Churches should be more dementia-friendly, Anglican expert says

As Canadians age, people with dementia are becoming increasingly common in  congregations—and there’s more that can be done to make churches welcoming to them, an Anglican authority on aging says.

“If we knew a bit more as a community, we might be a bit more accommodating” to those with dementia, says Mollie Cole, an advanced practice nurse now managing programs to improve the health care of seniors for Alberta’s provincial health authority. Cole, who is also president of the Canadian Gerontological Nursing Association, gave a talk on creating dementia-friendly congregations last fall in Calgary, where she attends St. Martin’s Anglican Church.

It’s important because churches have a unique role to play in helping the elderly stay socially connected and healthy, she says.

“People who have a circle of support tend to experience aging in what we call a healthier or better way, and it’s people who are socially isolated who are particularly vulnerable” to dementia, says Cole. “So I look at our church communities as a really excellent opportunity for us to continue to support older adults as they age.”

It’s estimated, Cole says, that nearly 10% of Canadians over 65 have some form of dementia; for those over 85, somewhere between 35-40%. Given that church communities typically have a lot of older adults, she says, it’s likely that a significant number of Canadian churchgoers have dementia of some kind.

Dementia, Cole says, is an umbrella term that includes a number of diseases causing cognitive impairment; of these, Alzheimer’s disease is the most common, affecting probably 60-70% of dementia sufferers. Dementia affects people’s mental functions in a number of ways, including their memory and judgment as well as their ability to communicate and orient themselves. It is a chronic condition that will afflict the sufferer for the rest of his or her life, and in its later stages, it causes physical as well as mental decline.

Often a lack of understanding of dementia, Cole says, can prevent us from accepting those who suffer from it. Cole recalls a churchgoer once told her that she didn’t enjoy talking with another member of her congregation, because that person, the churchgoer said, made her uncomfortable. The churchgoer didn’t realize, Cole says, that the person she was talking about suffered from dementia, and that the disease can cause people to speak and behave in ways that might seem disconcerting to many of us.

For example, she says, a phenomenon known as perseveration causes some people with dementia to repeatedly experience the same thought. Thus, a dementia-sufferer who feels too hot might take off his or her sweater, and then, following the same impulse, continue to undress beyond the point of social acceptability. Another person experiencing the disorientation of dementia might suddenly get up and walk out while the rest of the congregation is sitting and praying. Or a dementia-sufferer may talk about a long-dead spouse as though that person were still alive.

The Rev. Natasha Brubaker, rector at St. Martin’s, which hosted Cole’s talk, says she sees people with dementia every week while giving services at long-term care facilities or during pastoral visits. Anglican clergy in Canada generally aren’t trained on how to respond to people with dementia, and the experience, she says, can at times be challenging.

“I have had some wonderful experiences with people with cognitive impairment, and then I’ve had some where [because of] the way the illness has worked in their mind, I have felt very much out of my depth. They’ve been angry, they’ve been violent, their family hasn’t been coping well,” she says. “I’m not an expert, right? And yet I’m trying to come in and be that pastoral presence. And so, I think it’s really important for me to have at least a good understanding of how the disease works…and get over my own anxieties around it as well as have some tools” for better engaging with people with dementia.

There are many practical measures church leaders and others can take to make their churches friendlier to dementia-sufferers. (See sidebar.) It’s also important to remember, Cole says, that although they may be cognitively impaired, dementia-sufferers continue to have spiritual needs and a capacity for spiritual experiences. Part of making our churches dementia-friendly, she says, is connecting people to things that had meaning to them in the past, and helping create for them what she calls a “meaningful now,” or joy in the moment. For example, even if the person may not remember having gone to church, he or she may quite likely still have a memory of this feeling of joy.

Cole says she would like to see a monthly service, drawing from a number of congregations in her end of Calgary, specially designed for people with dementia and their caregivers. She also says she’s planning on creating an informal group to share ideas about making congregations more dementia-friendly; both she and Brubaker also say they’re happy to hear from anyone on the topic. Cole can be reached at [email protected] and Brubaker at [email protected].

Tips for making your church dementia-friendly

Experts on aging say there’s a wide range of things churches can do to make themselves more welcoming to people suffering from dementia. Here are a few:

1. Ensure church buildings are warm and well lit, with comfortable seating, accessible bathrooms and easy-to-understand notice boards and signs.
2. In services, avoid speaking too quickly or transitioning quickly from one element of the service to another. Use non-verbal cues, such as hand gestures, when it is time for the congregation to stand. Microphones can be useful in helping everyone hear what is said during a service.
3. Consider emphasizing sensory and other elements of a service that go beyond the merely cognitive (such as pondering the meaning of scriptural passages). Music, rote prayers and other rituals can be especially good for helping worshippers with dementia connect with the sacred because the memories of these things are stored in a different part of the brain than other memories, and they tend to last longer. Prayers the worshipper is likely to have learned early in life—such as the Lord’s Prayer and passages from the Book of Common Prayer—can also be more effective than more recent prayers.
4. When talking with someone with dementia, it can be helpful to focus on the emotion that might be underlying that person’s words rather than the literal meaning they convey. For example, someone who talks about a long-dead spouse as though that person were still alive may be missing him or her. You could use this as an opportunity to connect with the dementia-sufferer about his or her spouse—how they met, what the person was like, and so on.
5. Caring for people with dementia can be exhausting and socially isolating, so it’s important to care for the caregiver. Some congregations offer day support programs, with hymn singing and other activities, for people with dementia; these provide a break for their caregivers. Consider praying both for dementia sufferers and those who take care of them.
6. Consider hosting an information session on dementia in your church. For expert speakers, contact your regional branch of the Alzheimer Society of Canada.