What gives our lives meaning is different for every one of us.
For some it may be caring for children or grandchildren, for others making an impact in a chosen profession, or studying history, travelling, singing in a choir, getting one’s hands dirty in the garden, swimming in the ocean.
As we get older, and more physically and mentally frail, opportunities to connect in a meaningful way with other people and the world around us may gradually diminish.
For a person living with dementia in an aged care facility, those opportunities may no longer exist. This is a loss for the person themselves, and it places a burden on the system and the people caring for them. And it’s something we can change.
There are many examples of aged care providers making simple changes to help residents connect and find meaning. Hydroponic gardens so residents can grow their own vegetables for visiting families. Play areas that make aged care facilities inviting places for families with young children. Opportunities to peel vegetables in kitchens, or tinker in garden sheds. A mural to look at, instead of a brick wall.
Meaning is about the foundation of the desire to live; it’s what gives life its forward thrust. A sense of meaning is one of the three ingredients of ‘salutogenesis’, and probably the most important of all. Salutogenesis means ‘sources of health’ from the Latin word ‘salus’ (health) and the Greek word ‘genesis’ (source).
A ‘salutogenic’ approach is one that focuses on factors that support health and wellbeing, beyond a more traditional, pathogenic focus on risk and problems. Sociologist Aaron Antonovsky coined the term in 1968 to explain why some people manage to live well even when subject to extreme stress or illness. He described three conditions as being necessary to live as full a life as possible:
- Comprehensibility: the experience of making sense of one’s own context, life story and current circumstances
- Manageability: the experience of managing day-to-day physical realities; staying warm, dry, clean, rested and nourished
- Meaningfulness: the foundation of the desire to live; a belief that things in life are interesting, satisfying and worthwhile.
The salutogenic approach is widely used around the world; in health, education, workplaces, architectural design. And it has enormous relevance in aged care, particularly dementia care.
Residential aged care facilities have traditionally operated in the ‘manageability’ space by managing the world for a person with dementia.
‘Meaningfulness’ is more elusive because meaning is difficult to define and highly personal. But this is where the work we can do with people with dementia can be most profound.
Providing opportunities to find meaning in an aged care context can be seen as an ‘upstream intervention’, with real flow on benefits for staff and facilities. There are barriers inherent to the aged care sector (high staff turnover, heavy workloads, established cultures), but change is possible when organisations are willing to see the bigger picture, and invest in and commit to change.
As a national training organisation, our goal is to ensure that our courses and resources genuinely contribute to the wellbeing of people with dementia and the people who care for them, addressing all three ingredients of the salutogenic approach.
Concepts such as joy, happiness, enthusiasm, hope, and even excitement are not traditionally associated with dementia. And we ask, why not? This is not to be relentlessly positive about the experience of living with dementia, but to promote positive experiences, and meaning, as an essential part of the experience of living, even when dementia is a part of living too.
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