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Susan H. McFadden

Spiritual and Religious Foundations of Living Well in the Time of Dementia: What Researchers Tell us. Susan H. McFadden. The arc of the dementia story. 1870. 1906. 1975. 1997. 2010. Dr. Robert Butler named head of NIA; says we need research on AD. Senility as an expected outcome of aging.

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Susan H. McFadden

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  1. Spiritual and Religious Foundations of Living Well in the Time of Dementia:What Researchers Tell us Susan H. McFadden

  2. The arc of the dementia story 1870 1906 1975 1997 2010 Dr. Robert Butler named head of NIA; says we need research on AD Senility as an expected outcome of aging Dr. Alzheimer identifies plaques and tangles in the brain of Auguste D. Tom Kitwood publishes Dementia Reconsidered Social Citizen- ship Senility Biomedicalization of dementia Personhood and culture change

  3. Social cognitive neuroscience (Ochsner & Lieberman, 2001) Implications for persons living with dementia • Substantialist ontology: there’s some substance or quality of individuals that makes them who and what they are Freud: energy from biological drives is the primary factor in human development Other examples: cognitive psychology (emphasis on rationality) and neuropsychology (emphasis on neural structures and processes) • Relational ontology: people gain their sense of selfhood in relationship with others Buber (1936/1970): “In the beginning is the relation” Kitwood (1997): personhood “is a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being. It implies recognition, respect, and trust.”

  4. Dementia as a biopsychosocial condition (Downs, Clare, & Anderson, 2008) Spirituality and religious beliefs, practices, communities “The manifestation of dementia in any one individual can only be understood by considering the interplay of: Neurological impairment Physical health Sensory acuity Personality Biography and past experience Relationships Social resources”

  5. “When you’ve met one person with dementia, you’ve met one person with dementia.”(Kitwood, 1997)

  6. Psychosocial needs of people with dementia(Kitwood, 1997) The sense of self, and emotional well-being are constructed in relationships.

  7. MSP = Malignant Social Psychology NI MSP NI MSP MSP NI NI NI = Neurological Impairment Kitwood, 1997

  8. Social relationships can harm people living with dementia.Can they also help, and perhaps even reduce risk?What is the role of spirituality and religion in this mix of influences?

  9. “An active and socially integrated lifestyle in late life might protect against dementia” Laura Fratiglioni, Stephanie Paillard-Borg, and BengtWinblad (2004)

  10. Risk factors Genetic Risk factors Years 0 20 40 60 80

  11. Risk factors Genetic Risk factors SES- related factors Years 0 20 40 60 80

  12. Risk factors Depression Head Trauma Life Habits (e.g., smoking), Hypertension and other vascular risk factors, Occupational exposure Genetic Risk factors SES- related factors Years 0 20 40 60 80

  13. Risk factors Depression Head Trauma Life Habits (e.g., smoking), Hypertension and other vascular risk factors, Occupational exposure Genetic Risk factors SES- related factors Years 0 20 40 60 80 High Education Protective Factors

  14. Risk factors Depression Head Trauma Life Habits (e.g., smoking), Hypertension and other vascular risk factors, Occupational exposure Genetic Risk factors SES- related factors Years 0 20 40 60 80 High Education Diet: fish, vegetables Moderate alcohol Antihypertensive drugs, statins, NSAIDs Protective Factors

  15. Risk factors Depression Head Trauma Life Habits (e.g., smoking), Hypertension and other vascular risk factors, Occupational exposure Genetic Risk factors SES- related factors Years 0 20 40 60 80 High Education Rich social network Mental activities Physical activities Diet: fish, vegetables Moderate alcohol Antihypertensive drugs, statins, NSAIDs Protective Factors

  16. Does religiosity protect against cognitive and behavioral decline in Alzheimer’s dementia? (Coin et al., 2010) • 64 patients of the Alzheimer’s Assessment Center in Padova, Italy; two assessments 12 months apart • Behavioral Religiosity Scale (frequency of church attendance, prayer, reading religious literature, watching or listening to religious media) • Higher levels of religiosity correlated with slower cognitive and behavioral decline and less care partner stress

  17. Religious attendance and cognitive functioning among older Mexican Americans (Hill et al., 2006) • 3050 Mexican-origin persons, age 65+ in 5 states • Longitudinal study, 4 waves of data collection • MMSE to assess cognitive functioning • “Religious attendance is associated with slower rates of cognitive decline among Mexican Americans.” Attending more than once a week had the biggest effect. • Church attendance may be a unique form of social engagement compared to other types

  18. What predicts whether caregivers of people with dementia find meaning in their role? (Quinn, Clare & Woods, 2012) Interventions Predictors Provide programs to help develop caregiver skills High competence Low “role captivity” Provide respite services Help people identify meaning High intrinsic motivation Educate congregations & clergy High religiosity***

  19. Stories of resilience, serenity, and religious identity (Beard & Sullivan, in press) • Interviews with 75 persons with Alzheimer’s and family members (mostly African American) • Findings for diagnosed persons • Trust in God gives strength and hope • God as friend/don’t feel alone • God helps with memory • Faith reinforces a positive attitude • God helps people feel safe and contented

  20. Stories of resilience, serenity, and religious identity (Beard & Sullivan, in press) • The role of churches: Social and interpersonal benefits • Enjoyment of church services congregations provide concrete social support • But… some people thought church support was intrusive and prayer requests were a form of gossip!

  21. “Health care’s blind side: Unmet social needs leading to worse health” Robert Wood Johnson Foundation, 2011 • National survey • 1000 physicians (690 PCPs, 310 pediatricians) (5% response rate; 200,000 invited to participate) • 85% say unmet social needs directly lead to worse health for all Americans • 85% say social needs are as important to address as medical conditions (95% of physicians serving poor people said this)

  22. More findings… • 76% wish the health care system would cover costs associated with connecting patients to services that meet social needs • 20% feel confident or very confident to address patients’ unmet social needs • IF they could write prescriptions to address unmet social needs, this would represent 1 out of every 7 prescriptions

  23. What would you prescribe? • Fitness programs • Nutritious food programs • Transportation assistance • Employment assistance • Adult education • Housing assistance Can religion be prescribed? Can it be “dosed”?

  24. “…a relationship is a physiologic process, as real and as potent as any pill or surgical procedure” (Lewis, Amini, & Lannon, 2000)

  25. Implications for congregations Your turn!

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