Throughout our lives we have sought out people and places that are comfortable. Whether consciously or unconsciously, we gravitate to people, places, and groups which make us feel stronger than we do on our own. Whether you believe it stems from early primates grouping together for protection from predators or you see it as personal preference, comfort is a driving force for us.
Perhaps as a school-aged child you had a few friends, a club, a team that brought you a level of confidence. When you were with these individuals, you felt you fit in. You shared something in common. Maybe a skill or a background or perhaps a common understanding. When you were thrown into other groups outside your comfort zone, you felt it. Much like Goldilocks, you got out of the situation as quickly as possible.
In the dementia world, comfort zones are different than in a pre-dementia world. Where my spouse once prospered, he can no longer. Whether that is based on time of day, number of people, noise of environment, or even gender—he feels uncomfortable. His brain is no longer able to process all the demands of the situation. In the early days, this meant withdrawing to the hotel room in the middle of a guided tour. Now, it means we have to drop out of the virtual men’s group because of the topic of the discussions and napping every afternoon.
As a care partner, I sometimes can remember that I too have different comfort zones than I once had. The demands of care partnering take more bandwidth this year than in past years. For example, I now seek more solitude, tend to avoid night calls and choose solo fitness activities. Both of us have different cognitive bandwidths.
This principle of comfort zones and their link to our diagnoses has been a long-term care research topic. A recent study looking at clustering patients in long-term care found grouping individuals into comfort zones pays off in their overall health.1 By assessing and tailoring care to a group of individuals with similar needs, there were much improved results. Those clustered with higher cognitive and physical needs showed improvement with a tailored care plan specific to their needs.
A diagnosis of dementia significantly alters holistic care either in long-term care or in-home care. The one-size-fits-all brand of care doesn’t work. We found that out from the first neurology appointment. No easy answers, no cures, confusing information. But we can use the comfort zone approach to our care. Whether placing our care partner in long-term care or continuing in-home care, we have the ability to choose what is comfortable for them.
This philosophy is reiterated in research. A home-like environment is key to successful dementia care.2 You may have witnessed the opposite of this in a hospital setting.
Unlike a medical environment, research defines a home-like environment as small group living clusters, outdoor access, high staff-to-person ratio, homelike furnishings, and natural light. All things that bring universal comfort — but proven to be effective for dementia care.
As we take note of today’s comfort zone, it is important to remind ourselves that may differ from what their comfort zone used to be. Our care partner’s needs have changed as their brain has changed. We create and seek the comfort zone for them which meets today’s needs.
Cate McCarty, PhD’s background in nursing, activities and admissions has given her a passionate commitment to quality of life for the individual and family with dementia. Cate is currently the care partner for her spouse who has early-stage dementia of the Alzheimer’s type.
1Tobis S, Jaracz K, Kropińska S, Talarska D, Hoe J, Wieczorowska-Tobis K, Suwalska A. Needs of older persons living in long-term care institutions: on the usefulness of cluster approach. BMC Geriatr. 2021 May 17;21(1):316. doi: 10.1186/s12877-021-02259-x. PMID: 34001000; PMCID: PMC8130415.
2Gray C, Farrah K. Homelike Models in Long Term Care: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jun 5. PMID: 31479210.