A Dignified Life: The Best Friends Approach to Alzheimer's Care, A Guide for Family Caregivers


Four million Americans currently suffer from Alzheimer's disease and experts estimate that 22 million people around the world will be so afflicted by 2025. Far too many families are struggling with the emotionally and physically draining responsibility of redefining their relationship with, and caring for, someone who not long ago was a vibrant member of society, yet may not know their own name today.

A Dignified Life helps combat the burnout and frustration that often accompany...

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A Dignified Life: The Best Friends Approach to Alzheimer's Care, A Guide for Family Caregivers

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Four million Americans currently suffer from Alzheimer's disease and experts estimate that 22 million people around the world will be so afflicted by 2025. Far too many families are struggling with the emotionally and physically draining responsibility of redefining their relationship with, and caring for, someone who not long ago was a vibrant member of society, yet may not know their own name today.

A Dignified Life helps combat the burnout and frustration that often accompany the task of caring for an Alzheimer's patient. Author David Troxel, an Alzheimer's expert and executive director of the California Central Coast Chapter of the Alzheimer's Association, maintains that at its simplest this approach is based on treating the person like a best friend and working from their strengths, not their weaknesses. He explains: "As family members, caregivers and professionals, we have to try to connect with them. People with this disease in some way need someone to be . . . attentive and empathetic--someone who really tries to walk a mile in their shoes."

A Dignified Life goes beyond the typical tips offered by most books and takes advantage of readers' instinctive desire to build friendships and taps into the intuitive aspect of caregiving that is part of our very nature. It provides a complete model for care built around creative and effective communication and meaningful activities and includes touching stories that demonstrate how the Best Friends method continues to improve the lives of both those who have Alzheimer's disease and those who care for them.

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Product Details

  • ISBN-13: 9780757300608
  • Publisher: Health Communications, Incorporated
  • Publication date: 9/15/2002
  • Pages: 250

Meet the Author

Virginia Bell, MSW, developed the Helping Hand Adult Day Center sponsored by the Greater Kentucky and Southern Indiana chapter of the Alzheimer's Association in Lexington, Kentucky. The award-winning facility was one of the first dementia-specific adult day programs established in this country and remains one of the best. She received her master's in social work and served on two Kentucky Governor's Task Forces studying Alzheimer's care and service delivery. A frequent and popular speaker on aging, Ms. Bell has been directly involved with the annual conference of Alzheimer's Disease International for more than a decade.

David Troxel, MPH, is a recognized expert on the best practices in Alzheimer's care and is a popular keynote speaker at conferences related to Alzheimer's and aging services. Along with Virginia Bell and others, he established a statewide network of support groups and services in Kentucky for patients and their caregivers. Troxel is the executive director of the California Central Coast chapter of the Alzheimer's Association and is also the associate editor of Early Alzheimer's, an international newsletter sponsored by the California Central Coast chapter of the Alzheimer's Association.

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Read an Excerpt

Chapter 4
A New Start The Art of Friendship

Alzheimer's disease changes us all. Because of the associated memory loss and confusion, your mother, father, sister, brother, husband, wife, or partner may no longer know you or understand his or her relationship to you. Many caregivers are confused, frustrated, sad, or even angry about these losses. Your mother may have always been your closest confidante and strongest supporter; now, she does not recognize you. A spouse whom you counted on for many years to balance the checkbook, pay bills, file the income taxes, or cook three meals a day is no longer able to do these things. As a result, your relationship with the person changes whether you like it or not.

Adopting a Best Friends approach can help diminish this pain and loss and can have a powerful impact on the person with dementia. When you rethink, or recast, your relationships to individuals with dementia and become a Best Friend to them instead of just a caregiver, the person now feels you are on his or her side. In addition, friendship helps evoke some of the social graces or learned manners of the person with dementia. It helps put the person on his or her best behavior.

Caregivers using the Best Friends approach have made the Helping Hand day program of the Greater Kentucky/Southern Indiana Alzheimer's Association one of the most admired adult day programs in the United States. Many individuals with dementia in Helping Hand have been considered difficult and challenging by their own family caregivers. Yet at Helping Hand, because the staff and volunteers are acting as friends, they thrive. Families can have similar success using the Best Friends approach at home.

Rather than staying in a state of despair, caregivers can learn to work through the pain and focus on gaining maximum value from the present; caregiving is transformed from a terrible burden to a job that becomes meaningful and satisfying. The process changes from a series of failures to a series of successes. Recasting this relationship to become a Best Friend does not mean taking away love or loving the person with dementia any less. It simply means approaching the relationship differently.

One caregiver told us that he had always had a troublesome relationship with his father-so bad, in fact, that he ran away from home at age 16. He now cares for his father full time and says they have never been closer. They take a daily walk together, have an evening scotch and soda, and watch the grandchildren play soccer. They have found that they now enjoy each other's company. Because the father has forgotten much of the past and is often unsure of his relationship with his son, the son has realized that he, too, must let go of past slights and injustices. "What's the point of me dwelling on it?" the caregiver asks. "What's past is past."

Like many caregivers, the son never dreamed he would be in the position of taking care of his father, a father whom he admits disliking for much of his life. However, this family's approach to Alzheimer's care has helped heal not only the son's relationship with his father, but also wounds he has carried inside himself.

Being a Best Friend is not just about altruism. Caregivers who recast their relationships take advantage of the principles of friendship to gain new ideas for handling day-to-day care in a more natural, positive way; prevent problems before they happen; form a new relationship with a loved one based on getting the most out of every day; and replace the stress and strain of caregiving with satisfaction. Below are the key ingredients for success.

What is a Best Friend?


A Best Friend becomes the person's memory.
A Best Friend is sensitive to the person's traditions.
A Best Friend respects the person's personality, moods, and problem-solving style.

FRIENDS do things together

A Best Friend enjoys activities with the person with dementia.
A Best Friend involves the person in activities and chores.
A Best Friend initiates activities.
A Best Friend ties activities into the person's past skills and interests.
A Best Friend encourages the person to enjoy the simple things in life.
A Best Friend remembers to celebrate special occasions.


A Best Friend listens skillfully.
A Best Friend fills in the blanks.
A Best Friend asks questions that are easily answered.
A Best Friend recognizes the importance of non-verbal communication.
A Best Friend gently encourages participation in conversations.


A Best Friend gives compliments often.
A Best Friend carefully asks for advice or opinions.
A Best Friend always offers encouragement.
A Best Friend offers congratulations.


A Best Friend tells jokes and funny stories.
A Best Friend takes advantage of spontaneous fun.
A Best Friend uses self-deprecating humor often.


A Best Friend does not talk down to the person.
A Best Friend works to help the person "save face."
A Best Friend does not assume a supervisory role.
A Best Friend recognizes that learning is a two-way street.


A Best Friend is not overly sensitive.
A Best Friend does more than half the work.
A Best Friend builds a trusting relationship.
A Best Friend shows affection often.

Source: The Best Friends Approach to Alzheimer's Care.

Phil and Karen Zwicke renewed their marriage vows after 10 years of marriage. Surrounded by friends and family, the couple enjoyed the afternoon including champagne and wedding cake. Phil, 52, has been open with others about his diagnosis of Alzheimer's disease; both of them are determined to keep him active and enjoying life as long as possible.


The best friendships often involve a lot of talking. Whether it is on the telephone or over the office water cooler, friends generally love to swap stories, gossip, share ideas, send e-mails and instant-messages to each other, and confide in one another. Friends are also there to listen to each other, in good and bad times.

A Best Friend Listens

In Alzheimer's care, it is important to try to be there for the person when he or she wants to talk about important feelings. Individuals with Alzheimer's disease should be given time to offer their feelings or ideas. Sometimes patience is rewarded with an insight.

Maria Scorsone has spoken three languages in her lifetime: Italian as a child, Spanish when she lived in Argentina, and English after she moved to the United States. She now often mixes the three languages. Her in-home aides became her Best Friends by listening to Maria's words very carefully. When the aides cannot follow the exact words, they can usually still understand her by listening to the tone of her voice and watching her facial expression and other body language.

A Best Friend Fills in the Blanks

People with Alzheimer's disease begin to lose the structure of their sentences and language. When you can provide clues and cues, communication can vastly improve. Sometimes even filling in the blanks by supplying one or two words keeps the dialogue going.

Edna Edwards loves to converse but has major difficulty finding the right words. When Edna says "Those little ones, I miss them . . . at the school . . ." her Best Friend says "Picadome School?" Edna can continue, "Picadome, that's my school!"

Conversation can continue about early childhood days, her teaching, and her schoolchildren, all because her Best Friend brought up some familiar names of people, places, and things in Edna's life.

A Best Friend Asks Questions that Are Easily Answered

The person may become easily frustrated if asked questions to which he or she does not know the answer.

When Evelyn Talbott, a retired librarian, returned from a vacation, she would have been frustrated if someone had asked her to recall, "Where did you go on vacation," or "What was the name of the beach?" Instead, a friend asked skillfully, "Did you and your husband, Bob, have a good time watching those big waves on the ocean?"

When her Best Friend provided some details within the question, it triggered memories and allowed Evelyn to share her joy from her vacation and participate in the conversation.

A Best Friend Recognizes the Importance of Non-Verbal Communication

Because verbal skills are diminished, body language becomes very important in Alzheimer's care. A Best Friend should greet the person warmly, smile broadly, and hold out a hand. The handshake still holds special meaning with older people who remember a time when everyone in polite company would shake hands. Almost always, the person will respond with a handshake. A mutual handshake is the beginning of a bond, a deep-rooted symbol that one is a friend, not a foe. Talking with your hands can also be effective. Gestures such as tapping the seat on a chair can help the person get the message to sit down.

Because of Mary Burmaster's hearing loss, body language was especially effective for a day center volunteer relating to her. After making eye contact, the volunteer smiled and would say, "Mary, lunch is ready." The volunteer would then touch her gently on the shoulder, pat her hand, and guide her to the table.

A Best Friend's gentle touch spoke volumes.

A Best Friend Gently Encourages Participation in Conversations

It is important to include the person in conversations as much as possible. Broad, open-ended questions ("Tell me about . . ."; "What do you think about . . .") that touch on the person's life experience can be particularly effective.

There is so much in Jim Holloway's life to talk about: fishing with his uncle, raising German shepherd dogs, collecting yo-yos, studying great artists and their works, enjoying classical music, teaching theology, visiting Pompeii, attending Yale University, working on old cars, being a medic on a troop ship during WWII, and much more.

All of this stays tucked away until a Best Friend gently encourages conversation by saying, "Tell me about . . ."

¬2002. All rights reserved. Reprinted from A Dignified Life by Virginia Bell, M.S.W. and David Troxel, M.P.H. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, without the written permission of the publisher. Publisher: Health Communications, Inc., 3201 SW 15th Street, Deerfield Beach, FL 33442.

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Table of Contents

Dedication xiii
Acknowledgments xv
Introduction xix
I Alzheimer's Disease and Dementia
1 What's Happening? The Experience of Alzheimer's Disease 3
Worry and Anxiety
Isolation and Loneliness
The Best Friends Approach
2 What Is Known? Diagnosis, Treatment, and Research 21
Is It Normal to Have Memory Lapses Now and Then? Can a Doctor Help Someone Determine if There Is a Problem?
What Does It Mean if the Doctor Diagnoses Some Form of Dementia? Is That the Same as Senility?
Disorders That May Be Treatable
Disorders That Are Currently Irreversible
What Does It Mean if My Doctor Is Using the "A" Word--Alzheimer's Disease?
Do All People with Alzheimer's Disease Have the Same Course of Illness?
What Kind of Medical Treatment Is Appropriate?
Can Other Health Problems Worsen the Effects of Dementia?
What Are Psychotropic Drugs and Can They Help?
Is Alzheimer's Disease Inherited?
Can Alzheimer's Disease Be Prevented?
How Does a Person with Alzheimer's Disease or Dementia Become Part of a Research Study?
What Happens at the End?
3 What Now? Making Sense of the Diagnosis 45
Be Open with the Person About His or Her Situation
Deal with Denial
Be Open with Others About Your Family Situation
Get Legal and Financial Affairs in Order
Make a Financial Plan for Health Care Services
Make a Realistic Assessment of Yourself and Your Community
Make a Realistic Assessment of Your Loved One with Dementia
Work to Preserve, or Even Enhance, Family Relationships
Continue to Be Part of the Community
Make the Environment Simple and Safe
II The Best Friends Approach
4 A New Start: The Art of Friendship 63
Friends Know Each Other's Personality and History
Friends Do Things Together
Friends Communicate
Friends Build Self-Esteem
Friends Laugh Together Often
Friends Are Equals
Friends Work at the Relationship
5 Memory Making: Honoring a Person's Life Story 97
Ingredients of the Life Story
Young Adulthood
Middle Age
Later Years
Other Major Ingredients
How to Use the Life Story
Greeting the Person and Improving Recognition
Introducing the Person to Others
Improving Communication through Clues and Cues
Designing Appropriate Activities
Pointing Out Past Accomplishments
Helping to Prevent Challenging Behaviors
Incorporating Past Daily Rituals
Broadening the Caregiving Network and Resources
Life Story of Rebecca Matheny Riley
6 The "Knack": Basic Principles of Dementia Care 137
Being Well-Informed
Having Empathy
Respecting the Basic Rights of the Person
Maintaining Caregiving Integrity
Employing Finesse
Knowing it Is Easier to Get Forgiveness than to Get Permission
Using Common Sense
Communicating Skillfully
Maintaining Optimism
Setting Realistic Expectations
Using Humor
Employing Spontaneity
Maintaining Patience
Developing Flexibility
Staying Focused
Being Nonjudgmental
Valuing the Moment
Maintaining Self-Confidence
Using Cueing Tied to the Life Story
Connecting with the Spiritual
Taking Care of Yourself
Planning Ahead
III The Best Friends Approach in Action
7 Connecting: Communicating with "Knack" 163
Communicating with Knack
Avoid Arguments
Make Directions Clear
Coping with a Mother's Accusations
Doing Extra Work to Understand Seemingly Incomprehensible Words
Encouraging a Bathroom Stop
Dealing with Loss
8 Being Together: Managing and Valuing Activities 183
Be Productive or Make a Contribution
Experience Successes
Be with Others
Build Skills
Have a Sense of Control
Feel Safe and Secure
Fill Religious or Spiritual Needs
Experience Growth and Learning
9 Inner Passage: Spiritual Journeying and Religion 209
Celebrate the Person's Religious Heritage
Embrace Simplicity
Look to the Creative Arts
Nourish Your Own Spiritual Life
Give Spiritual Care Throughout the Illness
10 Finding Help: Navigating the Long-Term Care Maze 223
Care in the Home
Adult Day Center Care
Residential Care (Assisted Living, Skilled Nursing Facilities, Continuing Care Retirement Communities)
IV Living with Dignity
11 Self-Care: Being Your Own Best Friend 251
Ways to Take Care of Your Own Needs
When Everything Is Going Wrong
Consider the Future
The Power of a Diary: Rebecca and Jo Riley
12 Transformations 271
Serenity and Peacefulness
Community Resources for Making In-Home Care Easier 279
Organizations, Web Sites, and Recommended Readings 287
Biographies 299
About the Authors 321
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  • Anonymous

    Posted March 11, 2008

    Very Practical and Supportive Information

    Very good book for someone with a loved one who has Alzheimer's. I got a lot of useful tips on how to talk to my mother - what to say and what not to say and how to say it. This book gives several examples on how to handle certain situations, some of which I had already tried. It was reassuring to read about others who were in the exact same situation as I am and how they handled it. Some suggestions didn't work, but that's because everyone with this disease is different and some things will work and some won't. It helped me to understand that and to open me up for what may come as she progresses down this road. Definitely a 'must read'.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted December 6, 2010


    Good book for helping to create a positive mindframe.

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