14 July 2016
By Chris Ellicott-Brewer, Neuropsychiatry Nurse Practitioner
Imagine you’re packing books onto an enormous shelf, lining an enormous room in rows and rows. Each time you settle a book into place, another falls to the floor. As you scramble to collect and restack them, they continue to fall at a gathering pace. Muddled and lost, the books pile up – each filled with a single short term or long term memory. This is the easiest way to explain dementia.
Dementia is a challenging condition. It robs people of their lives, and families of their loved ones. The ‘top shelf’ short term memories are the first to go, increasing in speed until only the deeply-set long term memories are left standing on the ‘bottom rows’. In the worst cases, these fall away too. It is then little wonder that some people with dementia lash out in frustration. In some cases hurting those that are closest to them. It is when dementia reaches this stage that those affected might find themselves in a place like St Andrew’s, where I’m privileged to work as a nurse practitioner.
We work closely with families and loved ones to try and create a ‘home in hospital’ for patients. We spend time discovering their likes, dislikes, interests and hobbies, looking at ways we can improve their environment. We explore the kind of things they like to have in their rooms and what is needed to make the space more personal and homely. The value of personal items is very clear, though some items would fall under ‘contraband’ – a risk to security and safety. That’s when I first toyed with the idea of memory boxes.
A memory box is a very personal space, unique to each individual and their family. It’s a place to store treasured trinkets, keepsakes from home and mementos of family life which have been safeguarded across decades. Carried close to the heart, these are items that support memory, recall, and reminiscence. Place them together, safely stored in a transparent box, and you suddenly have a magical link to home, to a lifetime of special interests and personal journeys.
The NHS and the Alzheimer’s Society are among many groups lauding the benefits of memory boxes. Having items grounded in reality and familiarity have been shown to help orientate patients, improve their mood and reduce anxiety and feelings of social isolation. By involving family members in the process it can help to settle feelings of abandonment, loneliness and depression. More than that, I think that acknowledging this past is really significant in helping people with dementia to feel validated - for the person they were then and who they are now.
For us as nurses, carers and clinicians, seeing these items help us to instigate meaningful conversations. It improves our dialogue, therapeutic relationships and gives us an insight into the life experiences of that individual. For example, you may be looking at an old wedding photograph, but what is the story behind it? Was it their wedding? Where did they marry? How long ago? Did they have a honeymoon?
I’m writing now from the midst of the project, having started the process of assembling the boxes with patients who participate in woodwork as part of their therapy. Safety, quite naturally, is paramount and we’ve had to come up with a unique design involving wood and Perspex, which can be wall-mounted but is easy to move and adapt alongside the patient and their needs. I have been privileged to view a completed box, which is perfect and just what we need. Production is moving along well and I am now awaiting the final delivery. The next and most anticipated step will be to fill these boxes together with families. I’ll admit I’m somewhat impatient, but know deep down that the wait will be worth it. Each box will have, after all, taken a lifetime to build.