Staying Present with Dementia

by Rebecca Crichton

I am slightly embarrassed to admit that I only recently made the connection between my master’s degree in early childhood development, the other master’s degree in organization development, and the work I do in the Aging community. The throughline is so unconscious, I was blind to understanding that it exists.

Once detected, I became curious about their meaning in my life. I realized how much I love developmental models. From Piaget’s description of how children learn to our recognition of the many elements and phases of how we age, each chapter has its own demands and requirements.  

I find these models helpful guides to dealing with aging. Whether we seek it or not; embrace it or reject it; the fact of aging requires us to accept the step-by-step process of becoming ‘Olders,’ as Ashton Applewhite refers to us in her important book on Ageism, This Chair Rocks – A Manifesto Against Aging. The decisions facing us daily are ones we might never have chosen or imagined, yet we respond and learn. And grieve when necessary.

For ten years I was on the board of Elderwise, an organization that emphasizes accepting and valuing its participants who have cognitive loss. They use an approach called Spirit-Centered Care, which is detailed in the book, The Elderwise Way – A Different Approach to Life with Dementia, by founder Sandy Sabersky and NWCCA Associate Director Ruth Neuwald Falcon.

Most of us know the importance of staying in the present, and not always revisiting the past, or looking ahead to what comes next.

Being with small children requires us to stay in the present moment. Being willing to play, to engage with their imagination and the world created in play is the best gift you can offer kids of all ages. Being curious about what they think, the conclusions they have reached about the world and how they navigate reality and imagination reminds us of how inherently unique, yet similar we are at each stage of our own developmental arc.

Being with people in cognitive decline requires something similar of us. I have several close friends who are on the spectrum of cognitive loss. Some are at the beginning, and can still tie past, present, and future together. Others might remember stories from when they were young and perhaps retrieve an occasional memory of times we were together. They have trouble following conversations and their speech is filled with what is called ‘word salads.’

Being present to that strange mixture of presence and absence is, for many of us, the greatest challenge. It is hard to maintain connection when the givens of shared thoughts and memories, or discussing new learning and ideas no longer apply. It might mean being willing to engage in circular conversations where we revisit a topic repeatedly, perhaps with new words, but always with continued support and love.

I am not saying that people with dementia are the same as young children. I am suggesting that the ways we interact with younger people can be similar to how we relate to people with cognitive loss—but without the hope that the future will be different and new learning digested and applied.

There are many tips about how to interact and behave with people with dementia. A favorite top ten list reads:


  1. Agree – Rather than Argue
  2. Redirect – Rather than Reason
  3. Distract – Rather than Shame
  4. Reassure – Rather than Lecture
  5. Reminisce – Rather than say “Remember”
  6. Repeat – Rather than say “I already told you”
  7. Say “Do What You Can” – Rather than say “You Can’t”
  8. Ask – Rather than Command
  9. Encourage and Praise – Rather than Condescend
  10. Reinforce – Rather than Force.

I find these ideas can apply to many different conversations in our lives.

Many of us live with deep feelings of guilt and shame from how people treated us as we matured. Families, workplaces, and places of faith too often operate on the ‘Rather than’ side of these ideas. Adopting a few new approaches might well change more than our relationship with people with dementia.