Joyce Sasaki’s eyes light up when her dog Scotty is placed in her lap. Her smiling face is confirmation that she enjoys time with her Maltese, who has been the family pet for the past couple of years.
The 90-year-old Sasaki was separated from her furry friend for more than seven months following a stroke in October 2009 that left her incapacitated. Needing rehabilitation and care, she was transferred to Hale Nani Rehabilitation and Nursing Center on Pensacola Street.
» Hale Nani CEO John Megara will conduct a free class on techniques to encourage engagement and calmness in people with dementia from 6 to 7:30 p.m. tomorrow at Bristol Hospice, 500 Ala Moana Blvd., Building 4, Suite 547.
"The first time we brought (Scotty), we were worried. He’s normally very rambunctious," said Sasaki’s son, Clyde Sasaki. But the dog has become a regular part of the woman’s treatment since Namaste Rooms were established at Hale Nani.
"It’s a really difficult decision to put a loved one in a care-home facility. She struggled with depression and anxiety, along with dementia issues. After her stroke, things became more acute," he said. "She would cry all day long. I used to get calls in the middle of the night because the staff was unable to control her outbursts, so I’d go in and calm her down."
A month after the Namaste program began in 2009, the calls stopped. "She’s definitely become more stable," he said. "She may not be able to have a conversation with us, but she does recognize us. I let her talk to her sisters on the phone, and she recognizes their voices, too."
While the final stages of dementia leave most patients with little or no ability to engage with others, tantalizing their senses of sight, hearing, smell, taste and touch is still possible, explained John Megara, chief executive officer for Hale Nani. Familiarity can also trigger a response or create a sense of calmness for dementia patients.
Clyde Sasaki and wife Alison bring familiar items to his mother on a regular basis, including snacks, mail from friends and church newsletters that they read to her. "Occasionally, we also sing some of her favorite church songs and pray together with her."
Hale Nani has three Namaste Rooms and plans two more. Patients are provided soft blankets and comfortable pillows and massage. The room has soft lighting and music, and a video screen shows calming nature scenes. The patients can also watch their favorite movies on portable DVD players or have their hair combed while listening to their favorite music.
"’Namaste’ is a Hindu word that means ‘honoring the spirit within.’ Although the methods used won’t bring back mental functioning for people with dementia, it can give them and their caregivers precious moments of human connection that were thought to be lost," Megara said. "Family members who care for their loved ones at home can use these methods, too."
According to Elizabeth Stevenson, executive director and CEO of the Alzheimer’s Association, it’s estimated that 1 in 8 people will be diagnosed with Alzheimer’s or some form of dementia once they reach the age of 65.
"There’s an even greater risk when someone turns 85," Stevenson said. "It’s important to get diagnosed early since multiple treatments help to maintain cognitive function longer. If it’s caught early enough, we won’t see a rapid decline."
Dr. Patricia Blanchette, founder of the John A. Burns School of Medicine’s Geriatric Medicine Fellowship program and past president of the Aloha Chapter of the Alzheimer’s Association, serves as medical director at Hale Nani. She said that because people with dementia have a limited understanding and ability to communicate, activities to enhance their quality of life should be focused on the senses.
"There are some residents with dementia who surprisingly begin to verbalize and interact after they begin the Namaste program, even when they have not done so for months or years," she said.
Blanchette added that it’s not necessary to have a special room to create this sort of space. "The Namaste program can be done in a facility or in the home at the bedside or in a favorite chair," she said.
"The human connection is important always in interacting and caring for people, regardless of their diagnosis. It is often the most important thing we have to give."
The program at Hale Nani began after Megara was introduced to Joyce Simard’s book, "The End-of-Life Namaste Program for People with Dementia." The book offers simple and practical ways to maintain a human connection with patients.
Some of the techniques have dual purposes. For example, lotion massages help soothe anxiety while addressing skin problems.
"The elderly have very fragile skin. It can get so dry and become discolored," said Fely Pula, Hale Nani director of nursing. "If dementia patients are agitated, it can be signs of possible pain. They can’t express their needs or feelings. But if you rub lotion on their feet and hands, they may become calmer."
All of the patients involved in the program saw improvement in their skin, while 80 percent required less pain medication and 10 percent were able to stop pain medication altogether. There also was a decrease in agitation and aggression, which opened the door for an increase in family visits, Megara said.
Pula said one example of how the program is helping patients is a Hale Nani resident who began teaching hula from her wheelchair. "She was a hula instructor and hadn’t gotten out of bed until we had this program," she said.
"To see a response in someone who was completely disconnected is heartwarming and rewarding."