As human experience happens within the context of places, places can serve as a tool in understanding personal life experiences. Personal place-related experiences can be used to reconnect with people with dementia to their past. Information about past places, such as childhood homes, neighborhoods, and schools, as well as homes in early adulthood, is a potential resource for understanding the person behind the symptoms of dementia. In this study, place-biosketches of residents with dementia were developed based on interviews with the family members. A staff survey was conducted to assess the potential utility of the residents' place-biosketches in understanding the residents' personal life histories and programming activities that may be meaningful for them.
When I tell the story of my life, it is largely made up of the images that I create of the places of my life. Remembering the places and the emotions as I once experienced them is a tricky business … I invent my past as a grand fiction, the myriad details of which fit into a coherent pattern that is called a self-concept. There is much twisting and bending of the original event so that it can fit into the model of what I say I am, and what I say the world is. - E.A. White 1
Places are in our memories and places are in our imagination. The houses where we grew up, the neighborhoods where we played, the cities where we worked—all are part of the mental landscape that is deeply rooted in our memories. The physical grounding of personally meaningful places gives them the organizing potential around which to structure human remembering. Places, especially personally meaningful ones, may serve as mnemonic anchors in autobiographical recollections, even for the cognitively impaired, and be a means of recalling who we are. 2
Nursing homes are places that stand in contrast with the communities in which residents-to-be have lived all of their lives. There is limited opportunity for self-expression in the nursing home, where the organizational and collective approaches of caregiving quite often dominate the social and physical environment. Self-identity and personal meaning get largely overtaken by institutional policies and routines. 3 Caregivers in dementia care settings are often accustomed to labeling people with dementia as “confused residents.” This reflects a homogeneous perception of the residents solely on the basis of their stage of disease and observed symptoms. The lack of a process that would allow the staff to know about the residents as individuals—who have unique life histories, who come from diverse backgrounds, who have their own place experiences—limits their ability to appropriately empathize with residents. As a consequence, the seemingly incoherent conversation between a resident and staff is considered meaningless. This, in turn, may not allow the staff to listen and empathize appropriately. 4 Moreover, if the conversation is accompanied by emotional expressions, such as tears or sadness, caregivers tend to change the subject, try to distract the resident, or physically withdraw. Based on these preconceptions, caregivers typically do not take the time and effort to gather residents' past histories, and thus lose an opportunity to understand the unique individual behind the curtain of dementia.
Understanding the residents in the context of their former social lives in their homes and communities has the potential of reducing the strong institutional demarcation of social roles, i.e., “residents” versus “caregivers.” As the staff become more knowledgeable about personal life histories of the residents, they might develop increased level of tolerance, understanding, and empathy toward the residents. Aides who review residents' life histories may perceive the residents as more adaptable, goal setting, and possessing of interactional skills than aides who do not review life histories. 5 This can contribute to more meaningful and rewarding interactions between staff and residents, which in turn may potentially have a positive effect on staff attitude and job satisfaction in the long term. 6 Although the latter outcomes are relatively indirect, they could have important implications for residents' quality of life.
The potential contribution of reminiscence is substantial by capitalizing on what can be remembered from the distant past to help counter the threat to personhood in dementia. 6 Moreover, personal memories may be somewhat more accessible than nonpersonal events, e.g., memories of the particular home where the resident raised her children over several years may be relatively easier to recall than the name of the president of the United States at a certain time in the past. 7 Remembrance of past places can help in redefining aspects of the self in the current changed environmental context.
Assistant Professor in the Gerontology Programs & Gerontology Research Centre, Simon Fraser University, Vancouver, Canada.
The author wishes to acknowledge the guidance of Prof. Gerald Weisman, Prof. Dale Jaffe, and Prof. Christine Kovach, all at the University of Wisconsin-Milwaukee, in this study.
Address correspondence to: Habib Chaudhury, PhD, Assistant Professor, Gerontology Research Centre and Programs, Simon Fraser University at Harbour Centre, 2800–515 West Hastings St, Vancouver, BC, CANADA V6B 5K3. E-mail: chaudhuryesfu.ca.