Applying BASICS Part I
Looking at the Quality of Life of Individual Residents With Dementia
Our own identity - our internal "picture" of who we are - is what makes us unique. It is how we know ourselves, an expression of how we aspire to behave and how we wish to be seen by others. Preserving this image of self helps us to feel comfortable in our world. Being pressured to act contrary to this image of self, or our identity makes us uncomfortable. We also show different views of ourselves to different people in the various situations of our lives. How we act is sometimes triggered by what we believe others think of us or how we think they want us to behave.
Persons with dementia have difficulty remembering all aspects of their identities and how they should fit in to the here and now. This sometimes makes it hard for them to know how to act. They often feel they should know how to act and are afraid of making a mistake and looking foolish. At other times, they may think they are acting appropriately and are angered to find people responding to them as if they are behaving peculiarly. They need familiar persons and things to help them continue to engage in the normal routines that support their self-identity and provide a sense of comfort. Moving to the unfamiliar environment of a nursing facility, for which they have no reference in long-term memory to orient them, only compounds the problem for them. When cognitively intact persons move to a nursing facility, they at least have some idea of what the place is and why they are there. Most residents with dementia do not have this advantage.
To help us understand how residents with dementia feel about the impact that Alzheimer's or other dementia has on their identity and autonomy in a nursing facility, it is helpful to look at some of our own feelings about the way we see ourselves and our abilities. We have the same needs as our residents. We cannot attempt to meet our needs at the higher levels until each lower level of need is met. For example, if we had not eaten all day we could not take part in a social activity and enjoy it. In order to have our needs met, our environment must provide the means and support to help us meet each level of need. We need to feel safe, physically comfortable, experience some sense of control over our lives, feel valued as a person, receive optimal stimulation for our abilities and experience pleasure to have a good quality of life, so do our residents.