The question below resonated with many on the listserv regarding racism and dementia. The moderator, Kirsten Jacobs, Associate Director, Dementia and Wellness Education reached out to Kelly Carney (Board Certified in Geropsychology, Executive Director, Phoebe Center for Excellence in Dementia Care) for a response.
Question: One of our members is seeking information/resources for addressing expressions of racism by people living with dementia. Staff education tools? Books? Resources? Research article?
Answer: The question posed below is challenging. Racial prejudice is not only learned early in life – and therefore one of the last “memories” to leave in progressing dementia – but it is also very emotionally laden. This means that the racial prejudice is stored in the amygdala – a part of the brain that remains intact even as other memory pathways deteriorate. Given the deeply embedded and resilient nature of these prejudices, individuals who have reduced impulse control and poor judgment due to dementia do often give voice to these ugly thoughts and it can be difficult to alter.
With that in mind, the first line of defense is staff education that both validates the difficulties and hurtfulness of the behavior and provides a context for understanding why the individual is unable to alter their behavior. The education should also be support by behavioral intervention planning to minimize triggers to the behavior, and to the extent possible, provide staff with protection from the behavior, i.e. not assigning those most likely to be targeted to that patient.
There is also some support for the use of classical conditioning in these situations, but it takes a strong staff person to engage in the process. In brief, if there is one staff person targeted, that person can be charged with the being the deliverer of all things good – treats, privileges, etc. Each time the person offers that something special, they become associated with the good feeling elicited, and over time, they perception of the person changes from one of racial association to one as the “giver of gifts”.
Kelly O’Shea Carney has a new book out, Transforming Long Term Care: Expanding Roles for Mental Health Professionals
