Anne Ellett, N.P., M.S.N.
AANC Certified Gerontological Nurse
Founder, Executive Director – Memory Care Support
With our sincerest appreciation to Anne for allowing DAA to re-post the following article from her April 2017 newsletter.
Most of us are aware of research that shows that if teachers hold low expectations of a child’s abilities, that child is more likely to perform only to the level of the teacher’s low expectations. And conversely, if the teachers have high expectations, the child is much more likely to excel to the level of the higher expectations. In fact, teacher’s expectations for their students have a strong correlation to their students’ graduation rates. This correlation of outcomes with expectations is called the Pygmalion Effect and is well researched in the field of education.
People do better when more is expected of them! It makes sense! I think we have to ask ourselves, does the “Pygmalion Effect” also apply when we consider the abilities of people living with dementia (PLWD)? Can our expectations positively or negatively affect their abilities and behavioral expressions?
It would make sense that if we expect PLWD to be “unable”, “not all there”, “incapable”, “doesn’t understand”, “a shell of their former self”… we would have pretty low expectations for them. And where do lower expectations lead? They lead to a lower level of functioning.
So often, when a care partner is asked to describe a person they are supporting, they will start with the negative. “He can’t really do much. He used to be an attorney…so sad. Now he doesn’t even know what day it is. He just sits in his chair most of the day, he doesn’t really want to join in any activities.”
By starting the description with a list of things the PLWD is no longer doing, we’re telling a story of loss and inability, and also giving ourselves permission to not really try to engage him because he’s incapable, unable, unaware… What if instead we said, “He enjoys listening to music and he is really good at keeping time when there is music playing. He loves it when people stop and visit with him, his face lights up. He really enjoys the company of others. And when he is outside in the garden, he seems to appreciate all the colors and fragrances.”
This description makes no mention of previous inabilities, but rather highlights what he enjoys and is capable of at this time. From this second description, we would expect to find a man who is able to appreciate relationships and companionship, has a good sense of musical rhythm and loves the outdoors.
That’s a very different picture than the first description that was only about his losses and inabilities.
How much affect do our negative expectations have on PLWD? I think it is quite profound. For instance, care partners will often tell me about someone’s “challenging behavior”. What if we changed that description, and instead said, “Mr. J is trying to communicate something, I am not sure what he needs but I’m going to spend more time with him to help me understand what he is expressing.”
It’s about changing our own perceptions and the stories we tell. What if we use phrases such as, “She is able to…,” “He loves to do…,” “He’s very good at…,” or “she always enjoys…” when we describe PLWD, so we only focus on current abilities and pleasures? By telling a story of ability and retained talents, we would be more likely to offer new possibilities and choices, rather than limited and non-stimulating activities.
Help us change the story of living with dementia from one tragedy and loss to abilities and retained talents. Let’s change our language from “he can’t…” to “he’s able to…”
Have a great day!