. A quick survival check by the brain concludes “Yeah, we don’t need no psychohypo… psychohebejebee, or whatever it’s called. They conclude, “if I can’t pronounce it, I don’t need it.” And it’s completely understandable to feel this way. The term “psychosocial” can at first glance seem ominous.

My hope here is to reduce the trauma induced by simply hearing the word “psychosocial.” Maybe we can chip away at it until it is no longer such a turnoff.

Psychosocial Needs

Psychosocial needs are basic:

We want to know we are loved. Love, for example, is evident when others show us respect.
Strong sense of autonomy. Instead of ordering a loved one to put on the green sweater give them an option. “Would you like to wear the green sweater or the white sweater?”
Being successful in contributing to our community. Let them have chores to do they can succeed at. Things like dusting, setting/clearing the table, folding laundry, etc.
Perceive we are a person of value and worth. This can be achieved through simple acknowledgments like, “I appreciate the help you give with the kids.” Remember to say “thank you” for things they do. Ask for their opinion regarding family and important upcoming issues, like what model of car to buy, for example.
Others need our love. Ask for hugs, cuddle times. Give full, undivided attention when they are telling you something. Validate their feelings.
We are successful in achieving goals. Help them set easy, obtainable goals. Break bigger goals down into mini goals. Remind them again and again of their successful accomplishments.

Activities are not our “go to” response” during a confusing or anxious moment. We need to take care of those feelings first. Survival becomes questionable until real or imagined situations settle back down. Certainly with dementia, emotions quickly spin out of control with seemingly no hope of resolution in sight. To them it’s catastrophic.

Loved ones return to using those same expression for unmet needs

Through trial and error the new parents are becoming more efficient at speaking “infant.” Soon enough the time comes when parents and infant are “communicating.” Now the infant’s needs are getting met on a regular basis. This in itself eliminates a lot of unwanted behaviors. Needs satisfied, the infant enjoys quality of life by sleeping, cooing, and gurgling.

The loved one too no longer has the ability to articulate their needs efficiently. Truth is they have returned to using the same communication skills they used as an infant. This gives caregivers the task of learning to intuitively learning how to meet the loved one’s needs.

They yearn and need to be loved, protected, and nurtured. Moreover, they want to feel important and respected.

There simply is no evidence connecting any kind of value between eliminating unwanted behaviors through the use of activities. No matter what, the unmet physical, medical, or psychosocial need remains. Can asking me to dance quench my thirst? Will singing Christmas carols stop my cut from bleeding? Activities have a great place in the life of everyone. They just need to be appropriate to the cause.

Feelings + emotions + psychosocial needs = 100% quality of life and activities become an added bonus

Infant and loved ones experience the same trauma with the same outcomes when faced with unmet psychosocial needs. “Help me survive!” is the cry behind these expressed behaviors. Regardless of the need, death feels imminent without intervention.

That’s why it is so easy for them to respond with catastrophic responses. See why getting the loved one involved in an activity to divert their unwanted behaviors won’t work? It makes about as much sense as giving a crying infant a book to read. Most needs cannot be filled by pushing the loved one into doing an activity. To restore quality of life, the need must squarely be addressed.

Psychosocial Encouragement

Validate their feelings by echoing their own words back to them. “Yes, you sounded very angry!”
Look the loved one in the eyes when talking with them. It helps show respect.
Always be equal to or lower than the loved one while dialoguing with them. This too shows respect.
Ask about their past. Maybe favorite part of school, what games they played, who taught them to drive a car?