1. Dementia is already a common tragedy and will become more common.
Every time Jan came to my office she would smile and tell me “old age is not for cowards.” She would always laugh, proud of her originality but oblivious to the fact that in her dementia she had told me the same many times. Indeed, dementia is one of the greatest challenges of aging. And as life expectancy increases, dementia will be all the more common. It is estimated that over one-third of today’s seniors will die with some degree of dementia.
2. Dementia has many causes other than Alzheimer’s.
Alzheimer’s disease causes roughly 70% of dementia, but many other diseases lead to it as well, such as multiple strokes and Parkinson’s. There is no stereotypic case and each person with dementia must be approached differently.
3. Dementia slowly progresses.
Most types of dementia slowly get worse. The average life expectancy after diagnosis is seven years, but it may be as long as twenty.
4. Dementia has some purpose in God’s sovereign plan.
Dementia is one of the tragedies of life that forces us to cry out to God. But even in our desperation we can recognize God has a purpose in it. “I cry out to God Most High, to God who fulfills his purpose for me” (Ps. 57:2). God does not make mistakes. His purpose may be in the life of the victim, the caregivers, society as a whole, or all three. One of the challenges of dementia is to recognize those purposes and get in line with them.
5. All people with dementia are made in the image of God and deserve to be treated with dignity and respect.
Being made in the image of God is true of all human beings from the best to the worst of us. It is not dependent on functional abilities or IQ. Martin Luther King Jr. spoke rightly when he said: “There are no gradations in the image of God.” The image of God imparts a dignity to all people and demands our respect.
6. There is no good medical treatment for dementia.
One of the best ways to improve the quality of life of those with dementia is to respect their God-given dignity.
7. A good way to show respect for the dignity of those with dementia is to understand how they see the world and see things as they see them.
When my mother in her dementia thought I was my dad, my response was not to correct and belittle her but to say “I love you, Lois.” I spoke the truth and she was affirmed. We must also show respect by providing for their physical, emotional, social and spiritual needs even though it may be difficult to understand what they are.
8. In many cases giving care to those with dementia is harder than experiencing dementia itself.
The early stages of dementia can be very frustrating for a patient increasingly conscious of their cognitive decline. As the disease progresses many are quite content living in the present tense. They are not bothered by mistakes of the past and do not worry about the future. I remember Helen, a dear saint who had spent her life serving the Lord in Africa. She had developed severe dementia and was living in a dementia care facility. I would frequently see her telling stories from her years on the mission field to an attentive group gathered around. As she got to the end of the story she would slap her thigh and everyone had a good laugh. What did it matter that she told the same five stories over and over again? Everyone was having a grand time.
9. Dementia is a terminal disease and aggressive measures to prolong life are rarely appropriate or God-honoring.
In the advanced stages of dementia, when the patient is unable to eat, it is not appropriate to use feeding tubes or to attempt resuscitation in the event of cardiac arrest.
10. Dementia, like all other diseases, will be healed.
The hope of all Christians is to live eternally in the presence of God. Heaven will be a time to experience the glory of God in ways impossible while confined to our present bodies and brains. There will be no more dementia, and those afflicted by dementia will say with all other believers, “I shall know fully even as I have been fully known” (1 Cor. 13:12).
John Dunlop (MD, Johns Hopkins University) serves as an adjunct professor at Trinity International University and practices Geriatrics in New Haven, Connecticut, where he is affiliated with Yale School of Medicine. Dunlop is the author of Finishing Well to the Glory of God: Strategies from a Christian Physician and Wellness for the Glory of God: Living Well After 40 with Joy and Contentment in All of Life.