Aging Together: Dementia, Friendship & Flourishing Communities (review)

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 (1997). 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 briefl y introduced.

Chapters 10 and 11 briefl y discuss specifi c 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...