While completing my doctoral studies, I enrolled in a seminar course intriguingly titled “Evidence-Based Spirituality”. I was interested in person-centered care philosophies and, in particular, Martin Buber’s notion of the “I-Thou” relationship as applied to spiritual care of older people living with Alzheimer’s disease. This intriguing book by Susan H. McFadden and John T. McFadden would have been helpful to me in that course as I considered the impact of dementia on the spiritual dimension of what it means to be human.
Aging Together focuses on the importance of relationships between older people living with dementia and their friends. The premise is that persons with dementia are at risk for rejection from previous friendship roles, including those within faith communities. The authors propose that members of social communities in general, and spiritual communities in particular, are morally obligated to sustain people with dementia in their journey along the common pathway. The book stresses the importance of understanding dementia as a life experience that produces spiritual distress that can and must be mitigated within the domain of friendship.
The book is grounded in the principles of academic social psychology and liberal Christian ideologies, which the authors make clear at the outset. The structure includes an introduction and 12 chapters that follow a logical sequence from dementia diagnosis to an examination of the impacts of dementia on personhood, friendship, and membership in spiritual communities. The book concludes with a discussion about how faith communities can extend friendship to those living in “the thin places”, a metaphor representing the mystery of dementia. Also included are questions suitable for discussion by those interested in relational care.
Chapters 1 and 2 outline medical information about dementia’s impact on the brain, as well as the impact of experiences commonly associated with receiving a dementia diagnosis. The information is accurate and supported by scholarly references with respect to incidence/prevalence, diagnostic tests, alternative diagnoses such as mild cognitive impairment, and up-to-date treatments. Though positioned within the context of clinical research conducted in the United States, these imapcts are nevertheless highly relevant to the Canadian experience.
Chapters 3, 4, and 5 discuss personhood and friendship and how these are shaped by the dementia experience. The points are well aligned with seminal literature by such writers as Tom Kitwood (Reference Kitwood1997). The book also describes those supports that older persons with dementia need in order to enjoy rich, satisfying interpersonal relationships which sustain their spiritual selves and provide opportunities for reciprocity.
In Chapters 6 and 7, the reader is introduced to an “imaginary friend” whose story of living with dementia illustrates why aging baby boomers might at times reject those who exhibit symptoms of memory loss. Former friends are avoided because they mirror fears of dependency, loss of identity, and abandonment. The authors propose that the dementia experience will be reshaped through a new culture of care based on understanding, hope, joy, and love.
In Chapters 8 and 9, the notion of hospitality is introduced as a strategy that emerges from a mutual obligation to nurture, creating an inclusive community. The person with dementia is viewed as a “stranger” who is welcomed despite arriving at the door in a vulnerable form – a common metaphorical theme found in Judeo-Christian texts. The stranger is not turned away, but rather is welcomed and given a place of honor. The authors suggest that spiritual hospitality can take the form of visitation, respite at religious vacation camps, and religious rituals that are adapted for the unique needs and capacities of older persons with cognitive impairments. Such interpersonal activities as life review, spiritual reminiscence, and participation in prayer chains are briefly introduced.
Chapters 10 and 11 briefly discuss specific strategies that can be used by friends of people with dementia to promote reciprocity and sustain feelings of belonging within spiritual communities. The chapters describe activities that friends might use – such as advocacy, relational mindfulness, providing opportunities for conversation, and listening with the “third ear” (p. 173) – to interact with congregants who are living with dementia.
Chapter 12 introduces the notion of a more radical political advocacy for friends of persons with dementia. For example, older people with dementia and their friends are encouraged to proudly wear T-shirts emblazoned with the term demented, thereby reinforcing its positive power, not unlike the mental health movement embracing the term mad.
Overall, the book is well written and scholarly, although somewhat challenging to follow in some parts. It would have benefited from the guiding hand of a firm editor who could have eliminated some of the repetition between chapters. The book would have been further enhanced if the viewpoint of the imaginary friend (who makes a brief appearance in Chapters 6 and 7) were presented in other chapters. Some chapters also include an introductory poem or quote, and perhaps this device could have appeared consistently in each chapter.
The work adds to a growing body of knowledge about the significant role that community and neighbourhood plays in promoting spiritual resilience and health for older people living with cognitive impairments (Bartlett & O’Connor, Reference Bartlett and O’Connor2007; Keady et al., Reference Keady, Campbell, Barnes, Ward, Li and Swarbrick2012; Ramsey, Reference Ramsey2012). Aging Together also coincides with recent publications which challenge and expose to critical examination the negative discourse of disability and tragic loss traditionally associated with dementia (Behuniak, Reference Behuniak2011). The impact of cognitive impairment on spiritual practices of older people and the religious communities that surround them is well described and explained. However, while there are some references to Judaic and Islamic religious traditions, the book provides little insight into the spiritual lives of older persons who represent a broader variety of ethnic, cultural, and religious backgrounds that are present in the Canadian context.
The book’s dense content is grounded in philosophical and religious scholarship. It is not a how-to guide, and therefore would be heavy going for family members, volunteers, or congregants of faith communities. It is written in a style most suitable for a scholarly audience such as graduate students who are training as clergy or attending a graduate seminary, or for advanced-practice parish nurses. The book could be informative for family physicians and nurse practitioners who provide and explain the results of diagnostic tests to older adults who are experiencing cognitive changes. The text could also be useful for the health service planners and policy makers of community and religious organizations interested in meeting the spiritual and religious needs of older adults living with dementia. In addition, this book will be important for scholars interested in research related to dementia experiences that are grounded in the context of community.
In summary, I enjoyed reading this text and recommend that the authors consider extracting and editing portions of it into a more practical version. Families, volunteer visitors, lay chaplains, and clergy who work day-by-day alongside older persons with dementia would undoubtedly find such a version useful and would benefit from some of the strategies suggested in this scholarly work.
