When a parent has dementia: From strangers reconnecting through art and reminiscence therapy

As the population ages, dementia is becoming increasingly common. Data from the Department of Health indicates that one in every ten elderly persons aged 60 or above in Hong Kong suffers from this condition. When a parent is diagnosed with dementia, many children are shocked to find that the loved one who raised them has become a "familiar stranger." This is not only a medical issue but also a profound test of the parent-child relationship.

The Parent-Child Relationship: A 'Y-Shaped' Life Trajectory

Many caregivers may not realize that the relationship with their parents before and after the onset of the illness is fundamentally different. In the past, when children were young, the parents' lives revolved entirely around them. As children grow up and become independent, their lives gradually drift apart. When children are at their peak, busy with careers and their own families, their parents enter their later years. At this stage, although parents may still be able to care for themselves, they often do not want to disturb their busy children. Their life trajectories diverge like the letter "Y," and the distance between them slowly widens.

This long-term estrangement causes children to habitually take their parents' "independence" for granted. It is often not until a parent's diagnosis that they realize how little they know about this closest relative. Furthermore, early symptoms like personality changes and mood swings are often mistaken for normal aging, leading to missed opportunities for early intervention. When patients feel helpless due to their inability to control themselves, and family members feel fear, both sides simultaneously fall into the psychological "five stages of grief": denial, anger, bargaining, depression, and acceptance. If caregivers do not understand the patient's past personality, family background, and life experiences, it becomes difficult to interpret the root causes of their behaviors, making the caregiving process filled with frustration.

The Truth Behind a Patient's Agitation

There was a real-life case during the pandemic: an elderly man with dementia suddenly became agitated and tried to rush out the door while receiving home-based physical therapy, startling his family and the home rehabilitation assistant. After a multidisciplinary team comprising a social worker, registered nurse, physiotherapist, and occupational therapist intervened, they discovered this was not simply aggressive behavior. The man was feeling bored and stressed from being cooped up at home for so long and desperately wanted to go out for some fresh air.

More interestingly, the man had a disrupted routine—he was full of energy at night and would even tightly hold his wife's hand while watching television. This was a stark contrast to his previous image in the family as a silent, breadwinning figure. The team analyzed that after his illness, he naturally revealed his true personality and a desire to express his emotions. They suggested the wife respond to his hand-holding with simple physical contact, like gently leaning her head on his shoulder, to help him recall the warmth of the family.

Rediscovering Self Through Art and Reminiscence Therapy

During observation, his daughter was surprised to discover that her father was actually skilled at drawing with delicate brushstrokes—a side of him she had never seen while growing up. The team immediately suggested combining cognitive training with his interest in drawing. The training process was gradual and progressive, moving from monochrome to color drawing, and from 2D drawings to making simple 3D models with light clay. This type of training, which combined art, color, and tactile sensation, effectively improved the man's quality of life. This not only helped the patient regain a sense of self but also allowed his family to begin re-knowing him. Later, his daughter looked through old photo albums and confirmed that her father had indeed loved drawing when he was young. 

The man's transformation confirmed the value of "reminiscence therapy." The team encouraged the family to explore the patient's early life and interests to aid his rehabilitation more effectively. The family collected old photos of the patient and used a mobile app to create short videos with simple narration and music, serving as a form of "elderly art therapy." This process promotes mutual understanding and allows family members to reconnect with the once-familiar person.

Conclusion: Time and Attention – The Most Precious Gift

The most precious gift you can give is your time and attention. For caregivers, the challenge often comes not just from the patient's condition, but also from their own feelings of helplessness and stress. By delving deeper into the patient's past, caregivers can build a stronger emotional connection, allowing the patient to receive support and love in return during this difficult journey. May all caregivers, through this understanding and companionship, steadfastly meet the challenges ahead.

Author of original text: Ms. Chui Fung-ying, Lecturer, School of Nursing and Health Studies, Hong Kong Metropolitan University