Self-Actualization, Spirituality, and Transcendence

Well, I always went to church with my parents when I was a child, but it was really boring. Now, I sometimes go with my grandmother to make her happy. I see how important it is to her, and I wonder if it will be important to me when I get really old. I’m just too busy right now.

Lori, age 22

AN ELDER SPEAKS

This is a real problem! I have three children and don’t want them to squabble over my things when I’m gone. I would like it if they would each choose something special that would remind them of me, but every time I bring it up they cut me off and won’t talk about it. I know there will be a big fight over the piano!

Mabel, age 74

Learning Objectives

On completion of this chapter, the reader will be able to:

1. Provide a comprehensive definition of self-actualization and identify several qualities of self-actualized elders.

2. Discuss the nursing role in relation to the self-actualization of elders.

3. Describe several evidences of transcendence as experienced by older people.

4. Specify various types of creative self-expression and their positive impact on health, illness, and quality of life among older adults.

5. Understand the meaning of spirituality in the lives of older people and discuss nursing responses to facilitate spiritual well-being.

6. Define the concept of legacy and name several types of legacies and what the nurse can do to facilitate their expression.

http://evolve.elsevier.com/Ebersole/TwdHlthAging

Special thanks to Priscilla Ebersole, the original author of this chapter for her foundational and very wise contributions.

Self-actualization, spirituality, and transcendence are vague, ambiguous terms that mean whatever the theorist thinks. These expressions also serve as umbrella terms for other conditions and situations that are addressed throughout this chapter. These terms overlap a great deal, but we have attempted to tease out the meanings for the reader, knowing that the perception of the reader will cast a particular interpretation that we may not have thought or intended. These conditions are ineffable, within the awareness of the individual but often inexpressible. Why, if these concepts are so obscure, do we include them as the final chapter in a text for nurses working with elders? Because these concepts are the life tasks of aging, seldom fully approached earlier. Concerns of the young are to become established as adults; middle-aged persons are overwhelmed with the requirements of success and survival.

Older people are more in touch with their inner psychological life than at any other point in the life cycle (Cohen, 2006). Ferreting out the reason for being and the meaning of life is the concern of elders. “As people age, confronting mortality is part of it, but as things change, they begin to recognize who they are and who they aren’t, the strengths they have and haven’t. They begin to think about the value and meaning of life. Tending to look more inwards rather than outwards often happens when we are 45 to 50, but there’s a screaming need for it when we reach 85 or 90” (www.agingwellmag.com/news/septstory1.shtml). An understanding of the developmental phases in the second half of life assists in understanding the journey toward self-actualization (Box 24-1).

BOX 24-1

Developmental Phases in the Second Half of Life

• Midlife reevaluation: Early 40s to late 50s and characterized by seriously confronting the sense of one’s own mortality and thinking about time remaining instead of time gone by. A catalyst for uncovering unrealized creative sides of ourselves.

• Liberation: Mid 50s to mid 70s and characterized by a sense of personal freedom to speak one’s mind and do what needs to be done. With retirement comes a new experience of personal liberation and having time to experiment with something different.

• Summing-up: Late 60s to the 80s and beyond and characterized by the desire to find larger meaning in the story of one’s life and to deal with unresolved conflicts and unfinished business. Motivation to give of the wisdom accrued throughout life, share lessons and fortunes through autobiography and personal storytelling, philanthropy, community activism, and volunteerism.

• Encore: Any time from the late 70s to the end of life and characterized by the desire to restate and reaffirm major themes in one’s life and explore new variations on those themes or further attend to unfinished business or unresolved conflicts and a desire to live well until the end.

From: Cohen G: Research on creativity and aging: the positive impact of the arts on health and illness, Generations 30(1):7-15, 2006.

Nurses will likely see numerous older people who are apparently not seeking any of these esoteric states of existence and have never tried to cultivate their deepest inner nature. We live in a mechanistic, scientifically based culture in which cultivation of immeasurable states of being have not been necessarily regarded or regarded at all. The dramatic increase in the population of older people has been considered a problem to be solved in an era of dwindling resources rather than a resource to enrich society. Attempting to sort, dissect, and classify everything is a hazard of our society. Despite all the human efforts for the past millenia, we have not been able to completely grasp or dissect the human soul. Therefore, with effrontery and apologies, we will devote the last chapter to just that! I have many times approached this subject incorrectly by asking individuals what it is like to be old. Now that I am old, what it is like seems too concrete. What is the meaning of this stage of life? Every nurse must ask this question of his or her older clients, friends, and parents. Do not ask on your way out the door. For many people, this notion will take some pondering. For some, it will open the door of their later lives just a crack. Others will be enlightened and will teach you a great deal.

Self-Actualization

Self-actualization is the highest expression of one’s individual potential and implies inner motivation that has been freed to express the most unique self or the “authentic person” (Maslow, 1959, p. 3). The crux of self-actualization is defining life in such a way as to allow room for continual discovery of self. A critical consideration in developing self-actualization is an underlying sense of mastery and a sense of coherence in the life situation. This effort depends to a large extent on individual attributes, as well as self-esteem. In this unit, we hope to expose the nurse to the myriad evidences of self-actualization in old age and suggest ways in which the nurse can assist older people in seeking their own unique way of living and growing. The focus is on nursing actions that may encourage elders to seek new possibilities within themselves.

Characteristics of the Self-Actualized

In old age, threats to self-esteem are strong if value is measured only by attainment, containment, power, and influence. Ethics, values, humor, courage, altruism, and integrity flourish in people who continue to grow toward self-actualization. Numerous other attributions can be mentioned. We focus only on those qualities that seem most pertinent to the older people that health care professionals are serving (Box 24-2).

BOX 24-2 Traits of Self-Actualized People

• Time competent: The person uses past and future to live more fully in the present.

• Inner directed: The person’s source of direction depends on internal forces more than on others.

• Flexible: The person can react situationally, without unreasonable restrictions.

• Sensitive to self: The person is responsive to his or her own feelings.

• Spontaneous: The person is able and willing to be themself.

• Values self: The person accepts and demonstrates strengths as a person.

• Accepts self: The person approves of self, in spite of weaknesses or deficiencies.

• Positively views others: The person sees both the bad and the good in others as essentially good and constructive.

• Positively views life: The person sees the opposites of life as meaningfully related.

• Acceptance of aggressiveness: The person is able to accept own feelings of anger and aggressiveness.

• Capable of intimate contact: The person is able to develop warm interpersonal relationships with others.

Courage

Courage is the quality of mind or spirit that enables a person to conquer fear and despair in the face of difficulty, danger, pain, or uncertainty. We believe that facing a long, painful, and restricted existence requires the highest level of courage. An older man with diabetes, amputations, and failing vision sits in his room at the retirement home, looking out the window for hours each day, for weeks, months, and years. Yet, he retains his positive spirit and love of life. This is courage. An older lady crippled with arthritis attends her ailing spouse, who no longer recognizes her. This is courage.

When asking older people how they keep going day by day, various answers are given. No one has ever said to me, “It is because I am courageous.” Older people need to be told. A gold star can be given to people who have lived and survived the long battle of living many years filled with both joy and pain. Memorials are made for people who die in battle, but few monuments are raised to those who courageously wake every morning with no great purpose or challenge to push them out of bed. Believing that older people are unable to be self-actualized unless they are energetic, healthy, and wealthy is a mistake. The capacity of the spirit to find meaning in existence is often remarkable. Nurses may ask, “What sustains you in your present situation?”

Altruism

A high degree of helping behaviors is present in many older people. The very old will remember the Great Depression and the altruism that kept people physically and spiritually alive. Neighbor helped neighbor long before the government came to the rescue. Apparently, a sense of meaning in life is strongly tied to survival and is derived from the conviction of, in some way, being needed by others. Many nurses are in the field because of altruistic motives and can understand the importance of assisting others. This idea might be discussed with the elder.

Volunteering often involves new role development and endeavors that expand one’s awareness. When volunteer services are considered as a means of personal enrichment and an expression of altruism, it is important for the elder to augment some latent interest areas and launch into pursuits perhaps unavailable earlier because of time constraints or other commitments. Nurses may question elders about latent interests and talents that they may want to cultivate.

Humor

Metcalf (1993) explains humor: originating in the Latin root humor, meaning fluid and flexible, able to flow around and wear away obstacles. In the same way that water sustains our life and well-being, humor sustains our mental well-being. Cousins (1979) and many other researchers have recognized the importance of humor in recovery from illness. The physiological effects of humor stimulate production of catecholamines and hormones and increase pain tolerance by releasing endorphins.

Elders often initiate humor, and, in our seriousness, we may overlook the dry wit or, worse, perceive it as confusion. Older people are not a humorless group and frequently laugh at themselves. Objections to jokes about old age seem to emanate from the young far more than the old. Perhaps the old, from the vantage point of a lifetime, can more clearly see human predicaments. Ego transcendence (Peck, 1955) allows one to step back and view the self and situation without the intensity and despair of the egocentric individual.

Continuous Moral Development

The moral development of mankind, on an individual and collective basis, has been of interest to philosophers and religious leaders throughout history. The driving forces of morality are love (Plato) and intellect (Aristotle).

Kohlberg’s refinements of his original theories have focused on the evidence, derived from autobiographies, that in maturity, transformations of moral outlook take place. Kohlberg posited old age as a seventh stage of moral development that goes beyond reasoning and reaches awareness of one’s relative participation in universal morality. This stage of moral development involves identification with a more enduring moral perspective than that of one’s own life span (Kohlberg and Power, 1981). This effort involves moral expansion and the exemplary impact of the fully developing elder on the following generations, born and unborn. We have come to believe that these exemplary lives may be the most important function of elders as we decry the honor and recognition given to individuals who seem to have little integrity or reliability. Each individual carries a mass of motivations and desires. Some people are stunted, and some will flourish. Youngsters must have models of honorable, truthful, and honest elders if we hope to cultivate these qualities in society and human experience.

Self-Renewal

Self-renewal is an ongoing process that ideally continues through adult life as one becomes self-actualized (Hudson, 1999). According to Hudson, self-renewal involves the following:

• Commitment to beliefs

• Connecting to the world

• Times of solitude

• Episodic breaks from responsibility

• Contact with the natural world

• Creative self-expression

• Adaptation to changes

• Learning from down times

Collective Self-Actualization

The collective power of self-actualized older people has already brought about many changes in society. Power is a term describing the capacity of an individual or group to accomplish something, to take command, to exert authority, and to influence. The self-actualized older person is powerful and confident. Power is the gateway to resources and recognition.

The age-equality movement, older citizens returning to school, and the revolution of older people in movements such as the Gray Panthers have produced major changes in the status and recognition of older people. Gray Panthers recognize that issues of aging are not narrow or exclusive but, rather, are representative of human rights for people of all ages. Maggie Kuhn (1979), founder of the Gray Panthers, died in 1995 at the age of 89, but her beliefs and followers survive. Kuhn perceived that the issues confronting older people are not those of self-interest. As “elders of the tribe,” the old should seek “survival of the tribe” (Kuhn, 1979, p. 3).

Wisdom

Wisdom is an ancient concept that has historically been associated with the elders of a society. Wisdom represents the pinnacle of human development and can be compared to Maslow’s self-actualization or Erickson’s ego integrity. In many cultures, older people are respected for their years of experience and are awarded the role of wise elder in political, judicial, cultural, and religious systems (Ardelt, 2004; Hooyman & Kiyak, 2011).

Over the last two decades, there has been renewed interest in the concept of wisdom and the capacity of the aging brain to develop unique capacities (Ardelt, 1997, 2000, 2003, 2004, Baltes 1991; Baltes and Smith, 2003, 2008). Many skills improve with age but are not identified on standard cognitive screens, and certain testing conditions have exaggerated age-related declines in cognitive performance (Chapter 19). The bulk of research has focused on cognitive declines and strategies to help older people find ways to overcome cognitive failings (Helmuth, 2003). Because of this emphasis, research on cognitive capacities in aging and possible ways to stimulate wisdom has been limited (Ardelt, 2004).

Moving beyond Piaget’s formal operational stage of cognitive development, adult development theories propose a more advanced cognitive stage, the postformal operational stage. In this stage, individuals develop the skills to view problems from multiple perspectives, utilize reflection, and communicate thoughtfully in complex and emotionally challenging situations (Parisi et al., 2009). Recent neuroimaging research has suggested that changes in the brain, once seen only as compensation for declining skills, are now thought to indicate development of new capacities. These changes include using both hemispheres more equally than younger adults, greater density of synapses, and more use of the frontal lobes, which are thought to be important in abstract reasoning, problem solving, and concept formation (Hooyman and Kiyak, 2011; Grossmann et al., 2010).

Characteristics of wisdom. One does not become wise simply because one grows old. Nor is wisdom achieved simply because of an accumulation of life experiences. Parisi and colleagues (2009) noted that “after centuries of trying to understand what it means to be wise, there is still considerable debate about the essential components of wisdom, how it is acquired, and how it is activated” (p. 868). Most agree that the achievement of wisdom is a developmental process that requires the ability to “integrate experiences across time and utilize these experiences in a reflective manner” (Parisi et al, 2009, p. 867).

Maturity, integrity, generativity, the ability to overcome negative personality characteristics such as neuroticism or self-centeredness, superior judgment skills in difficult life situations, the ability to cope with difficult challenges in life, and a strong sense of the ultimate meaning and purpose of life are also associated with wisdom (Ardelt, 2004) (Box 24-3). The renewed emphasis on wisdom and other cognitive capabilities that can develop with age provides a view of aging that reflects the history of many cultures and provides a much more hopeful view of both aging and human development.

BOX 24-3

Dimensions of Wisdom

• Cognitive: Knowledge and acceptance of the positive and negative aspects of human nature; the limits of knowledge, and of life’s unpredictability and uncertainties; a desire to know the truth and comprehend the significance and deeper meaning of experiences, phenomena and events

• Reflective: Being able to perceive phenomena and events from multiple perspectives; self-awareness, self-examination, self-insight; absence of subjectivity and projections (e.g., the tendency to blame other people or circumstances for one’s own situation, decisions, or feelings)

• Affective: Sympathetic and compassionate love for others; positive emotions and behaviors toward others

From: Ardelt M: Wisdom as expert knowledge system: a critical review of a contemporary operationalization of an ancient concept, Human Development 47:257-285, 2004.

Paths to growing older and wiser can be fostered throughout life. Viewing older people as resources for younger people and our society places the reason for and the immense value of aging at the center of focus. This is in contrast to the view of aging as inevitable decline, personal diminishment, disengagement from life, and a drain on society. Nursing too must turn to the wise leaders who came before us as we chart our course for the future (Chapter 1). Priscilla Ebersole, one of the geriatric nursing pioneers and co-author of this chapter, shares her reflections on wisdom from the perspective of her 83 years (Box 24-4).

BOX 24-4 Reflections on Wisdom

Priscilla Ebersole, Geriatric Nursing Pioneer

In thinking about wisdom, I wonder what it is and if we ever achieve anything near that in one lifetime. I now have more questions about life than I have answers.

Where are we in the process of human evolution? We seem to be consumed with speed and technical wonders. What about the extrasensory perceptions and amazing coincidences that seemingly arise randomly? Are we still primitives?

Dying: doesn’t it present more questions? I have become immunized as so many I love have preceded me, but it would be wonderful to know how much time I have—or would it?

How can one develop true compassion? I have flashes of it but find I still have many judgmental feelings about many persons and events. Is this not practical?

How can I learn more from others? I am rather trapped in my own skin and imperfections.

Is it true that our hormones really affect us so much? Yes, undoubtedly I have become much more aggressive with the almost total loss of estrogen. Do I care?

Is the search for prolongevity a worthy goal? Only when one is healthy and has something to offer the world. But, really, what is healthy? Only function? Mind health?

Does history really teach us anything? Though we seem to repeat so much of it yet pondering it and our roots remains significant for me.

And what about the universe, both macro and micro of which we really still know so little? Pondering and wondering, I will never know even a bit of all I wish.

Yet, becoming old is becoming as life seems to hold many lifetimes in one. There are so many challenges and circumstances that change one’s perspective and beliefs. One begins to feel a part of and connected to every living thing; Aunt Laura expressed it well. The youth and elders in one’s lifetime are so significant in one’s philosophy. Grandchildren and great grandchildren open new vistas of thought and opportunities to redo some of the faltering actions of parenthood.

Catherine, my friend who died at 106, taught me more about aging than any experience in my life. She still giggled like a school girl as she told me of some amusing event in her life.

With the prospect of longer and healthier lives, older people are looking for more meaningful and challenging ways to foster continued growth and contribute to society. Programs such as Foster Grandparents, the Experience Corps, and the Sage-ing Guild are examples of this new view. Further resources can be found on the Evolve website.

Creativity

Creativity is a bridge between the growing self and the transcending of self. Creativity may be the transit mechanism between self-actualization (the reaching of one’s highest potential) and the step beyond, to transcend the limitations of ego. “Creativity has always been at the heart of our experience as human beings … this need for creativity never ends” (Perlstein, 2006, p. 5). American culture has neglected to recognize the innate creativity in elders who are too often viewed as debilitated, in need of medical attention, and the focus of societal problems. Recently, our understanding of aging has expanded to a view that older people possess unique strengths and wisdom. Promoting health in aging is more than targeting problems and developing interventions for health promotion and disease prevention. Aging is potential as well as problems. A focus on creativity and aging and the positive impact of the arts on health, illness, and quality of life is gaining importance in our understanding of health and well-being among older adults (Cohen, 2006).

The National Center for Creative Aging, established in 2001, is dedicated to fostering the relationship between creative expression and quality of life for older people. The Beautiful Minds: Finding Your Lifelong Potential campaign is a new initiative from the Center that focuses on raising awareness of people who are keeping their minds beautiful and the actions people can take to maintain the brain. Research suggests that there are four dimensions to brain health: the nourished mind, the socially connected mind, the mentally active mind, and the physically active mind. These dimensions stress the importance of healthy diet, social engagement, cognitive stimulation, and physical activity to brain health (www.creativeaging.org).

The Creativity and Aging Study is the first formal experimental study investigating the “influence of professionally conducted, participatory arts programs on the general health, mental health, and social activities of older people” (Cohen, 2006, p. 11). Preliminary results indicate that participation in the arts programs has positive effects on physical health, independence, and morale of participants when compared with a control group (Cohen, 2006).

Products of creativity are less important than creative attitudes. Curiosity, inquisitiveness, wonderment, puzzlement, and craving for understanding are creative attitudes. Much of the natural creative imagination of childhood is subdued by enculturation. In old age, some people seem able to break free of excessive enculturation and again express their free spirit when practical matters no longer demand their sole attention.

Creativity is often considered in terms of the arts, literature, and music. A truly self-actualized person may express creativity in any activity. Breaking through the habitual or traditional mode into authentic expression of self is creativity, whether it is through cooking, cleaning, planting, poetry, art, or teaching. Creative expression does not necessarily mean that the older person has to create a work of art. Subtler ways of expressing creativity are present even in the frailest of older people. Consider Priscilla Ebersole’s description of Catherine at 100 years old and living in a nursing home:

Catherine was self-actualized and creative to the best possible extent. Her physical constraints were enormous: she had no material assets, her range of activity was limited to her small cubicle in a skilled nursing facility, and her body was frail. However, her spirit was strong, and she knew and used her potential. Catherine’s creativity was expressed at each meal when she rearranged, mixed, and added to her food. She carefully chopped a pickle and sprinkled it on her cottage cheese and added a little honey to her applesauce. Each meal was a small adventure. Several friends would visit regularly and bring Catherine small items she enjoyed. They could always count on being entertained with creatively embroidered tales of the past. The gifts they brought were always used in extraordinary ways. A scarf might be tied around her head. Powder, perfume, books, and other things would be bartered for favors from staff members or given as gifts. Her radio brought news of the day interspersed with classical music. Catherine created a milieu in which she enjoyed life and maintained her self-esteem. That she was self-actualized was never in doubt. Her artistry overflowed in myriad small gestures.

Creative Arts for Older Adults

Maximizing the use of self in the later years in unique ways might be termed creative self-actualization. Many individuals will need the stimulus of an interested person to uncover latent interests and talents. Other people will need encouragement to try new avenues of self-expression—some will be fitting for them and others not. Several ideas are presented here for nurses working with older people who may need an introduction to creative use of leisure time.

Many aspects of the developmental needs of older people are met by artistic expressions. Among these achievements are (1) conflict resolution, (2) clarification of thoughts and feelings, (3) creation of balance and an inner order, (4) a sense of being in control of the external world, (5) creation of something positive from defeating experiences or in the face of paralyzing depression, (6) artistic communication as an integral part of human experience, and (7) the sustenance of human integrity. Wikstrom (2004, p. 30) suggests that art and aesthetics “help individuals know themselves, become more alive to human conditions, provide a new way of looking at themselves and the world, and offer opportunities for participation in new visual and auditory experiences.” Each person has a private, symbolic, feeling world that can be brought out by certain expressive activities.

Ideas for developing creative activities with older people are presented in Box 24-5.

BOX 24-5 Ideas for Developing Creative Abilities

Art

Using oil pastels, create a drawing that represents self, or select three colors you like and three colors you dislike, using all six colors to create a self-portrait.

Draw a representation of your world.

Create a collage or mobile out of an assortment of materials and pictures that can represent subjects, such as the self, part of self you like or dislike, or the family.

In small groups, use clay to create an art piece or a statement.

Music

Play a variety of music; focus discussion on imagery and any feelings that the music evokes.

Discuss or have clients bring in music that elicits feelings of sadness, happiness, and so on.

Show a picture (can be cut from a magazine), and ask members to see if they can imagine the sounds that might go with the picture.

Express self or group through dance and movement to select music.

Movement

Create a movement to fit the way you are feeling while introducing self to group.

Have members stand and initiate a slow, swaying motion (good exercise with which to end the group session).

Have members mirror each other’s movements, such as hands or the entire body, creating a duet.

Imagery

Use guided fantasies and imagery to facilitate stress reduction and relaxation, awareness, the power of one’s own healing capability, and self-expression through symbols and symbolisms.

Writing

Encourage journals or diaries; set a group time available to write and share ideas.

In small groups, create a group poem.

Read selected poems or stories as a group, and then share reactions and feelings from the readings.

Create a book to be distributed to group consisting of a collection of members’ writings.

Krampe and colleagues (2010) conducted a pilot study investigating the use of a specific type of therapeutic dance, the Lebed Method, with frail older people at a PACE Center. The Lebed Method, originally developed for women with lymphedema, combines low-impact dance with upbeat participant-specific music. Results included positive trends in the functional status of the participants, including improvement in balance and gait. Further research is needed, but the intervention shows promise for improving balance and gait and reducing fall risk. Many community centers and adult day programs for older people are incorporating dance into their activity programs, and this modality holds promise for enhancing movement, decreasing fall risk, and contributing to socialization and enjoyment.

Music

Music is a familiar and universal experience. Tonal or rhythmic music can be an inward experience or an outward expression. As such, music is adaptable to each individual. Music therapy is an individual music program prescribed by a professional music therapist to bring about desirable changes in behavior. However, the use of music listening in a clinical situation does not require special knowledge of music and is considered a safe, simple, low-cost, and evidence-based intervention nurses can use independently to improve the environment of older adults and enhance well-being (McCaffrey, 2008; Witzke et al., 2008).

The self-determined use of music as a means of enjoyment and personal expression can be achieved by listening, meditating, improvising, relaxing, moving to music, creative dancing, composing, learning new songs, studying music history, rhythmic patterning, mastering an instrument, building an instrument, or in any other manner an individual chooses to adapt music toward self-fulfillment. Music can be a comforting, structured expression, a therapeutic tool, or it can provide the opportunity for creative and imaginative self-expression. People with dementia often respond to music, moving to the rhythms and singing the words to old songs, even when their verbal communication skills are quite impaired.

The therapeutic benefits of music for older people have been well described and include comfort and pain relief, improved cognition and reduced acute confusion after knee or hip surgery, decreased anxiety and stress, improved food consumption, decreased agitation in older adults with dementia, and decreased need for physical and chemical restraints (Gerdner, 2000, 2005; Hicks-Moore, 2005; McCaffrey, 2008; McCaffrey and Freeman, 2003; McCaffrey and Good, 2000; McCaffrey and Locsin, 2006; Twiss et al., 2006; Witzke et al., 2008). An evidence-based guideline, Individualized Music for Elders with Dementia (Gerdner, 2010) (www.guideline.gov) can be used by nurses to better understand the use of music with older adults with dementia. This guideline also has a consumer version for family caregivers. Additionally, an interactive online continuing education module for nurses to learn more about individualized music interventions is provided through Sigma Theta Tau International and the John A. Hartford Foundation (Gerdner, 2010).

Poetry

Music and poetic expression are similar in rhythmic beauty. Traditionally, poetry has been judged and categorized by its rhythmic meter. However, modern poetry may have style and quality without a categorical rhythm. Older people enjoy the traditional patterns, rhyming qualities, and free verse. Many people who never thought of themselves as poets have discovered a talent for poetic expression.

Killick (1997, 2000, 2008) has done beautiful work with poetry writing with persons who have dementia. Killick (2005) has said that “people with dementia can often find a real solace and satisfaction and a creativity in speaking in this way and having it recognized as being of value because they’re so used to being put down” (www.bbc.co.uk/radio4/youandyours/transcript_2005_46_fri_02.shtml). Koch (1977) wrote a delightful book explaining the way he began poetry groups with older individuals who did not think of themselves as poets.

Reading for Self-Development

Reading is an ageless activity, and some older people prefer the individual, passive involvement in reading to group activities. Group reading and discussion can also be enjoyable, as demonstrated in the Great Books discussion groups that meet routinely in many libraries. When an array of books is available, many older people find them sustaining. Books extend boundaries imposed by physical limitations, allow exploration into untouched areas of thought, and enrich the individual. For many older people, reading has been a major pleasure throughout life and, common as it seems, should not be underestimated as a form of self-discovery and self-actualization. Many libraries have developed creative programs to serve older people. Some of these include talking books for the visually impaired, large-print books and magazines, and a 24-hour audio reader service through a closed-circuit radio station.

Creative Arts and People with Dementia

Creative and expressive activities are not limited to the cognitively intact elder. Art, poetry, dance, music, drama, and storytelling activities are therapeutic interventions that offer great value to people with dementia. According to Bastings (2006, p. 17):

To people with dementia, the arts bring tools that enable them to express themselves and their vision of the world. The arts operate on an emotional level, one needn’t have control of rational language to write a poem, create a dance, or take a photograph. Where rational language and factual memory have failed people with dementia, the arts offer an avenue for communication and connection with caregivers, loved ones, and the greater world.

The National TimeSlips Project (Bastings, 2006) is an example of a creative storytelling program designed for people with dementia (see Chapter 6). Arts for Alzheimer’s, Arts for the Aged, and the Age Exchange Theater are other examples of creative arts programs for people with dementia. At the Louis and Anne Green Memory and Wellness Center in the Christine E. Lynn College of Nursing at Florida Atlantic University, the “Artful Memories” program provides opportunities for individuals with mild to moderate dementia to learn techniques of artistic creation and expression in artistic media in a supportive and nonjudgmental environment. Works created are on display at the Center and have been made into calendars as well (Figure 24-1). Participants have derived a great deal of pleasure, pride, stimulation, and camaraderie from the time spent creating art. The arts offer people with dementia the opportunity for expression of feelings, connections, and joy and hold tremendous promise to improve the quality of life for people with dementia (Bastings, 2006). Additional resources related to creative arts for people with dementia can be found on the Evolve website.