ZEISEL, John – I’m Still Here, (Alzheimer’s)

I’M STILL HERE by John Zeisel
A New Philosophy of Alzheimer’s Care

QUOTES FOR DISCUSSION

I have learned over the last fifteen years that treating people with Alzheimer’s the old way was often better. In order to treat people living with Alzheimer’s as people rather than as patients, we first have to appreciate their capabilities as well as their losses.
(John Zeisel, “I’m Still Here,” page 2)

…the treatment principles involved are equally valid for autism, mental illness, mental retardation, manic depression, diabetes, HIV, and even for a simple cold, or a twisted knee. 

…the physical environment, the communication, and the programs all independently act to reduce residents’ symptoms, including agitation, anxiety, aggression, and apathy.

I advocate treating people living with Alzheimer’s a “people” first and then as those with an illness. I advocate including people living with Alzheimer’s in society – at museums and theaters, among other places. I explain that people usually live with Alzheimer’s for over a decade and that for much of that time they can function with less help than most people think, can enjoy themselves, and things.
(John Zeisel, “I’m Still Here,” page 3)

1 The Skills and capacities of people living with Alzheimer’s that don’t diminish over time, or do so more slowly, provide windows for connection and communication.

2. Through those windows lie opportunities to establish and build new and vibrant relationships that can sustain us and them over time, supporting both care and well-being.

(John Zeisel, “I’m Still Here,” page 4)

Love is a universal language understood far into the illness, even to the end of life. If everyone involved with the illness learns to say “I love you” to the other, the other person will understand and be more present and relationships can grow.

Everyone has preexisting, instinctual abilities that building a caring relationship can capitalize on, such as our ability to understand music, facial expressions, and human touch – the meaning of a song, a smile, and a hug. Drawing on these innate abilities enables everyone living with Alzheimer’s to function better than expected, because they are never lost.

Memories are not held in just one part of the brain into which we place them like a DVD disk for later retrieval. Rather, we place attributes of experience in various parts of the brain – faces in one part, colors in another, emotions related to the experience in another. Later, a brain function that acts like a call to Scotty in Star Trek – “Beam me up, Scotty” – retrieves them. Art, music, environment, and Alzheimer’s – competent communication help those memories reappear, just as Scotty helps Captain Kirk and his crew reassemble aboard the Enterprise.

Alzheimer’s’ is treatable, and the best treatment is one that carefully balances nonpharmacological with pharmacological approaches. Nonpharmacological treatment includes carefully planning and managing both the social and physical environment of the person.

(John Zeisel, “I’m Still Here,” page 5)

It is important that all caregivers burdened with guilt remind themselves that Alzheimer’s’ is an organic illness of the brain, and that sharing care-partnering tasks with others is keeping a promise, not breaking it.

Partners get sick more often that do the people they care for: Those who care for people living with Alzheimer’s’ tend not to take care of themselves. They tend to get sick more often than for longer periods than the people they care for. Taking care of oneself is the surest way to help the person you love.

People living with Alzheimer’s live in the present moment. Mindfulness of being in the present moment ourselves is a first step toward being in the mind of a person living with Alzheimer’s. Being totally prestn to our own breath through medication can help us experience that fleeting moment.

Many people as they grow older forget one thing or another. This is not Alzheimer’s.

(John Zeisel, “I’m Still Here,” page 6)

An Alzheimer’s diagnosis is seen as an Alzheimer’s “sentence.” But this just isn’t so. Throughout the more than decade-long progress of the disease, the person crying out, “I’m still here.” We all need to start hearing that cry before it fades away completely.

(John Zeisel, “I’m Still Here,” page 7)

But to build healthy relationships with those living with Alzheimer’s’, each of us has to connect through those capacities and facilities that don’t diminish with the progression of the disease, or at least diminish most gradually. When we listen to music or visit a museum together, we are building such relationships. We are reducing the secondary and tertiary symptoms of Alzheimer’s. Those living with Alzheimer’s who use part of their brains that still function well, feel enabled and competent, and are less apathetic, agitated, anxious, and aggressive.

(John Zeisel, “I’m Still Here,” page 9)

It is easy to count the ways that the analogy between Alzheimer’s and childhood is inaccurate. A child has limited history and memories, while people in old age with or without Alzheimer’s’ have a long history of experience. They have lived through several historical eras, in various cities and perhaps countries, and they have experienced the world changing around them in major way. They have seen technology develop, and political upheaval. Most have children and grandchildren. They know to repair broken objects, cook, build houses, teach, write, paint, play piano, knit – to name a few of the things that they can do that children can’t. They have profound personal life experiences. Some have fought in wars, marched for peace, suffered in concentration camps, or moved from the countries of their birth as refugees. They have held responsible jobs and achieved accolades of their achievements. They are definitely are not like children.

(John Zeisel, “I’m Still Here,” page 10)

What kind of future is it if people can’t remember their children and where they are?” Those who don’t understand the disease ask. That question assumes that memories are gone, which they are not, they are just increasingly inaccessible without some help. It also assumes that the future is based in the past and in past memories. It is not. The future is based on many present moments, moments that the person experiences fully every day and every minute. The future for people living with Alzheimer’s promotes new relationships, quality of life, and joy.
(John Zeisel, “I’m Still Here,” page 11)

Neither can our relationships be the same. While the person still cares for us and continues to love us and we them, we must have new expectations and build a new relationship. The first step is to discard old expectations and role relationships that limit our ability to see the person and relate to him or her in a new way. Each family member hold one key to the person’s past, present, and future.
(John Zeisel, “I’m Still Here,” page 11)

SO WHAT, IF THE NAME IS FORGOTTEN?
Recalling a name or a recently posed question is really a small part of his or any of our memoires.
(John Zeisel, “I’m Still Here,” page 12)

MEMORIES STILL THERE: SENSE MEMORIES
smell/fragrance memory
touch memory
visual memory
body memory
music memory
taste memory
sound memory
proprioceptive body memory
(John Zeisel, “I’m Still Here,” page 13)

MEMORIES STILL THERE: EMOTIONAL MEMORIES
times of joy
sad memories
fear memory
pain memory
love memories
excitement
regret
shock
compassion
(John Zeisel, “I’m Still Here,” page 13)

MEMORIES STILL THERE: BODY MEMORIES
having a baby
riding a bicycle
throwing a baseball
putting a golf ball
dancing the fox-trot
breaking a leg
carrying a heavy load
(John Zeisel, “I’m Still Here,” page 13)

MEMORIES STILL THERE: SKILL MEMORIES
cooking
dancing
drawing
knitting
bowling
sewing
digging
 (John Zeisel, “I’m Still Here,” page 13)

MEMORIES STILL THERE: HARDWIRED MEMORIES
the sun
smiles
fireplace
(John Zeisel, “I’m Still Here,” page 13)

MEMORIES STILL THERE: ART MEMORIES
paintings
poetry
music
sculpture
dance
 (John Zeisel, “I’m Still Here,” page 13)

MEMORIES STILL THERE: ENVIRONMENTAL MEMORIES
color
place
object
texture
environmental mood memory
spatial memory
(John Zeisel, “I’m Still Here,” page 14)

MEMORIES STILL THERE: SONG MEMORIES
popular tunes
religious hymns
children’s songs
military music
dance music
 (John Zeisel, “I’m Still Here,” page 14)

MEMORIES STILL THERE: COLLECTIVE MEMORIES
MAJOR EVENTS EXPERIENCED
World War I
D-day
The great NYC blackout
Elvis Presley on Ed Sullivan
Assassination of Kennedy
9/11 Terror attack
 (John Zeisel, “I’m Still Here,” page 14)

MEMORIES STILL THERE: AUTOBIOGRAPHICAL MEMORIES
life period memories
childhood
school
teenage
hunting
going to the beach
chopping firewood
special events
family memories
wedding
child’s graduation
 (John Zeisel, “I’m Still Here,” page 14)

MEMORIES STILL THERE: STORY MEMORIES
How I met my spouse
When I was a child…
That time when…
childhood events
When I saw my first movie
fairytales
 (John Zeisel, “I’m Still Here,” page 14)

MEMORIES STILL THERE: SOCIAL NORMS MEMORIES
How to be polite to others at dinner
how to greet someone coming to visit
how to behave at holiday parties
How to behave at religious ceremonies
How to behave at a wedding
How to say hello
 (John Zeisel, “I’m Still Here,” page 14)

MEMORIES STILL THERE: TIP-OF-THE-TOUNGE MEMORIES
Names you know, but can’t recall without a cue
 (John Zeisel, “I’m Still Here,” page 15)

MEMORIES STILL THERE: HABIT MEMORIES (LEARNING)
Eating with chopsticks.
Putting eyeglasses in the same spot every night
Setting a table the same way
 (John Zeisel, “I’m Still Here,” page 15)

MORE COMPROMISED MEMORIES: COGNITIVE, MAP, FINDING
I know where I am when I’m there
I know where I am going if I can see my destination
I know where I was going when I get there
Getting to the bathroom at night without a light
Finding way back to a childhood haunt
Getting home from wherever you are
 (John Zeisel, “I’m Still Here,” page 15)

MORE COMPROMISED MEMORIES: FACTUAL, LEARNED
Things I know: names of presidents, grandchildren’s birthdays
Test memory: “Cramming for an exam” memory
(John Zeisel, “I’m Still Here,” page 15)

MORE COMPROMISED MEMORIES: COMPLEX SEQUENCE
brushing one’s teeth
organizing a meal
cooking a complex meal
getting dressed
putting a diaper on a baby
(John Zeisel, “I’m Still Here,” page 15)

MORE COMPROMISED MEMORIES: MESSAGES
Remember what was just said
Remembering a person you recently met only once
Remembering a phone message
A phone call you just finished
A phone number
(John Zeisel, “I’m Still Here,” page 15)

MEMORIES READILY ACCESSIBLE WITH APPROACHES
The memories listed as “MEMORIES STILL THERE”
All these memories except those at the end of the list are readily accessible to people living with Alzheimer’s and their partners. Message, factual, learning, way finding, and complex sequence memory can be accessed with appropriate approaches and communication.
 (John Zeisel, “I’m Still Here,” page 16)

UNIQUE CAPABILITIES: EMBRACE THEM
Everyone has their own unique capabilities. These may include reading the newspaper out loud to others, singing, gardening, or dancing. Whatever they are, they are there and it is our job to uncover, celebrate, and embrace them so that everyone living with Alzheimer’s, no matter where in the progress of the illness they are, maintains their dignity, independence, and self-respect.
(John Zeisel, “I’m Still Here,” page 17)

ARTISTIC EXPRESSION
An artist expresses himself from his heart, avoids being overly self-critical, and can unselfconsciously express his “self” in his art. The lack of a fully functioning brain “comparer” makes many people living with Alzheimer’s better artists than they were before the disease… often freer, more honest, and more expressive than most others. 
(John Zeisel, “I’m Still Here,” page 17)

EXPERIENCES WITH ART BUILD NEW RELATIONSHIPS
Art experiences enable them to focus for longer periods, to perceive and express their perceptions, and to access both long and short term memories. Art of all sorts also enables people living with Alzheimer’s and those without it to focus together on something outside themselves, rather than on each other. Such shared experiences bring everyone closer together and serve as a basis for building new and strong relationships.
(John Zeisel, “I’m Still Here,” page 19)

JUST AS ELOQUENT, ALTHOUGH EXPRESSING THEMSELVES DIFFERENTLY
It is too easy to classify those who have lived with Alzheimer’s for many years as nonpeople because they might no longer relate to the world the same way they used to, or as we think we do. Discarding people in this way reduces their quality of life and ours. We burden them with disregard and loneliness. We burden ourselves with “having to visit” again and again with nothing to say and do.
(John Zeisel, “I’m Still Here,” page 21)

NEW RELATIONSHIP - GET TO KNOW EACH OTHER AGAIN
Why does society shunt these people away? One reason for this is our own ignorance of how to build a relationship with someone going through the changes associated with Alzheimer’s. …every relationship…can still be vibrant and rewarding – even improved from earlier relationships – but only if both people first get to know each other again.
(John Zeisel, “I’m Still Here,” page 22)

NO ONE LIKES FINALS WEEK
“Hi, Mom, remember me?” is a test of memory, which can be upsetting, and is likely to elicit the anxious response “No, who are you?”
(John Zeisel, “I’m Still Here,” page 23)

INTRODUCE YOURSELF
Look her directly in the eye, and say, “Hi, Mom, I’m you son Alex, we have wonderful times together, and I love you very much.” Such an introduction is more likely to elicit a smile and the response: “Oh, Alex, it’s so nice to see you.”
(John Zeisel, “I’m Still Here,” page 23)

MEMORIES KEEP US ATTACHED TO LIFE
They stopped visiting because, “what’s the use?” The “use,” I tell them, is that they and their memories keep their friend attached to life.
(John Zeisel, “I’m Still Here,” page 24)

PHOTOGRAPHS
I suggest they assemble a book of photographs from trips they have taken together or from an anniversary party. Introduce themselves by name, and look through the book, recalling feelings they may have had at the time, and talking about the wonderful memories.
(John Zeisel, “I’m Still Here,” page 24)

TOO DISTRACTED TO LOOK AT PHOTO ALBUMS?
The trick is to focus you own attention intensely on the task at hand, no matter what else is happening, and to repeatedly ask for help understanding the photographs.
(John Zeisel, “I’m Still Here,” page 24)

LOVE – THE UNIVERSAL LANGUAGE
Expressing love to someone living with Alzheimer’s is one of the keys to making and keeping contact. Love is a universal, hardwired language. People understand until the end of life that by loving them you accept them for who they are.
(John Zeisel, “I’m Still Here,” page 24)

SHIFT YOUR POINT OF VIEW
…their family member has changes and so has the relationship. The road to easing the burden of Alzheimer’s beings with shifting one’s point of view.
(John Zeisel, “I’m Still Here,” page 25)

THE GIFTS OF ALZHEIMER’S
Each of us grows and changes continually. If we choose to stay connected others as they and we change during the passage of the disease, we learn about ourselves, about relationships, and even about the meaning of life.
(John Zeisel, “I’m Still Here,” page 25)

INTO THE LIGHT
If others begin to avoid her because she’s “different,” she become even more isolated and feels even more that she is not there. When people help her celebrate her continuing abilities and successes, she can “come out of the closet” of shame and into the full light of day. She can fully be herself.
(John Zeisel, “I’m Still Here,” page 26)

I AM A WHOLE PERSON
“I was a whole person the moment I was born. I was a whole person, yes, even in my teen years. I am a whole person now. Even near death, even in death I am a full and whole person.” -5 January 2007, Richard Taylor, sixty-three years old, diagnosed with early on-set Alzheimer’s at age fifty-nine.
(John Zeisel, “I’m Still Here,” page 28)

WHAT HAVE I DONE WRONG?
The person living with Alzheimer’s becomes less aware of being ill. On the other hand, he remains as aware as ever of the fact that he either fits in with others socially or he doesn’t. He feels even worse because he may remember only with difficulty and therefore understand even less what he has done wrong and why he is being berated. He still has access to his many memories, but has a harder time directing himself to the right part of his “memory bank.”
 (John Zeisel, “I’m Still Here,” page 29)

RESPECT AND DIGNITY: ADDRESSING THE PERSON DIRECTLY
Never referring to him indirectly when you are in his presence.
(John Zeisel, “I’m Still Here,” page 30)

RESPECT AND DIGNITY: SUBTLY HELPING HIM TO BE IN CONTROL
Neatening clothes that may be out of place, quietly reminding him how to get somewhere on his own, waiting until he expresses himself rather than speaking for him.
(John Zeisel, “I’m Still Here,” page 30)

RESPECT AND DIGNITY: PROVIDING CUES
Keeping photographs and other mementos at hand that cue significant memories, introducing these with a phrases like, “You remember little Pie-Pie-, your grandson.”
(John Zeisel, “I’m Still Here,” page 30)

RESPECT AND DIGNITY: NEVER TESTING THE PERSON’S MEMORY
Never asking, “Do you remember my name?” or showing him a picture and asking “Do you remember who this is?”
(John Zeisel, “I’m Still Here,” page 30)

BE THERE
Touching her hand or shoulder – physically – always works to make her aware that you are there, that she is there, and that you and she still have a relationship. A family member’s presence is also always appreciated – even if other say the person living with Alzheimer’s doesn’t know you’re there. She does!
(John Zeisel, “I’m Still Here,” page 30)

MUSIC, IMAGES, PERFUME
Nonverbal forms of communication let the person with the illness know that someone who cares for her realizes she is present. To sense her saying, “I’m still here,” you first have to believe and be ready to hear it yourself.  Respond to the signs: a smile, a raised hand, a hug in response to a hug.
(John Zeisel, “I’m Still Here,” page 30)

PRIMARY BEHAVIORAL SYMPTOMS due to Alzheimer’s
Cognitive impairments: difficulty accessing memories about what to do in specific situations, how to make casual conversation, organizing big complex sequences of activities, speech deficits, using tools and utensils.
(John Zeisel, “I’m Still Here,” page 32)

SECONDARY BEHAVIORAL SYMPTOMS due to stress
A reaction to not being able to handle what is happening to him: 1) agitated, striking out – disturbs us and others, therefore we attempt to control it. 2) apathy – uninvolved with one’s surroundings. We tend to ignore or overlook it because we are not being disturbed. Meaningful activities can treat this symptom.
 (John Zeisel, “I’m Still Here,” page 33)

AGGRESSION – NOT A SYMPTOM, A REACTION
Aggression is not a disease symptom. It is a natural reaction to feeling that another person is being aggressive to her, reaction to other factors such as unmet physical needs, inappropriate environment, upsetting personal interactions.
 (John Zeisel, “I’m Still Here,” page 34)

HUNGER or THIRST or PAIN
A person might get aggressive when she feels hungry or thirsty yet is unable to identify and express those needs. Unrecognized and under treated pain can be another overlooked cause of aggression.  Room temperature that is either too hot or too cold, a noisy environment, lack of space can upset the person and lead to disturbing behaviors.
(John Zeisel, “I’m Still Here,” page 34)

HOW WOULD YOU REACT?
People may be confused when suddenly being “cared for” and resist attempts to provide care. How would you react if a complete stranger pretended to know you and unexpectedly tried to pull down your pants? This is what the person with Alzheimer’s may be experiencing.
(John Zeisel, “I’m Still Here,” page 34)

UNPROVOKED
It is important to realize that most people living with Alzheimer’s do not strike out unprovoked and that partners have the responsibility to prevent “resistiveness to care” from escalating into combative behavior.
(John Zeisel, “I’m Still Here,” page 35)

PREVENTING COMBATIVE BEHAVIOR
This can be achieved by modifying strategies for bathing, rooming, and eating by for example, substituting washing up with a facecloth, delaying care until the person has calmed down, or distracting the person with stories about their past.
(John Zeisel, “I’m Still Here,” page 35)

AGITATED, A SIDE EFFECT, NOT A SYMPTOM
Being agitated or aggressive, a natural reaction when in a questionable setting, clearly is not a disease symptom, but rather a side effect that can be alleviated.
(John Zeisel, “I’m Still Here,” page 35)

WHAT ARE WE DOING?
I injured my left-knee ligament in a yoga class. I couldn’t walk as easily – PRIMARY SYMPTOM. Walking more than I should, my knee hurt – a SECONDARY SYMPTOM.  Feeling pain, I got irritable - a TERTIARY SYMPTOM. No one would define irritability as a symptom of an injured ligament, but that’s what we do to people living with Alzheimer’s. We blame the illness rather than understanding what we might be doing that contributes to these outcomes.
(John Zeisel, “I’m Still Here,” page 39)

THE 4 A’S (understanding proper treatment and response)

Agitation: Nervous behavior disruptive to others

Anxiety: Worrying about things we can’t control

Aggression: Striking out or shouting

Apathy: Lack of involvement

 (John Zeisel, “I’m Still Here,” page 40)

AGITATION

Nervous behavior due to boredom, disruptive to others. The actual symptom is the lack of ability to self-initiate activities, resulting in restlessness, repeated actions, shouting, and talking continually.

 (John Zeisel, “I’m Still Here,” page 40)

ANXIETY

Worrying about things we can’t control; due to not having a clear picture of time and relationships, exhibiting nervous energy, retreating from social situations.

 (John Zeisel, “I’m Still Here,” page 40)

AGGRESSION

Striking out or shouting at others to get attention and create something lively; due to inability to control one’s own impulses, not understanding what is happening. “Why am I not allowed to go outside?”

 (John Zeisel, “I’m Still Here,” page 40)

APATHY

Lack of involvement due to inability to perceive and remember the future. Lack of having anything interesting to do. Non disruptive because it is not directed at others, is often overlooked.

 (John Zeisel, “I’m Still Here,” page 41)

NO CURE does not mean NO TREATMENT
When dementia was labeled “senility” and “hardening of the arteries,” it was considered an attribute of natural aging and few people paid much attention to this condition because they considered it chronic, hopeless, and untreatable. Shifting Alzheimer’s into the same class as cancer turns Alzheimer’s into a treatable condition, rather than a hopeless one, bringing them back to the realm of the living, from limbo in which they are merely waiting to die.
(John Zeisel, “I’m Still Here,” page 42)

REDUCING AND IMPROVING
Treatment means reducing symptoms and improving conditions, as well as curing illnesses.
(John Zeisel, “I’m Still Here,” page 44)

THE 4 A’S CAN BE TREATED
The four A’s can all be treated – that is, reduced – through a coordinated evidence-based approach in which social and physical environment as well as medications are creatively employed.
(John Zeisel, “I’m Still Here,” page 46)

3 STEP APPROACH
1. Describe the behavior and identify contextual triggers.
2. Adapt the caregiver, physical environment, or medication.
3. Employ lowest possible dosage of pharmacologic treatment IF needed.
(John Zeisel, “I’m Still Here,” page 47)

THOSE CELLS HOLD HOPE
The good news is seldom evoked. People living with Alzheimer’s still have 90 billion active brain cells. Those cells hold memories, the ability to learn the ability to be creative and to enjoy life.
(John Zeisel, “I’m Still Here,” page 56)

INSTINCT
Our brains contain hardwired, universal, preexisting images and abilities – sometimes called instincts or natural feelings.
(John Zeisel, “I’m Still Here,” page 56)

THEY ARE NEVER LOST
We already have indications of certain hardwired human skills and memories. Among these are facial expressions, responses to the touch of another, singing, and landmarks for finding – all abilities that last our entire lives, even if we have Alzheimer’s. hardwired brain functions are important for people living with Alzheimer’s because they are never lost and are always accessible.
(John Zeisel, “I’m Still Here,” page 59)

UNIVERSAL – IN EVERY CULTURE
Expressing and recognizing emotions in human facial expressions are hardwired, universal, and preexisting – they’re the same in every culture.
(John Zeisel, “I’m Still Here,” page 60)

MASSAGE
Massage releases oxytocin. It makes us feel comfortable, open toward one another, and caring. Human touch is seldom misunderstood.
(John Zeisel, “I’m Still Here,” page 61)

NATURE
It is likely that the need for contact with the natural environment and the feelings we have about nature and being outdoors are hardwired, partly because this is the source of our food. Sunshine, flowers, shade, moonlight, and trees are all so much a part of our basic nature that on one has to be taught to respond appropriately to such stimuli.
(John Zeisel, “I’m Still Here,” page 62)

THE CREATIVE ALZHEIMER’S BRAIN: The Interpreter
Located in the left brain, the interpreter enables us to make sense of the world by developing images of reality, stories that interpret what we sense. This part of the brain functions well in people with Alzheimer’s, who can make up stories as well as anyone else.
(John Zeisel, “I’m Still Here,” page 63)

SUCCESSFUL DAY – Interpreter
If a person with Alzheimer’s fills his day with tasks and adventures that rely primarily on the INTERPRETER in the brain, he is likely to have a successful day of quality experiences.
(John Zeisel, “I’m Still Here,” page 67)

THE CREATIVE ALZHEIMER’S BRAIN: The Actor
Based on the interpreter’s images, the brain perceives, conceptualizes, and engages the rest of our body to act. They are less aware of the limitations of their bodies and minds. With cognitive mapping ability impaired, they are still happy to walk away from home without realizing thy may get lost.
 (John Zeisel, “I’m Still Here,” page 64)

OUTINGS AND EXPERIENCES – Actor
Activities that stimulate the brain’s ACTOR functions, such as museum visits, short films, and listening to poetry are extremely accessible to people living with Alzheimer’s.
(John Zeisel, “I’m Still Here,” page 67)

THE CREATIVE ALZHEIMER’S BRAIN: The Comparer
People continually assess outcomes of actions by comparing what actually happens to what was expected. If we expect to find out care parked on the third floor and it isn’t there, we try another floor.  The A-10 nucleus of the frontal lobe is damaged early in the illness. He may repeat an action over and over, even when the results are not what he wanted.
 (John Zeisel, “I’m Still Here,” page 64)

AVOID FRUSTRATION - Comparer
While it is always good to exercise our brains, activities that rely primarily on the person’s brain COMPARER, (comparing a recent experience with one of the past), are likely to be more difficult and lead to frustration.
(John Zeisel, “I’m Still Here,” page 65)

MYTH of LOSS OF SHORT TERM MEMORY
Alzheimer’s disease is popularly seen as memory loss because on the surface a person appears to “forget” things. Because hippocampal damage results in people not being able to index and insert experiences into their brains as easily as before, it appears to others that the person is having difficulty remembering immediately experiences soon after they occur. Most people believe that the main symptom associated with Alzheimer’s is that people “forget” things, but it is not.
(John Zeisel, “I’m Still Here,” page 66)

MYTH of LOSS OF SHORT-TERM MEMORY AND KEEPING LONG TERM MEMORY

The oversimplified view is not helpful in understanding the full complexity of the person, nor does it lead to developing effective treatment or to living a quality life. The degree of difficulty a person has indexing and then recalling an event changes throughout the illness. Just as your key unlocks the glove compartment where maps and other information are stored, the hippocampus supports a variety of functions including emotion and long-term memory, provide access to the memories already stored.
 (John Zeisel, “I’m Still Here,” page 67)

INDEXING AND RETRIEVING MEMORIES
The hippocampus enables us to embed memories into our long-term memory banks, tagging them for later retrieval. Because this brain element is damage early in the illness, people seem to have difficulty “remembering” things that have just happened, unless they are prompted and cued by a person or object in their context; tastes, smells, and visual images enhance access to memories.
(John Zeisel, “I’m Still Here,” page 68)

ALL OF OUR MANY MEMORIES ARE IN OUR BRAINS.

We don’t forget; it is just harder to access them without help. It’s not surprising that cueing memories with key words, photos, and music is a tried and true method of therapeutic interaction with people who are living with Alzheimer’s.
(John Zeisel, “I’m Still Here,” page 68)

REPETITION
Using repetition and repeated success, people living with Alzheimer’s can learn and can remember. Mary gets angry or upset when you seat someone else in her chair. Before moving to the residence, Mary didn’t know where her chair was. She must have learned it since getting there.
(John Zeisel, “I’m Still Here,” page 69)

COMPLEX TASKS
Over fifty steps are required just to get dressed, and that’s only one of the sequences we need to perform every day. Brushing teeth, taking a shower, cooking breakfast, traveling to work, driving a car, paying bills, and shopping are all extremely complex sequences. People living with Alzheimer’s with damaged frontal lobe executive function find it difficult to carry out seemingly simple operations that are actually extremely complex sequences. They didn’t forget how to do these things; it’s not a memory problem. If there props for the task are appropriately set up and visible, they can complete the tasks successfully.
(John Zeisel, “I’m Still Here,” page 70)

IMPULSE CONTROL
When you or I get angry with someone in a social setting we don’t immediately punch him. When we do something we later regret, we admonish ourselves to better control our actions. Lack of social impulse control is not “forgetting” how to behave; it is losing control over naturally occurring feelings. If someone tens to get angry easily, make sure that a birthday party is held in a dining room, rather than an institutional community room that he sits next to a favorite grandchild and that the grandchild wear a festive name tag. The dining room lets him know “dinner behavior” is appropriate. The grandchild evokes hardwired caring instincts, and the name tag cues his memory.

(John Zeisel, “I’m Still Here,” page 71)

HALLUCINATIONS AND DELUSIONS: Emotional damaged system
Misperceived: the damage system is emotional. The person sees and recognized his wife (visual and perceptual), but something emotional just doesn’t computer. He doesn’t feel about her as he knows he would feel if the person were his wife. The wife might quietly leave the room, then reenter smiling broadly and saying, “Hi, Joshua, I’m you wife, Sylvia, and we love each other very much.”
(John Zeisel, “I’m Still Here,” page 73)

HALLUCINATIONS AND DELUSIONS: Visual and perceptual damaged system
Shifting shadows look like a person hiding in the shadows. If moving shadows are causing a problem, someone can close the curtains at night and turn on a soft light.
(John Zeisel, “I’m Still Here,” page 73)

HALLUCINATIONS AND DELUSIONS: psychologically damaged system
The person feels that everyone she sees is taking advantage of her – paranoia. Psychological and paranoid hallucinations and delusions are more difficult to affect and might require more immediately medical interventions.  Some factual mistakes may be the result of poor memory and eyesight, and should not be mistaken for delusions.
(John Zeisel, “I’m Still Here,” page 73)

NOT CRAZY
Knowing that delusions and hallucinations are a result of specific brain changes out to help partners realize that the person living with Alzheimer’s is not “crazy.” It enables them to accept that in many cases a specific action can help reduce hallucinations and delusions, such as leaving the room, reintroducing self, showing his profession a diploma, or changing the lighting in the room.

(John Zeisel, “I’m Still Here,” page 74)

HALLUCINATIONS AND DELUSIONS: NOT ALL BAD
Not all delusions and hallucinations are bad things that need to be changed. But when they cause the person constant pain or are dangerous and can’t be changed non-pharmacologically, medications are likely to be needed.
(John Zeisel, “I’m Still Here,” page 75)

HANDBAG - PERSONAL IDENTITY

What is kept in a handbag, except one’s “personal identity,” and if you don’t have you bag, how do you know who you are? All your important stuff is in that bag. What may be needed to make her who is to give her purpose and make her feel like a person who is valued.

(John Zeisel, “I’m Still Here,” page 75)

LANGUAGE: 2 deficits – not necessarily both impaired.
Language centers become impaired and may be less able to find the words they need to express themselves or they appear not to be able to understand others. These two deficits do not necessarily go hand in hand. A person with temporal lobe dementia is likely to have greater difficulty in find the words to express a thought that in understanding others.
(John Zeisel, “I’m Still Here,” page 75)

LANGUAGE: use other senses to understand
Just because a person living with Alzheimer’s is not able to find certain words, she is likely to know the meaning of what she wants to say. Somewhere deep inside she knows what she wants to say. The trick is to use all the other senses we have to read what the other person is trying to express.
(John Zeisel, “I’m Still Here,” page 76)

OUR INTERNAL CLOCK
When the area called the chiasmatic nucleus is damaged, our natural internal time clock, (set closer to a 25 hour day than 24 hours), goes haywire. Our internal clock enables us to know what time of day it is, even in a windowless conference room. Someone with Alzheimer’s asks repeatedly, “When are we leaving?” or waking up in the middle of the night thinking that it’s daytime.
(John Zeisel, “I’m Still Here,” page 76)

EMOTION
The amygdala maintains its function late into the disease and is the key to communicating and having a fulfilling relationship with a person living with Alzheimer’s. Whenever we have an emotional reaction to a person, event, or place, or we express ourselves emotionally, our amygdalas are at work.
(John Zeisel, “I’m Still Here,” page 77)

MORE GOES ON IN THE BRAIN
In sum, a great deal more goes on in the brain of a person living Alzheimer’s than mere memory loss. We need to be sensitive to all the changes if we are to avoid throwing out the baby with the bathwater – if we are not to discard the person merely because we can’t deal with a “loss of memory.”

(John Zeisel, “I’m Still Here,” page 78)

THE NEED FOR ART
Visiting Art museums and attending poetry readings and concerts are relaxing diversion in a life focused on family, work, and even recreations. Few of us integrate artistic expression in to our daily lives, or even attend performances and art exhibits regularly. We are the poorer for it. We each have a need and natural aptitude for art that we realize how much we miss only when we find ourselves without other supports in our lives.
(John Zeisel, “I’m Still Here,” page 79)

ART GIVES MEANING TO LIFE
The arts can provide meaning in what to many is experienced as an ever increasingly meaningless life. Art connects people to their culture and to their community. It gives meaning to life and it is meaning that people living with Alzheimer’s so dearly crave.
(John Zeisel, “I’m Still Here,” page 80)

THEY CAN ENJOY ART EXPERIENCES
Partners have to believe that the person they love who is living with Alzheimer’s without a strong short-term memory can actually have a satisfying and enriching art experiences. Art can be therapeutic, but doing art isn’t necessarily therapy. When you play with your dog at home, it is not pet therapy. When you paint a serious picture or visit an art gallery it is not art therapy, although it may have therapeutic effects. We label them as therapy because do not really believe people with this disease can truly enjoy such an experience as we do, we doubt they remember it, and therefore ewe do not encourage art experiences as an integrate part of their everyday lives.
(John Zeisel, “I’m Still Here,” page 80)

ART LINKS BRAIN LOCATIONS
Art touches and engages the brain in a more profound way than other activities. Music, painting , sculpture, comedy, drama, poetry, and the other arts link together separate brain locations in which memories and skills lie.

(John Zeisel, “I’m Still Here,” page 81)

MUSIC: SENSING, KNOWING, FEELING
Music, for example touches parts of the brain that link what we sense, know, and feel. As the brain is affected in Alzheimer’s disease and particular locations and abilities are damaged, the fact that art touches so many areas of the brains masks single-location deficits.
(John Zeisel, “I’m Still Here,” page 81)

NATURAL ARTIST
The more someone is in touch with his or her feelings, the more he or she can appreciate art. The same is true for creating art. Artists who think too much edit their work mentally before they can express the. Because people living with Alzheimer’s tend to express what they think and feel at the moment, they are natural artists and natural audiences for artistic expression.

(John Zeisel, “I’m Still Here,” page 81)

ART EXPRESSION AND APPRECIATION
A young child does not have to taught to relax when she hears a lullaby, nor does she need to be taught to paint colorful picture, or to laugh at a silly joke. These universal, preexisting, and hard wired abilities, lost ONLY LATE in the progress of Alzheimer’s IF at all, serve as the basis for successful art expression and appreciation throughout the progress of the disease.
(John Zeisel, “I’m Still Here,” page 81)

ART CLASSES
The first “Artists for Alzheimer’s” (ARTZ) program class began by teaching technique, employing watercolor, acrylic paint, and colored pencil. Then she moved on to conduct several classes concerned with still life drawing and copying photographs, to give participants a sense of creating an art object. She ended by getting participants to use art to express who they are – to express their “selves” through art. This is something you can do with your partner if you are inclined to the visual arts.
(John Zeisel, “I’m Still Here,” page 83)

ARTZ AIMS: PROVIDE EXPERIENCES
Provides regular artistic experiences, performances and hand-on involvement by competent artists of all ages. Artists include comedians performing stand-up comedy, actors reading plays and poetry, photographers taking pictures and sharing their work, industrial designers and sculptors working in class, guitarists and violinists performing, painters and graphic artist, and opera singers.
(John Zeisel, “I’m Still Here,” page 83)

CONTACT THROUGH ART COMMUNICATION
When his son saw the painting, he was moved to learn that so much feeling was still alive in his father. You too can achieve contact with your partner’s feelings through art communication. For each person coping with Alzheimer’s, living in a world with less stigma associate with the condition will ease their burden.
(John Zeisel, “I’m Still Here,” page 85)

ART TOURS: MEANINGFUL EXPERIENCES
Guided art museum tours broaden the range of meaningful art experiences available to people living with Alzheimer’s.
(John Zeisel, “I’m Still Here,” page 87)

ARTZ “Artists for Alzheimer’s”
Take advantage of these programs (ARTZ) if they exist in your area, and advocate for museum you frequent without such tours.

(John Zeisel, “I’m Still Here,” page 88)

MUSEUM TOUR: HOW TO - Day 1
Day 1: At their residence, introduce and allow them to enjoy and review some art images or reproductions of selected artwork they will be viewing at the museum they will be visiting.
(John Zeisel, “I’m Still Here,” page 88)
Choose paintings that elicit cognitive strengths of the participants and then employ a question-asking approach that elicits participant’s perception and discussion. (John Zeisel, “I’m Still Here,” page 90)

MUSEUM TOUR: 30 PRINTS FOR SELECTION
Thirty prints were presented to respondents in the selection interview. Ten paintings seemed to be totally not understandable, ten other prints were understood by some, and not by others, and ten everyone understood. Five of the well-understood artworks were considered by participants to be too risqué to hang in a home, while the other five were more acceptable.
(John Zeisel, “I’m Still Here,” page 91)

MUSEUM TOUR: HOW TO - Day 2 – the display
The same artworks they reviewed in their residence are on display and discussed at the museum.
The size of each group is kept to 5 or 6 participants with one educator. Each comes alone or brings a partner.
 (John Zeisel, “I’m Still Here,” page 88) 

MUSEUM TOUR: HOW TO - Day 2 – the questions
Interview people with Alzheimer’s about their reactions to an array of paintings, sculptures and photographs at the museum. The participant, not the educator, selects the art to be included in the tour. (John Zeisel, “I’m Still Here,” page 90)  Sample: “I need some advice. Look at these paintings and tell me whether you think I should hang this artwork in my home.” (John Zeisel, “I’m Still Here,” page 91)

MUSEUM TOUR: HOW TO - Day 2 – sketching what they saw
The tour ends with the participants are asked to sketch what they saw on a white card attached to a small clipboard. (John Zeisel, “I’m Still Here,” page 88)

MUSEUM TOUR: HOW TO – Day 3 - Create
Back in their residence, make drawings of the art using colored pencils.
(John Zeisel, “I’m Still Here,” page 88)

MUSEUM TOUR: HOW TO - Day 4 – Show and Tell
Participants choose an object to show and share stories from their lives.

(John Zeisel, “I’m Still Here,” page 88)

MUSEUM TOUR: ELICIT RESPONSE – DO NOT OVERWHELM
Skilled educators know how to present art and to elicit participants’ response and opinions to specific artworks. They know how to make everyone’s opinion count. And to provide just enough information so that viewers feel they have learned something without being overwhelmed.
  (John Zeisel, “I’m Still Here,” page 90)

PEOPLE LIVING WITH ALZHEIMER’S UNDERSTAND VISUAL ART BY:

1. Perceiving and describing, talking about what they see in the artwork
  (John Zeisel, “I’m Still Here,” page 92)

PEOPLE LIVING WITH ALZHEIMER’S UNDERSTAND VISUAL ART BY:
2. Telling a story, narrating the story they see in the painting.

  (John Zeisel, “I’m Still Here,” page 92)

PEOPLE LIVING WITH ALZHEIMER’S UNDERSTAND VISUAL ART BY:
3. Linking it to their own lives, describing personal and historical memories.

  (John Zeisel, “I’m Still Here,” page 92)

PEOPLE LIVING WITH ALZHEIMER’S UNDERSTAND VISUAL ART BY:

4. Identifying the emotion, naming and expressing the emotions in the artwork.

  (John Zeisel, “I’m Still Here,” page 92)

PEOPLE LIVING WITH ALZHEIMER’S UNDERSTAND VISUAL ART BY:

5. Identifying objects that make up the painting, seeing, naming and describing the objects. 
 (John Zeisel, “I’m Still Here,” page 92)

PEOPLE LIVING WITH ALZHEIMER’S UNDERSTAND VISUAL ART BY:
6. Making critical judgments, commenting on moral issues raised in “risqué” artwork.

  (John Zeisel, “I’m Still Here,” page 92)

INSPIRED QUESTIONS
Artworks from the “partly understood” paintings engage the curiosity of participants and engender lively conversation when the exceptional guides point out and explain characteristics of each painting and engage participants through insightful questioning.

  (John Zeisel, “I’m Still Here,” page 92)

7 PAINTINGS ON TOURS
On the basis of its research, ARTZ recommended that seven paintings serve as the focus of most tours.
  (John Zeisel, “I’m Still Here,” page 93)

MUSEUM TOURS DO NOT JUST HAPPEN.

Museum tours do not just “happen,” and museums that do not follow all the steps to guarantee that their tours will be Alzheimer’s competent, run the risk of having a negative effect on people and their partners. Museum educators must learn how to relate to people living with Alzheimer’s, helping them feel comfortable, discussing artworks that resonate with them, followed by critique.  You can use these same principles when you visit yourself with your partner.
(John Zeisel, “I’m Still Here,” page 95)

ARTZ COMMUNICATION PRINCIPLES: Scope out the building.
Map the building Plan how participants will get around the building.
(John Zeisel, “I’m Still Here,” page 95)

ARTZ COMMUNICATION PRINCIPLES: Set the stage.
Have name tags ready. Decide on first or last names in addressing participants. Ask, “Would you like me to call you Mary or Mrs. Smith?”
(John Zeisel, “I’m Still Here,” page 96)

ARTZ COMMUNICATION PRINCIPLES:  Introduce yourself.
Wear your name tag. Point to your first name when you introduce yourself. Identify yourself by name. Explain what your role is.
(John Zeisel, “I’m Still Here,” page 96)

ARTZ COMMUNICATION PRINCIPLES:  Employ friendly body language.
Stand in front of the person, to be least threatening. Hold their hand. Look into their eyes. Smile.
(John Zeisel, “I’m Still Here,” page 96)

ARTZ COMMUNICATION PRINCIPLES:  Alleviate participants’ anxiety about where they are.
Answer their question, “Where are we?” without being asked. Repeat regularly: “We are at the Central City Museum here in Minneapolis.”
(John Zeisel, “I’m Still Here,” page 96)

ARTZ COMMUNICATION PRINCIPLES:  Alleviate participants’ anxiety about why they are there.
Answer their questions without being asked. (Why are we here? What do they want me to do? What if my wife is looking for me? When am I leaving?)  Repeat as often as necessary: “We will be looking at wonderful works of art. Your family and friends know you are here. You will be here for one hour.
 (John Zeisel, “I’m Still Here,” page 96)

ARTZ COMMUNICATION PRINCIPLES:  Involve each participant.
Frame the question: Related the question to something specific in the work. “Why is that woman standing there?” NOT: “What does this represent to you?”
(John Zeisel, “I’m Still Here,” page 96)

ARTZ COMMUNICATION PRINCIPLES:  Avoid testing.
Don’t say: “Who painted this, do you know? Come on, this one is real easy!” Instead, slowly reveal the work of art with simple descriptions and question, thereby allowing participants to explore the artwork with you. In this way, they maintain their dignity and sense of accomplishment.
(John Zeisel, “I’m Still Here,” page 96)

ARTZ COMMUNICATION PRINCIPLES: Make the experience positive.
Positive experiences lead to self-esteem and self-esteem lasts a long time as an Alzheimer’s treatment, reducing agitation, aggression, and social withdrawal. If you see someone getting anxious, change the subject.
(John Zeisel, “I’m Still Here,” page 97)

ARTZ COMMUNICATION PRINCIPLES: Positively reinforce.
When they “get it,” or get a painter’s name or anything about the artwork, be positive without seeming surprised.
(John Zeisel, “I’m Still Here,” page 97)

ARTZ COMMUNICATION PRINCIPLES:  Make everything failure free.
The entire experience is supposed to be failure free – to touch their amygdala, the emotion center of the brain – positively. Don’t ask participants to compare paintings they saw half an hour earlier with the one they are looking at.
(John Zeisel, “I’m Still Here,” page 97)

ART MUSEUM TOUR: How much do you teach?
How much do they encourage the participants to express what they see and feel about the art? A shift was necessary in this type of tour from primarily teaching and convincing to enabling the people and viewers to look and express themselves.
(John Zeisel, “I’m Still Here,” page 98)

LIST OF ARTWORKS
The following artworks and objects were identified as increasing participants’ focus of attention, engagement, and self-confidence.
(John Zeisel, “I’m Still Here,” page 99)

ARTWORKS

The Card Sharp, Georges de la Tour, 1633-1639

(John Zeisel, “I’m Still Here,” page 99)

ARTWORKS

Charity, Jacques Blanchard, 1633

(John Zeisel, “I’m Still Here,” page 99)

ARTWORKS

Cardinal Richelieu, Philippe de Champaigne, 1639

(John Zeisel, “I’m Still Here,” page 99)

ARTWORKS

Peasant family, Le Nain brothers, 1640

(John Zeisel, “I’m Still Here,” page 99)

ARTWORKS

Peasants’ meal, Le Nain brothers, 1642

(John Zeisel, “I’m Still Here,” page 99)

ARTWORKS

Christina’s World, Andrew Wyeth, 1948

(John Zeisel, “I’m Still Here,” page 100)

ARTWORKS

Agrarian Leader Zapata, Diego Rivera, 1931

(John Zeisel, “I’m Still Here,” page 100)

ARTWORKS

The Sleeping Gypsy, Henri Rousseau, 1897

(John Zeisel, “I’m Still Here,” page 100)

ARTWORKS

La Goulue at the Moulin Rouge, Henri de Toulouse-Lautrec, 1891-1892

(John Zeisel, “I’m Still Here,” page 100)

ARTWORKS

Girl with Ball, Roy Lichtenstein, 1961

(John Zeisel, “I’m Still Here,” page 100)

ARTWORKS

Portrait of George Crowninshield, Jr. attributed to Samuel F. B. Morse, 1816

(John Zeisel, “I’m Still Here,” page 100)

ARTWORKS

Queen Elizabeth I, large-scale model, Basset-Lowke Ltd, 1949

(John Zeisel, “I’m Still Here,” page 100)

ARTWORKS

Miss H., Douglas Volk, 1880

(John Zeisel, “I’m Still Here,” page 100)

ARTWORKS

Waves, Yuko Nishimura, 2008

(John Zeisel, “I’m Still Here,” page 100)

ARTWORKS

Radio Man, Gina Kamentsky, 2006

(John Zeisel, “I’m Still Here,” page 100)

ARTWORKS

Sunflowers for Vincent, Mark di Suvero, 1978-1983

(John Zeisel, “I’m Still Here,” page 101)

ARTWORKS

Listening Stone, Joseph Wheelwright, 1995

(John Zeisel, “I’m Still Here,” page 101)

ARTWORKS

Requiem to the 20^th Century, 1936, Chrysler Air Stream, Nam June Paik, 1997

(John Zeisel, “I’m Still Here,” page 101)

ARTWORKS

The Musical Fence, Paul Matisse, 1980

(John Zeisel, “I’m Still Here,” page 101)

ARTWORKS

The Flapper, Margarte Preston, 1925

(John Zeisel, “I’m Still Here,” page 101)

ARTWORKS

The Dover’s Wife, Russell Drysdale, 1945

(John Zeisel, “I’m Still Here,” page 101)

ARTWORKS

The Landing of the Pilgrim Fathers in America, A.D. 1620, Charles Lucy, 1868

(John Zeisel, “I’m Still Here,” page 101)

ARTWORKS

Benjamin Franklin, Joseph Wright, 1782

(John Zeisel, “I’m Still Here,” page 101)

ARTWORKS

George Washington, Rembrandt Peale, 1847

(John Zeisel, “I’m Still Here,” page 101)

ARTWORKS

Sunday Stroll, Robert Dickerson, 1960
(couldn’t find an image)

(John Zeisel, “I’m Still Here,” page 101)

ARTWORKS

Interior in Yellow, Grace Cossington Smith, 1962, 1964

(John Zeisel, “I’m Still Here,” page 101)

NATIONAL HERITAGE DISPLAY
Raggedy Ann doll, 1939-1949
Baseball glove, Draper-Maynard Co., 1920-1925

 (John Zeisel, “I’m Still Here,” page 101)

NATURAL HISTORY MUSEUM

Whale skeleton

Gorillas
Hippopotamus fossil

Glass flowers

(John Zeisel, “I’m Still Here,” page 100)

DO IT YOURSELF MUSEUM TOUR
Find out what artworks are on display at the museum you choose. Ask the museum if there is a special day of the week or time of day during which the museum is quieter than usual. If you think she will get tired and need a folding chair during the tour, arrange this with the museum beforehand. At home, show a dozen images of the artworks on display that you think your mother might enjoy. Ask her to choose the ones she likes best and ask why. Take notes. At the museum, stop in front of each artwork and ask her again what she feels, likes, and dislikes about each one. Prompt her with the notes you took from the earlier conversation.
(John Zeisel, “I’m Still Here,” page 104)

FLOOD GATES OF MEMORY OPEN
“As soon as we hear a song that we haven’t heard since a  particular time in our lives, the flood gates of memory open and we’re immerse in memories… a key unlocking all the experiences associated with the memory for the song, it’s time and place.” – Daniel J. Levitin
(John Zeisel, “I’m Still Here,” page 105)

The Dramatic Arts: music, poetry, theater, films and the circus
Dramatic Arts different from the visual arts because they touch multiple sense and thus different types of memories. They surround with sound, sights, and proprioceptive body experiences. It’s harder to look away.
(John Zeisel, “I’m Still Here,” page 105)

RHYTHM
The rhythm and the beat of music are as engaging as the song. Why does her father like listening to reggae music so much, which he never heard before? Rhythm and beat contain their own messages. (John Zeisel, “I’m Still Here,” page 105)

WATCH OR CREATE
Listen to music or create it. Attend the circus or put on a clown’s face and clown around yourself. Watch a play or write and act in one. Each engagement brings with it special challenges and joys. Each draws on unique brain abilities. Each can be part of your relationship building.
(John Zeisel, “I’m Still Here,” page 106)

THEATER: ATTENTION
Drama grabs the attention of people living with Alzheimer’s both when they are part of a theater audience and when they are acting in plays. Drama coveys feelings and ideas more forcefully than any formal lecture presentation can.
(John Zeisel, “I’m Still Here,” page 106)

PERSONAL STATEMENTS
One of the actors in that performance expresses eloquently that he is very much still alive and engaged in life: “I still get excited about politics. I am concerned about the war in Iraq and hurricane Katrina and what’s happening in Washington and Staten Island. I do have an opinion about President Bush. I do worry about the future of our country and our world. I also worry about my future.”
(John Zeisel, “I’m Still Here,” page 109)

PERSONAL STATEMENTS
Above all, I want to tell you: Don’t avoid us! Don’t forget us! Don’t abandon us! The stigma of this illness stands in the way of all of us being part of society with respect and dignity. My name is Jim. I am a husband. I am a father. And I am a person living with Alzheimer’s.”
(John Zeisel, “I’m Still Here,” page 110)

POETRY
Poetry is an art form that also turns on parts of the brain that mere words do not. Both the reading and writing of poetry cuts across the brain’s dysfunctions, enabling people living with Alzheimer’s to engage fully – it touches parts of the brain that song also activities.
(John Zeisel, “I’m Still Here,” page 111)

ARTZ LIST OF POEMS
(John Zeisel, “I’m Still Here,” page 115-116)
List of Poems that Grab the attentions of participants with Alzheimer’s
Sonnet 18, William Shakespeare, 1609
The Tyger, William Blake, 1794
The Daffodils, William Wordsworth, 1804
How Do I Love Thee? Sonnet 43, Elizabeth Barrett Browning, 1845
The Arrow and the Song, Henry Wadsworth Longfellow, 1845
The Owl and the Pussycat, Edward Lear, 1871
I Hear America Singing, Walt Whitman, 1860
I’m Nobody! Emily Dickinson, 1870
The New Colossus, Emma Lazarus, 1883
Wynken, Blynken, and Nod, Eugene Field, 1889
The Road Not Taken, Robert Frost, 1916
Stopping by Woods on a Snowy Evening, Robert Frost
Sea-Fever, John Masefield, 1902
The House with Nobody in It, Joyce Kilmer, 1914

DO-IT-YOURSELF POETRY
You can write poetry with an individual living with Alzheimer’s or with a group. Poetry writing enables the person living with Alzheimer’s and their partner the opportunity to express insights and to creatively use words.
(John Zeisel, “I’m Still Here,” page 117)

FIRST RULE FOR POETRY WRITING:
Keep quiet and listen intently. It is too easy to fill a silence with your own chatter. Instead, give the person time to gather thoughts and feeling san give her all the time she needs to find the right words.
(John Zeisel, “I’m Still Here,” page 118)

ASK PERMISSION
Ask permission to write down or tape-record their words. Never transcribe what a person says without the common courtesy of asking permission.
(John Zeisel, “I’m Still Here,” page 118)

AVOID SUGGESTING A SUBJECT
You are there to record, not direct. Stop when they seem to have had their say or too tired. Tell the person you will bring a typed version of what they have said next time.
(John Zeisel, “I’m Still Here,” page 118)

STRIP AWAY, BUT DON’T ADD
Search for rhythm, repetition, emotional phrases, metaphors. Rhyme is the least likely characteristic, except occasionally by accident. Strip away irrelevant or unhelpful elements. At no point add anything. Every word must come from the person.
(John Zeisel, “I’m Still Here,” page 118)

REVIEW AND REVISE
Bring the poem back to the person. Read it. (At this point you could ask inspired questions, guiding them to add anything else that comes to mind, and see if anything should be added.) Ask permission to share.
(John Zeisel, “I’m Still Here,” page 119)

STORYTELLING PURPOSE
Partners can create stories together as a way of developing relationship. These art experiences focus on the person’s abilities, they are essentially ways for two or more people to relate to each other, and they bring joy and fulfillment.
(John Zeisel, “I’m Still Here,” page 120-121)

STORYTELLING: FANTASTIC PHOTO
Pass around a unique and surprising photograph – a baby sitting in an old leather doctor’s bad, a woman in a long dress aiming a rifle along railroad tracks, a mountain climber leaping, almost flying, between boulders over a deep ravine. Using a fantastic, slightly unreal photo, instead of natural snapshots, enables the person to imagine a story without the risk of being “wrong” about facts.
(John Zeisel, “I’m Still Here,” page 121)

STORYTELLING QUESTIONS
Draw on the ideas and words that the photograph brings to mind, enabling the creation of entertaining and interesting stories. The facilitator asks questions, honoring every answer. What name would you give this person? When do you think this takes place? Where might she have come from? How long do you think he has been doing this? Every answer is okay.
(John Zeisel, “I’m Still Here,” page 122)

MOVIE MEMORY LANE
ARTZ has identified a set of mostly Hollywood movies, musicals and television scenes that seem to grab the attention of an audience of people living with Alzheimer’s. They touch the emotions.
(John Zeisel, “I’m Still Here,” page 127)

ARTZ LIST OF TV/MOVIE SCENES
(John Zeisel, “I’m Still Here,” page 128)

“Oh, What A Beautiful Mornin',” Gordon MacRae, (Rodgers & Hammerstein's OKLAHOMA! 1955,)
“Somewhere Over The Rainbow,” Judy Garland, (Metro-Goldwyn-Mayer’s The Wizard of Oz, 1939)
“If I Were a Rich Man,” Chaim Topol, (Norman Jewison’s Fiddler on the Roof,1971)
"I am Dracula,” Bela Lugosi (Dracula, 1931)
“Let ‘em Roll!” The Chocolate Factory, Lucille Ball and Vivian Vance (I Love Lucy, 1952) “Vitameatavegamin,” Lucille Ball, (I Love Lucy, 1951)
“A Plumbing We Will Go” (The Three Stooges, 1940)
“Singing in the Rain” Gene Kelly ( Singing in the Rain, 1952)
“Do Re Mi,” Julie Andrews (The Sound of Music, 1965)
“We'll Always Have Paris,” Humphrey Bogart and Ingrid Bergman (Casablanca, 1943)
“The Richest Man in Town” Jimmy Stewart, (It’s a Wonderful Life, 1946)

FROM ARTZ LIST OF TV/MOVIE SCENES

“Oh, What A Beautiful Mornin',” Gordon MacRae, (Rodgers & Hammerstein's OKLAHOMA! 1955,)
https://www.youtube.com/watch?v=O5APc0z49wg

FROM ARTZ LIST OF TV/MOVIE SCENES

 “Somewhere Over The Rainbow,” Judy Garland, (Metro-Goldwyn-Mayer’s The Wizard of Oz, 1939)
https://www.youtube.com/watch?v=U016JWYUDdQ

FROM ARTZ LIST OF TV/MOVIE SCENES

 “If I Were a Rich Man,” Chaim Topol, (Norman Jewison’s Fiddler on the Roof,1971)
https://www.youtube.com/watch?v=sjwsICAItgE

FROM ARTZ LIST OF TV/MOVIE SCENES

"I am Dracula,” Bela Lugosi (Dracula, 1931)
https://www.youtube.com/watch?v=V8Gl6S8C6iI

FROM ARTZ LIST OF TV/MOVIE SCENES

 “Let ‘em Roll!” The Chocolate Factory, Lucille Ball and Vivian Vance (I Love Lucy, 1952) https://www.youtube.com/watch?v=R8CuaWdmWzA

FROM ARTZ LIST OF TV/MOVIE SCENES

 “Vitameatavegamin,” Lucille Ball, (I Love Lucy, 1951)
https://www.youtube.com/watch?v=cwkzNclZR4s

FROM ARTZ LIST OF TV/MOVIE SCENES

 “A Plumbing We Will Go” (The Three Stooges, 1940)
https://www.youtube.com/watch?v=xXHVVXAcNYM&t=34s

FROM ARTZ LIST OF TV/MOVIE SCENES

 “Singing in the Rain” Gene Kelly ( Singing in the Rain, 1952)
https://www.youtube.com/watch?v=D1ZYhVpdXbQ

FROM ARTZ LIST OF TV/MOVIE SCENES

 “Do Re Mi,” Julie Andrews (The Sound of Music, 1965)
https://www.youtube.com/watch?v=XjN3XW1h0Hs

FROM ARTZ LIST OF TV/MOVIE SCENES

 “We'll Always Have Paris,” Humphrey Bogart and Ingrid Bergman (Casablanca, 1943)
https://www.youtube.com/watch?v=pa-dGYjSq5k

FROM ARTZ LIST OF TV/MOVIE SCENES

 “The Richest Man in Town” Jimmy Stewart, (It’s a Wonderful Life, 1946)
https://www.youtube.com/watch?v=0k_Vsmqf6X8

WHY WATCH MOVIE SCENES TOGETHER? EMOTION: FEELING PRESENT AND ENABLED
The point is not to have THEM watch it, but to watch together and discuss it. The most important feature of all these movie excerpts is the emotions each evokes: joy, anxiety, fear, sadness, hope, humor, silliness, love, regret, and relief. What is the effect to evoking emotions? The person feels present and enabled. Partners make connections at a deep personal and familiar level.
(John Zeisel, “I’m Still Here,” page 129)

INTRO MOVIE SCENES:
“The next clip you’re going to see if from one of the most tender and yet saddest films I know, a real love story. What might that be? [Wait for an answer.] It takes place in North Africa in World War II, in a city with a casbah. One of the famous lines from the movie is: “Play it, Sam.” The movie stars one of the most famous actors of all times, Humphrey Bogart, “Bogey,” and one of the most beautiful, Ingrid Bergman. [They may guess the movie before all the cues are given.]
(John Zeisel, “I’m Still Here,” page 129)

QUESTIONS AFTER MOVIE SCENE
Isn’t that the saddest scene? It’s also very tender and loving. Have you ever been in love like that? Have you ever had to leave a loved one behind? Many people lived during World War II. Did you know someone that lived through the war? Were you in the army or did you know someone that was?
(John Zeisel, “I’m Still Here,” page 130)

DO IT YOURSELF MUSIC AND PERFORMANCE

(John Zeisel, “I’m Still Here,” page 131)

Why even take notes? It’s our life!

THE CIRCUS
Why does circus have the same effect as other art experiences? It feels familiar to all of us. The noisy audience expresses its feelings. Circus people use their bodies to show off their skills, and use facial expressions. The circus is fun. The sense of self people living with Alzheimer’s develop, knowing that they are out and about in the city and taking part in life, enable people to say, “I’m still here” and build relationships.
(John Zeisel, “I’m Still Here,” page 134)

ENVIRONMENT CAN REDUCE SYMPTOMS
I had the exceptional opportunity to explore in depth the relationship among sociology, architecture, interiors, landscape, and planning. If I could discover how physical environment helps people in this extremely vulnerable group find their way and access their memories, these same principles could be used to create healthy environments of all sorts.  In fact, the designed physical environment can reduce Alzheimer’s symptoms.
(John Zeisel, “I’m Still Here,” page 137)

8 MAJOR CHARACTERISTICS CORRELATED WITH REDUCTION IN SYMPTOMS
1) Exit control, 2) walking paths, 3) privacy, 4) shared spaces, 5) gardens, 6) home-like living, 7) five senses, 8) independence and empowerment.

(John Zeisel, “I’m Still Here,” pages 138-143)

REDUCTION IN SYMPTOMS: EXIT CONTROL
Safe and completely secure gardens with unobtrusively locking doors, windows, fences, and other potential exits, camouflaged exits that lead to danger. Oxytocin is released when people feel safe, contributing to lower stress and greater trust.
(John Zeisel, “I’m Still Here,” pages 138)

REDUCTION IN SYMPTOMS: WALKING PATHS
Clearly understood and visible destinations. Landmarks where decisions must be made, at corners or doorways. Music, smells of food and a hearth are excellent landmarks.
(John Zeisel, “I’m Still Here,” pages 138)

REDUCTION IN SYMPTOMS: PRIVACY
surfaces on which mementos and other personal objects may be easily displayed. All living creatures want some territory that is their own.
(John Zeisel, “I’m Still Here,” pages 139)

REDUCTION IN SYMPTOMS: SHARED SPACES
Decoration and furnishings that clearly differentiate one place from another help promote appropriate behaviors in each room, telling us what is expected of us.
(John Zeisel, “I’m Still Here,” pages 139)

REDUCTION IN SYMPTOMS: GARDENS
porches, patios, and gardens provide safe access to the out-of-doors. Early in the progress of Alzheimer’s, people’s sense of time is disturbed. Physical contact with nature (time of day, the weather, the passing seasons), help them remain aware of time passing.
(John Zeisel, “I’m Still Here,” pages 140)

REDUCTION IN SYMPTOMS: HOMELIKE LIVING SPACE
Homelike bedrooms that are not too big, with familiar decor on the walls. Territorial imperative, also linked to oxytocin, is centered at “home” for all living creatures.
(John Zeisel, “I’m Still Here,” pages 141)

REDUCTION IN SYMPTOMS: THE FIVE SENSES
If the kitchen is intended to be the social hub, it should look feel, sound, and smell like a social hub. If a garden is to be used frequently, it needs to be inviting and visible through a window. Multiple sensory cues to understand the environment, reduces agitation and psychotic symptoms.
(John Zeisel, “I’m Still Here,” pages 141)

REDUCTION IN SYMPTOMS: INDEPENDENCE AND EMPOWERMENT
Enable people to do by and for themselves, fostering independence as much as possible. Have bathroom doors that are visible. High toilet seats, (making it easier to sit down and get up), ensure more frequent independent use.  Safe, secure gardens enable independent use. A sense of control over our environment leads to a greater sense of empowerment.
(John Zeisel, “I’m Still Here,” pages 142)

5 RULES OF COMMUNICATION
1) Hear and respond to the other person’s “reality.” 2) Be honest. 3) Always address the person directly. 4) Don’t test! 5) Don’t say “don’t”; divert and redirect instead.
(John Zeisel, “I’m Still Here,” pages 155-163)

RULES OF COMMUNICATION: #1 Hear and respond to the other person’s “reality.”
People who live with Alzheimer’s may not know that the person they are talking to has a different reality. It’s kinder and much more respect to understand and respond to whatever reality the other expresses. Responding to the feelings underlying what another is saying can reduce anxiety, agitation, and aggression. 
(John Zeisel, “I’m Still Here,” pages 156 )

RULES OF COMMUNICATION: #1 continued (understanding the other person’s reality)
It would be as if someone persistently tried to convince you that you are actually a citizen of the moon, and refused to stop no matter how much you objected. At some point your patience would wear thin. When others attempt to get someone to change how they see the world, the reaction is predictable: anger, resistance, and withdrawal.
(John Zeisel, “I’m Still Here,” pages 156 )

RULES OF COMMUNICATION: #1 continued (How do you respond to others?)
An upset friend complains “I’m having the worst day of my life.”  You wouldn’t say: “No, not really. The worst day was probably when your father died in a crash.” I would only upset your friend more, getting more angry, anxious, and unhappy. This is the same effect that correcting the reality of a person living with Alzheimer’s has on her.
 (John Zeisel, “I’m Still Here,” pages 156 )

RULES OF COMMUNICATION: #2 Be honest.
Honesty means being yourself. Some people interpret honesty to mean expressing every attitude and feeling they have, even telling the other person that they are wrong, correcting the person each time you see things differently. A person can correct in a non-confrontational and respectful manner by expressing her own reality. To someone who thinks night is day, your truth could be presented as:  “I believe it’s the middle of the night.”  Others have their truth; you have yours.
(John Zeisel, “I’m Still Here,” pages 157 )

RULES OF COMMUNICATION: #2 continued (empathy)
Honesty includes responding with empathy. It is not a lie to feel concern when a person cries about being abandoned. She feels abandoned. Address the feeling without correcting. Not telling someone that the husband she is waiting for died is no more a lie than not correcting your spouse when she says it was the worst day of her life.
(John Zeisel, “I’m Still Here,” pages 158 )

RULES OF COMMUNICATION: #3 Always address the person directly.
 No one likes hearing people talking about them as if they were not there. In every situation be sure to talk directly to the person living with Alzheimer’s. The person knows she is there. It is up to others to remember and recognize this always. Acknowledging the person by words and actions reduces symptoms.
(John Zeisel, “I’m Still Here,” pages 158 )

RULES OF COMMUNICATION: #3 continued (Donald L. Coburn’s “The Gin Game,” 1977)
HE: I hate it when people say, “Are we hungry for dinner now?”  When they mean, “Are you hungry?”
SHE: I feel even worse when they talk about me in the third person to someone else, and I’m sitting right there. “Do you think she needs a bath?” they ask another nurse.
 (John Zeisel, “I’m Still Here,” pages 159 )

RULES OF COMMUNICATION: #3 continued (PBS documentary, “The Forgetting,” 2004)
Professionals can get it wrong. In a PBS television special, on scene takes place in a doctor’s office. The doctor is giving advice to an older couple in which the wife is living with Alzheimer’s. Throughout the scene the doctor addresses all his remarks to the husband, ignoring the wife’s presence, as if she could not hear, understand, or were not there.
 (John Zeisel, “I’m Still Here,” pages 159 )
http://www.pbs.org/program/forgetting/

RULES OF COMMUNICATION: #4 Don’t test!
Every day we ask others for information and data because we don’t know the answer. The term, “Can you” is a test question that always needs to be avoided. From the very beginning of the illness, posing such questions feels increasingly like a test of memory they are sure to fail. The person wishes he were the same person he always was. We all wish he had the same access to memory, the same recollections, the same skills.

(John Zeisel, “I’m Still Here,” pages 160 )

RULES OF COMMUNICATION: #4 continued (Our relationship and their enjoyment)
Every time a person is tested, he is made aware again that he is losing a grip on reality. He knows he ought to remember the child’s name, but he can’t. We test to make OURSELVES feel better. We want to exist in the person’s mind. Avoid testing for knowledge.
(John Zeisel, “I’m Still Here,” pages 161 )

RULES OF COMMUNICATION: #4 continued (Give him the answers)
Give him the answers rather than asking questions. Adam could wear a name tag. “Hi Mom, this is your grandson Adam who you always enjoy singing songs with.” Such an introduction gives her all the information she needs to be socially appropriate. This is a critical form of Alzheimer’s treatment that makes her feel competent and in control.
(John Zeisel, “I’m Still Here,” pages 161 )

RULES OF COMMUNICATION: #5 Don’t say “don’t”; divert and redirect instead.
A person living with Alzheimer’s doing something silly, inappropriate, or dangerous is not likely to realize the effects of his actions. “Don’t,” doesn’t mean anything to a person who does not understand why he should not do something. Explaining the reason may not help. It’s kinder and more effective to change the subject (divert) so that the person focuses on something else, and then to suggest another alternative (redirect).
 (John Zeisel, “I’m Still Here,” pages 162 )

RULES OF COMMUNICATION: #5 continued (divert FIRST before redirecting)
If someone asks you not to leave when you are headed for the door, you may get annoyed. But if you are stopped by someone asking about your kid’s music lessons, or are stopped by the clamor of pots being dropped in the kitchen and then asked, there is less likelihood of being annoyed. Create a diversion first before suggesting a more appropriate activity.
 (John Zeisel, “I’m Still Here,” pages 163 )

CHANGING ME, NOT THE PERSON WITH ALZHEIMER’S
Communication is the building block of relationships; others building blocks include understanding and embracing the other person for who they are.  This section is about not changing the person living with Alzheimer’s; it’s about changing and modifying the way you react so you don’t make matters worse.
(John Zeisel, “I’m Still Here,” pages 164 )

THE 7 RULES OF RELATIONSHIP BUILDING

1) Respond, don’t react  2) Be present 3) Do as little as possible to help the person to be successful  4) Use all the senses  5) Find the person’s doodling  6) The principle of “I” in the “we”  7) Follow the flow of the day.
(John Zeisel, “I’m Still Here,” pages 164-176 )

RELATIONSHIP BUILDING #1 Respond, don’t react: Responding is treatment
When they get angry, you get defensive and angry back. When they repeat themselves, you get frustrated and tell them stop. Thus they get more anxious, agitated and aggressive. We don’t smash our car into every other care that cuts into our lane; we think first. When we are small children, we react more than we respond, as we become adults, we respond more and react less. Responding is treatment.
(John Zeisel, “I’m Still Here,” page 164 )

RELATIONSHIP BUILDING #1 Respond, don’t react: Repeated questions
When the person asks the same question over and over, answer the question over and over with no emotion, or impatience. Give the person a note with the answer written clearly on it. Each time they ask, remind them to look at the note.
(John Zeisel, “I’m Still Here,” page 165 )

RELATIONSHIP BUILDING #1 Respond, don’t react: control yourself
When the person gets angry, control yourself and don’t get angry back. Don’t escalate the anger. Each measured response contributes to reduced agitation and aggression. Each measured response is treatment.
(John Zeisel, “I’m Still Here,” page 166 )

RELATIONSHIP BUILDING #2 Be present – are you ignoring her?
Pay attention. When you smile, frown, pay attention to what is being said, or have your attention diverted – all these actions directly affect the relationship. If you go out for ice cream with the person who has Alzheimer’s it is likely they will react to: the strange environment, the menu choices, little understood topics of conversation, interesting activity outside on the street. She will look out the window, interrupt your conversation, and be disruptive.
(John Zeisel, “I’m Still Here,” page 166 )

RELATIONSHIP BUILDING #2 Be present – focus on her
If you move to a simpler place and focus on her, she will focus back on you. Their minds are not wandering. They are not thinking about something else to do because you are there and you are what they are doing. If your mind wanders, so will the person’s. Express tenderness, caring, and love.
(John Zeisel, “I’m Still Here,” page 167 )

RELATIONSHIP BUILDING #3  DO LESS – let them do for themselves
(Do as little as possible to help the person be successful, but leave nothing undone.)
The more we do for someone, the less they do for themselves. The more dependent they grown on you, the less they learn how to get themselves out of trouble. Often wanting to do the right thing, they say, “I’ll do it for you.” Don’t say this. Do only what is needed.
(John Zeisel, “I’m Still Here,” page 168 )

RELATIONSHIP BUILDING #3  DO LESS – fill in the blanks and organize the task for them
(Do as little as possible to help the person be successful, but leave nothing undone.)
People living with Alzheimer’s slowly but surely need more help with dressing, bathing, eating, grooming, walking, and so on. Fill in the blanks, organize the steps, and help the person carry them out. The more you do, the faster they learn helplessness. The less they do, the more you do, and the easier it is for them to slip in to apathy. 
(John Zeisel, “I’m Still Here,” page 168 )

RELATIONSHIP BUILDING #3  DO LESS – allow their success
(Do as little as possible to help the person be successful, but leave nothing undone.)
The more a person is self-sufficient, the more successful she feels. Success breeds success in every activity. “Use it or lose it” holds true with Alzheimer’s. The more the person controls the outcomes of his actions the longer these skills last in his life.
(John Zeisel, “I’m Still Here,” page 169 )

RELATIONSHIP BUILDING #4  Use all the senses – encourage the experience
Don’t talk so much. The language centers are not working will. It is more difficult for him to pay attention. Non-verbal cues can convey it is dinnertime. Broadcast the smell of the chicken, the sound of dinner plays as the table is set, activity in the kitchen, a taste of the soup for “testing.”
(John Zeisel, “I’m Still Here,” page 169 )

RELATIONSHIP BUILDING #4  Use all the senses – prepare before asking
A hug, a rub on the back, and a kiss always covey love better than words. If you want to take a walk, put on your overcoat first and get hers out before suggesting a walk. Use sounds, sight taste, sensations of warmth and cold to communicate. If that does not work, use words.
(John Zeisel, “I’m Still Here,” page 170 )

RELATIONSHIP BUILDING #5  Find the person’s doodling (SKILLS)
By “doodling” I mean his own unique self-expression. It may be knitting, playing the piano, reading aloud to others, painting, and working on a computer. Each has his specialty. Find those skills that relaxes and soothes him.
(John Zeisel, “I’m Still Here,” page 170 )

RELATIONSHIP BUILDING #5  Find the person’s doodling (a place with no Alzheimer’s)
Mary doesn’t have to think about how to bowl strikes when she bowls. She knows. It’s second nature to her. Repeated years of practice embedded the know-how. When Mary bowls, she is not confused, she fits in, and she enjoys herself; there is no Alzheimer’s in the bowling alley for Mary.
(John Zeisel, “I’m Still Here,” page 171 )

RELATIONSHIP BUILDING #6 The principle of “I” in the “we” – give them something to do
Everything we do is part of our definition of who we are. Jobs or social positions develop a strong self-image, their sense of self. A significant part of our spiritual and personal growth is to understand who we are in within a greater collective whole – the “I” in the “we” and how we are connected.
(John Zeisel, “I’m Still Here,” page 173 )

RELATIONSHIP BUILDING #6 The principle of “I” in the “we” – always call everyone by name
Instead of randomly tapping a balloon, they each had to catch a large ball. When caught, they were congratulated by name with a “well done!” Everyone heard their own name and recognized the others in the circle by name.  Every social event can include these two elements. Address each by name when sitting down to dinner. Introduce them to their neighbor: “Do you want to sit next to your grandson Evan?”
(John Zeisel, “I’m Still Here,” page 174 )

RELATIONSHIP BUILDING #7 Follow the flow of the day. – Provide things to do
 A person living with Alzheimer’s who enjoys doing things may find it burdensome to play a sequence of tasks to do to keep herself busy all day long. Providing the person a daily flow of things to do that engages her mind, body and spirit helps her live a more normal life.

(John Zeisel, “I’m Still Here,” page 175 )

RELATIONSHIP BUILDING #7 Follow the flow of the day. - Morning energy
Our brains have a higher level of neurotransmitter acetylcholine in the morning when we wake up, so we have a greater energy than when we go to sleep at the end of the day.
(John Zeisel, “I’m Still Here,” page 175 )

RELATIONSHIP BUILDING #7 Follow the flow of the day. – Mealtimes
Usually we are hungry three times a day – although this may be more cultural than hard-wired. Meals are preceded by preparation and succeeded by cleaning up. Preplanning and shopping are part of longer-term meal preparation. 
(John Zeisel, “I’m Still Here,” page 175 )

RELATIONSHIP BUILDING #7 Follow the flow of the day. – social contact
In our daily lives we have social contact with others – family, friends, those with whom we have commercial interactions, and even strangers. Some of the things we do require us to engage actively, to participate, whole we may engage in other activities passively – watching and enjoying.
(John Zeisel, “I’m Still Here,” page 175 )

RELATIONSHIP BUILDING #7 Follow the flow of the day. – different purposes
Some of the things we do for relaxation, exercise, to engage our aesthetic or spiritual capacities. The day has more and less active times. In the evening we get tired and go to sleep.
(John Zeisel, “I’m Still Here,” page 175 )

RELATIONSHIP BUILDING #7 Follow the flow of the day. – engage
The more of the day is natural, the more this treatment will engage him, keep his attention, and reduce anxiety, agitation, aggression, and apathy.
(John Zeisel, “I’m Still Here,” page 176 )

APPRECIATING THE NEW RELATIONSHIP - Accepting the changes in a loved one living with Alzheimer’s.
In a healthy parent-child relationship, each time one person goes through a major life change, both have to develop a new relationship. Partners have a choice to build a new and dynamic relationship with the person living with Alzheimer’s or not. Many make the latter choice.
(John Zeisel, “I’m Still Here,” page 177 )

TRANSFORMATION WITH LIFE’S PASSAGES
I develop a new relationship with my children when each moved from being a dependent child to an adult. In one sense, they remain my children; in another, they have become adults to whom I must relate to as an adult. They had changed; I had to change too. Each of life’s passages is a transformation we all experience. We must face the shifts presented us just the same, whether happy or less happy.
 (John Zeisel, “I’m Still Here,” page 178)

HAPPY TRANSFORMATIONS
The child becomes an adult; I have a friend as well as a dependent. The child has children; I am a grandparent. My colleague was promoted; I have a friend in a position of influence.
(John Zeisel, “I’m Still Here,” page 178)

LESS JOYOUS TRANSFORMATIONS
Her son is addicted to heroin; she has to express her love in a different way. The wife left him for another relationship; he has to establish a more distant yet respectful relationship to her. My mother is getting old; I have to forget the many slights of childhood and make peace.
(John Zeisel, “I’m Still Here,” page 178)

HOW WE RESPOND DETERMINES QUALITY OF LIFE AFTER TRANSITION
If we deny the changes and fight against them, we have a bad divorce, a bad parent-child relationship, a bad relationship with our aging parents. If we accept the changes, we have the opportunity build a new and fruitful relationship that can enrich our lives.
(John Zeisel, “I’m Still Here,” page 179)

MAKE THE BEST OF THE CHANGE
We have the choice of making this change miserable for everyone; or we can make the best of it. We can do even better – we can improve all our lives. We all need friends with whom we can build a relationship. The person you used to love is turning into a new person whom you can embrace and enjoy. All happy change is tinged with sadness; all sad changes are tinged with joy. Continue to see the good as well as the bad as the disease and relationship continues to change.
(John Zeisel, “I’m Still Here,” page 179)

REPLACE UNREAL IMAGE WITH REALITY
It is incredible difficult to give up the person we love and that has shared many of life’s other passages, and who we expected to enjoy later in life, but you don’t have to. The person living with Alzheimer’s still has many of the experiences and characteristics that have made her who she has always been. She just can’t draw on these life experiences and express them in the same way. Instead give up the unreal image, the future you dreamed of having, the fairy tale stories. Replace them with new reality-based dreams.
(John Zeisel, “I’m Still Here,” page 180)

ACCEPTANCE FEELS LIKE LOVE
Bill Keane, on the board of the National Alzheimer’s Association, tells a story of his mother falling ill with Alzheimer’s. He visited her daily, bringing her favorite things, a hug, and a smile. Bill’s father felt his life was over when he realized she had Alzheimer’s and never accepted her for the person she had become. Somehow she knew this. A major reason for accepting and even embracing the changes is that the person you love will know that you continue to love them.
(John Zeisel, “I’m Still Here,” page 182)

NEW RELATIONSHIP GOAL: To discover the uniqueness of the person living with Alzheimer’s.(John Zeisel, “I’m Still Here,” page 183)

BEGINNING A NEW RELATIONSHIP: 1. Keep a written log
(John Zeisel, “I’m Still Here,” page 183)

BEGINNING A NEW RELATIONSHIP: 2. Take notes
(John Zeisel, “I’m Still Here,” page 183)

BEGINNING A NEW RELATIONSHIP: 3. Record actual behavioral observations.
(John Zeisel, “I’m Still Here,” page 183)

BEGINNING A NEW RELATIONSHIP: 4. Write down “quotations” to which you might want to refer later.
(John Zeisel, “I’m Still Here,” page 183)

BEGINNING A NEW RELATIONSHIP: 5. Note the time of day and day of the week.
(John Zeisel, “I’m Still Here,” page 183)

BEGINNING A NEW RELATIONSHIP: 6. Describe the physical environment and social context of each observation.
(John Zeisel, “I’m Still Here,” page 183)

BEGINNING A NEW RELATIONSHIP: 7. Take digital photos of activities, interactions, and physical context.
(John Zeisel, “I’m Still Here,” page 183)

THEIR NEW SKILLS
Staying present to the person enables discovery of present skills and aptitudes, not only those he USED to have and you WISH he still had. While the person you used to know was exceptional at multitasking, the new person is better at focusing.
(John Zeisel, “I’m Still Here,” page 184)

WHAT MAKES HER HAPPY?
You will discover what makes her happy, that she loves holding hands, walking in gardens, shopping, pets, children, and old movies.
(John Zeisel, “I’m Still Here,” page 184)

WHAT MAKES HER SAD?
He’ll remember his wife passed away, or thinking of lost friends, or when you leave after visiting. Based on your observations, you can build your new relationship.
(John Zeisel, “I’m Still Here,” page 184)

CREATING A POSITIVE  RELATIONSHIP: How to say hello
Sit down next to her, hold her hand, look her in the eye and say, “Hi, Mom. I’m you daughter Miriam, and I love talking with you about Oakland, where you were born.” Don’t just say, “Hi, Mom.” As you used to.
(John Zeisel, “I’m Still Here,” page 185)

CREATING A POSITIVE  RELATIONSHIP: Topics of conversation
Tell him about your day, and discuss what you know of his day. Talk about sports, politics, family, his past, your past together, the job he used to have, or just any subject that comes to mind. Don’t sit quietly waiting for a topic of conversation to arise. It won’t.
(John Zeisel, “I’m Still Here,” page 185)

CREATING A POSITIVE  RELATIONSHIP: The rhythm of visits
Start each visit excitedly talking about the things you did that day and slowly turn down the energy level until she walks you to the door. Or calmly chat the entire time you’re there and then divert her attention to something else when you quietly slip away. Don’t expect her to dictate the rhythm of the encounter.

(John Zeisel, “I’m Still Here,” page 185)

CREATING A POSITIVE  RELATIONSHIP: The images you bring to communicate with him.
Bring photos, trophies from your childhood, news clippings from significant events in his life, a video of the family saying hello, or that day’s newspaper to tell him about the world.
(John Zeisel, “I’m Still Here,” page 185)

CREATING A POSITIVE  RELATIONSHIP: The props with which you surround the person.
Make sure there are familiar paintings on the wall and discuss them with you’re with him. Make sure he has a bedspread he knows is his. It is a memory jogger. Don’t buy new things to make him feel good as it might you.
(John Zeisel, “I’m Still Here,” page 185)

CREATING A POSITIVE  RELATIONSHIP: Arranging the room.
Simplify the kitchen so it is least confusing. Move the coffee table in the living room and put her favorite chair directly opposite window so that she does not bump her knees.
(John Zeisel, “I’m Still Here,” page 186)

CREATING A POSITIVE  RELATIONSHIP: Things you do together.
Create opportunities to do things together. Don’t wait for them to arise on their own. Take the initiative to walk in the garden together or down the street. Take the initiative to drive to an ice cream shop and share an ice cream cone. Go out to dinner.
(John Zeisel, “I’m Still Here,” page 186)

CREATING A POSITIVE  RELATIONSHIP: Cultural events
Go regularly to the museum he was a member of. Buy tickets to the opera for him and you. What about the circus? Would he enjoy that? If you think he might, get tickets and have a good time. What about visiting the local historical society with pictures of the town when he was young?
 (John Zeisel, “I’m Still Here,” page 186)

CREATING A POSITIVE  RELATIONSHIP: Sequence of things you do together
Decide how you are going to spend your time together. Don’t leave it to chance. Plan a sequence, such a sitting together, going out, driving around, stopping for a snack, returning home. Get his coat on the right away, go out, and then sit for a while when you get back before you leave. Don’t expect things to just happen by themselves.
 (John Zeisel, “I’m Still Here,” page 186)

CREATING A POSITIVE  RELATIONSHIP: The way to say good-bye
Decide if you are going to explain to her when you leave where you are going when you will be back. If so, describe these events simply. In a group setting, when you are going to leave, make sure she is involved in another activity with someone else before leaving. If you find this works well, time your leaving to coincide with something else going on that will interest her, then, if it makes you comfortable, prepare what you are going to take with you. Pick it up and offhandedly say, “Bye, Mom,” as you are at the door.
 (John Zeisel, “I’m Still Here,” page 187)

CREATING A POSITIVE  RELATIONSHIP: Leaving a record of you visit. Decide what sort of trace you will leave of your visit. Every time you come to see her, write your name, the date and time, and a note about what you did together. If that feels too formal, place a large calendar on the wall and sign it each time you see her.
 (John Zeisel, “I’m Still Here,” page 187)

CREATING A POSITIVE  RELATIONSHIP: Leaving a record of you visit. Decide what sort of trace you will leave of you visit. Every time you come to see her, write your name, the date and time, and a note about what you did together. If that feels too formal, place a large calendar on the wall and sign it each time you see her.
 (John Zeisel, “I’m Still Here,” page 187)

DISCLAIMER OF CREATING A POSITIVE RELATIONSHIP: While some of these principles apply to all partners, each needs to be practiced differently by family members.
(John Zeisel, “I’m Still Here,” page 187)

A TWO WAY STREET: WHAT YOU SAY AND DO HELPS THEM FIND EMOTIONAL RESPONSE
A person living with Alzheimer’s actually does need other people. The more sensitive to emotional expressions YOU show, the more responsive he will be to other people’s needs. A person with Alzheimer’s can find she needs to give as well, to figure out how to make you feel better, express empathy, and tell you how much she loves you. She is responding with the hardwired part of her brain where a need to care for others is embedded.
(John Zeisel, “I’m Still Here,” page 189)

PROVIDE MEANING: Amygdala emotions
Be sure to ask the person with Alzheimer’s for expressions of emotions rather than cognitive data. Ask how they feel about a topic, not who was there a little while ago, or someone’s name.
(John Zeisel, “I’m Still Here,” page 190)

PROVIDE MEANING: Memory joggers
In conversation, bring up all the topics you have identified as jogging her memory. These may include a particular aspect of her life – her neighborhood or her job, her children or grandchildren, or particular life events. Whatever you do to trigger her access to memories plays a part in her treatment.
(John Zeisel, “I’m Still Here,” page 190)

PROVIDE MEANING: Visual props
Photographs you share, mementos of special events, graduation certificates, military medals, a local team’s baseball hat, anything three-dimensional that has meaning and that you can employ to generate interest or conversation is part of his treatment. Don’t worry if there is a sad reaction to some of this. Enabling him to be present to his own memories and emotions is the gift and the goal.
(John Zeisel, “I’m Still Here,” page 190)

PROVIDE MEANING: Be the conversation generator yourself
Be prepared to talk about your day, the kids, your work the way you feel about a movie you saw, a trip you took recently. Don’t expect the other person to draw on his memory bank of topics and recent experiences to generate conversation. If you have to carry the conversation as a monologue, carry it. To do this you may need to make and refer to a written list of topics you are going to cover, like a cue card.
(John Zeisel, “I’m Still Here,” page 191)

PROVIDE MEANING: ONE AT A TIME
A person who tries to implement all of the suggestions in this book might well collapse from exhaustion. To do everything oneself to maintain a relationship and provide meaning to another’s life would take more time than there is in a day, and more energy that anyone has. It is essential, therefore to take the things-to-do suggestions one at a time, and even to think of getting others to help carry them out.
(John Zeisel, “I’m Still Here,” page 191)

CAREGIVING:
Life cannot be the sole responsibility of a single person. There is literally never any real rest. See the parallel between the destruction of the liver or heart, and the destruction of the brain.  Alzheimer’s is an organic illness of the brain. Sharing care tasks is keeping a promise, not breaking it.
(John Zeisel, “I’m Still Here,” page 192)

CARE OF YOURSELF
Those who care of people living with Alzheimer’s tend not to take care of themselves.  They tend to get sick more often and for longer periods than the people they care for. If the partner of someone living with Alzheimer’s gets sick, the person living with Alzheimer’s suffers. 
(John Zeisel, “I’m Still Here,” page 209)

WHEN THINGS GET DIFFICULT:
Live within your own capabilities and limits; Don’t push the limits as far as they can go; Establish your own life and rhythm; Establish a lifeline or two; Learn to say: “Please help me;” Learn to give up.
(John Zeisel, “I’m Still Here,” page 211)

WHEN THINGS GET DIFFICULT: Live within your own capabilities and limits
How much can you endure/ Determine how much care giving and treatment a partner can take on. Your health depends on living within the limits of you capability. If we don’t, the person we are caring for suffers as well. 
(John Zeisel, “I’m Still Here,” page 211)

WHEN THINGS GET DIFFICULT: Don’t push the limits as far as they can go
The measure of when to get help or attend a support group is when it is best for the relationship – which means when it is best for both the person with Alzheimer’s and the partners. “It’s not bad enough yet” = enduring discomfort, suffering, pain instead of a healthy, compassionate relationship.
(John Zeisel, “I’m Still Here,” page 211)

WHEN THINGS GET DIFFICULT: Establish your own life and rhythm
The person with Alzheimer’s will have a new life and become a new person. Establish your own new life; it is the only way to stay healthy.  Decide on a schedule to be with her, (schedule whether to have afternoons, or mornings, or evenings for yourself).  Develop new skills, hobbies, pleasures, trips, and friends.
(John Zeisel, “I’m Still Here,” page 212)

WHEN THINGS GET DIFFICULT: Establish a lifeline or two
It becomes more trying as the disease progresses. There will be times when you will despair. You need to have friends or professional helpers who are lifelines you can rely on. Find someone to whom can you vent?  Find a formal support group of people dealing with similar issues.
 (John Zeisel, “I’m Still Here,” page 213)

WHEN THINGS GET DIFFICULT: Learn to say: “Please help me”
One of the gifts of Alzheimer’s is that the act of caring for another teaches us to be aware of our own limits. We need others; they need us. Learn to say, “Please help me.”
(John Zeisel, “I’m Still Here,” page 214)

WHEN THINGS GET DIFFICULT: Learn to give up
You have to learn to do what you can and learn to give up and drop it when the task is overwhelming.
Know yourself well enough to do what you can, accept what you can’t and avoid deceiving yourself into believing that you can achieve the impossible.
(John Zeisel, “I’m Still Here,” page 215)

THE GIFTS OF ALZHEIMER’S - Insights gained from learning to give and receive.
“Feelings form the base for what humans have described for millennia as the human soul or spirit.” – Antonio R. Damasio.  More can be positive in a life with Alzheimer’s. Relationships foster and unwrap gifts; we learn a great deal about them and ourselves.
(John Zeisel, “I’m Still Here,” page 216)

THE FALSE IMAGE FOR FUNDRAISING
The term, “Alzheimer’s bring to mind for many a false image of a sick, old, bedridden person whose mind wanders, who forgets the names of friends and family, and who is rapidly becoming a nonperson. This extreme mental picture develops because the media frequently presents this image and because those how fund-raise for cure research find that such an image stirs people’s hearts – as well as their pocketbooks.
(John Zeisel, “I’m Still Here,” page 216)

ENGAGING CAN AWAKEN
The picture of them attending a concert, enjoying a museum, does not pull on the heartstrings of potential donors. People with Alzheimer’s live most of their lives with bodies at least as healthy as those of others their age – and minds that work, although stressed more by everyday situations than true for many others. This book has described how engaging people living with Alzheimer’s can awake them and their partners.
(John Zeisel, “I’m Still Here,” page 217)

THROUGH FATHER’S EYES
After Ellen’s mother died, when she was only seven, he became distant and paid more attention to his work.  “I would never have said we were close – until he got Alzheimer’s.” He showed wonder, surprise, and pleasure whenever he saw her and was extremely kind, sharing his food when she visited. Many parents and children never achieve this.
(John Zeisel, “I’m Still Here,” page 218)

HOW HAVE I IMPROVED?
No one embraces the disease saying, “I am so happy my wife is living with Alzheimer’s.” All say that if there were a way to return to the time before Alzheimer’s they would jump at the chance. But there isn’t. The way each of us has “improved” as human beings as a result of the relationship we have built with our loved one’s over time. These are the gifts we receive.
(John Zeisel, “I’m Still Here,” page 219)

WORKING WITH ALZHEIMER’S PATIENTS LED TO PROFOUND RELATIONSHIPS.
I used to be angrier. Angry that my kids were not with me, I took it out on my family. I was impatient, seldom present to what others were experiencing. I pushed the limits of every relationship. As I increasingly spent time with people living with Alzheimer’s, I realized that anger and impatience worked against me. I was led to more profound friendships and relationship than when I thought I was the center of the world.
(John Zeisel, “I’m Still Here,” page 219)

THE GIFT OF EMOTIONAL OPENNESS
My mother is exquisitely open emotionally to me and to those around her. I am learning form her to be more open and loving myself.
(John Zeisel, “I’m Still Here,” page 220)

THE GIFT OF CHERISHING MEMORIES
With gentle reminders, my father recalls many memories of childhood, family, and friends. These seem timeless and appear not to be fading. The more I am with him the more I cherish these things in my own life.
(John Zeisel, “I’m Still Here,” page 221)

THE GIFT OF A SENSE OF HUMOR
I have to laugh sometimes at the things that happen and at the things she says. Now I can laugh at situation in the rest of my life that otherwise used to drive me up the wall.
(John Zeisel, “I’m Still Here,” page 221)

THE GIFT OF ACCEPTING HELP
I always thought I had to do everything myself, that I had to do all the caring. Now I can accept the help of others more. It is a blessing to be relieved of all the pressure I felt.
(John Zeisel, “I’m Still Here,” page 221)

THE GIFT OF TAKING CARE OF MYSELF
I always thought I needed to do everything for everybody. Now I realize that if I don’t take care of myself, I won’t be able to help my mother.
(John Zeisel, “I’m Still Here,” page 221)

THE GIFT OF RECOGNIZING THE IMPORTANCE OF HOME AND HEARTH
The more I get to know him again and realize the importance of his home to him, the more I value the friendliness of others, of sharing food, of having a place of my own.
(John Zeisel, “I’m Still Here,” page 221)

THE GIFT OF LIFE STORIES
My mother has an active imagination and deep memories of places and times from her past. She loves an appreciative audience. I hone my skills at storytelling the more I realize that this is a skill that will continually increase throughout my life.
(John Zeisel, “I’m Still Here,” page 222)

THE GIFT OF PATIENCE
Whenever I try to speed things up when I am with my father I become aware that life has its own pace and that there is little I can do to speed it up or slow it down. He just tells me bluntly to relax. Every time I am with my father, I develop more patience and understanding.
(John Zeisel, “I’m Still Here,” page 222)

THE GIFT OF ENJOYING THE MOMENT
My mother is perpetually in the moment. Whenever we are together, I am given the cherished gift of being there with her at that moment. Any regrets about the past I might have, or hopes and fears about the future, have little place in our relationship at that moment.
(John Zeisel, “I’m Still Here,” page 222)

THE GIFT OF SELF-AWARENESS
Every expression and every movement of mind counts when I am with my mother and her friends. The notice everything around them and are exquisitely sensitive to nuance and detail. I have learned from her how important everything I do is to others.
(John Zeisel, “I’m Still Here,” page 222)

THE GIFT OF SEEING OTHERS FOR WHO THEY ARE
While they may still have certain skills or even money, those achievements and possessions pale in the light of who they are. Their smiles, their tenderness, their sensibilities – their basic human instincts become the person I relate to – not their possessions.
(John Zeisel, “I’m Still Here,” page 223)

THE GIFT OF DISAPPEARING PROBLEMS
My mother gets upset when she senses others are coping with unresolved problems. Whenever I drive to see my mother, I prepare myself by emptying my mind of daily problems, no matter how immediate they may be. This is a skill I have only mastered since Mom has been living with Alzheimer’s. Now I do the same things with my friends and family.
(John Zeisel, “I’m Still Here,” page 223)

THE GIFT OF THE IMPORTANCE OF FAMILY
Even though I am only thirty years old, contact with my friend living with Alzheimer’s has made me realize how fragile and transitory life is. I cherish the time I spend with my parents – no matter how difficult those relationship might be.
(John Zeisel, “I’m Still Here,” page 223)

THE GIFT OF REALIZING THAT PLATO WAS RIGHT
Plato describes life as a cave at the center of which is a fire that casts shadows on the wall of people chained there. Reality is different to everyone because each person sees different shadows on the wall. People didn’t see either the fire or themselves, only ever changing shadows. Reality is like that. My father sees the shadows one way, and I see them another. And we’re both right.
(John Zeisel, “I’m Still Here,” page 224)

THE GIFT OF BEING PREPARED
I never knew how much being prepared could help others and could help me. When Mom first started living with Alzheimer’s, I had trouble helping her get dressed. Last week I had all her clothes laid out for her before she came into the room. It was a lot easier this time. It’s a lesson for life.
(John Zeisel, “I’m Still Here,” page 224)

THE GIFT OF KNOWING MY WORK IS GOOD WORK
When I massage these clients, they have a big smiles. I give them the gift of touch; in return they give me the gift of value.
(John Zeisel, “I’m Still Here,” page 224)

THE GIFT OF GOING WITH THE FLOW
When my husband I learned how just to be appropriate and to say the right thing. I learned I can only do what I can do – no more. So what if I can’t go to a show or an event I wanted to attend. I greet each morning without plans. I just go with the flow. Something I’ve never before been able to do.
(John Zeisel, “I’m Still Here,” page 225)

THE GIFT OF COPING WITH THE COMPLICATED
Nothing is simple with Alzheimer’s. It’s all just complicated. I’ve learned over time that I can handle it. I can handle all sorts of complicated things in the rest of my life too that I hadn’t been able to handle.  (John Zeisel, “I’m Still Here,” page 225)

THE GIFT OF KEEPING GOING
When my husband was diagnosed a few years ago, I decided we’re just going to keep going. Last month we took a boat ride to Nova Scotia. We play golf each week. We’ve been happily married for forty-two years. Every day I just try to make life as happy as it has always been – and it works.
(John Zeisel, “I’m Still Here,” page 225)

THE GIFT OF GREATER INSIGHT
Alzheimer’s has opened a window into a part of my mother that was mostly guarded in the past. Now she is able for the first time to show the more affectionate part of her nature. There is less conflict between us now. I have become more open not only to her but to my family and friends as well.
 (John Zeisel, “I’m Still Here,” page 225)

THE GIFT OF GIVING
It was always hard to please my father – no matter how hard I tried. Now he has ‘the smile of the moment that means everything.’ Now I always know when he is happy with something I have done for him and I am able to give more freely of myself.
(John Zeisel, “I’m Still Here,” page 226)

THE GIFT OF COMMUNITY
When I come to visit my mother is’ fun because all the people here respond so gleefully to me Each person in this community has unique characteristics. It’s wonderful for me and for my mother.
 (John Zeisel, “I’m Still Here,” page 226)

THE GIFT OF MY OWN HUMANNESS
I have learned to let go of my view of what is beautiful is the right view. It’s their beauty that’s important. They don’t ask for your résumé. All they want is a smile and a kind, warm look. Your humanness is all that matters.
(John Zeisel, “I’m Still Here,” page 226)

THE GIFT OF EMOTIONAL TIES
With people living with Alzheimer’s you have a strong feeling of doing what has to be done to make their lives better. It’s not a matter of thinking about what to do or figuring out what’s needed. You just know. It’s so immediate. Rather than having emotional baggage, you find you have emotional ties.
 (John Zeisel, “I’m Still Here,” page 226)

THE GIFT OF LISTENING
People just want to be listened to. It’s as if you’re called out of a tense meeting for a phone call as opposed to having your cell phone go off in the meeting. It gives you a chance for energetic cleansing. That’s what it’s like being with my mother. She listens so well, and I listen to her so well. 
 (John Zeisel, “I’m Still Here,” page 226)

THE GIFT OF ACCEPTING DEATH.
We always want to fix everything, and yet there are certain things we can never fix. The true gift I have learned to give my mother is the strength to face her upcoming death. By accepting her for who she is, by my not feeling fear and alarm, she is at peace – and so am I.
(John Zeisel, “I’m Still Here,” page 227)

THE GIFT OF GROWING UP
In order for me to cope with this disease and to learn new ways of being with my mother, I had to grow first, emotionally, spiritually, and mentally. From this growth I have gained hope – hope and belief that I have a chance of growing up someday.
 (John Zeisel, “I’m Still Here,” page 227)

THE GIFT OF “WE”
It’s hard to make it an “I” when I am with my mother. If I am not connected to her when we are together, we lose each other. I have to give up the “I” and become the “we” with her.
(John Zeisel, “I’m Still Here,” page 227)

THE GIFT OF A KINDER WORLD
My father shows more emotion now than he used to. He sees the world differently – not as competitive and not as possessive. I am learning to see it that way too.
(John Zeisel, “I’m Still Here,” page 227)

THE GIFT OF NURTURE
I never had children so taking care of someone is new. It put me in a different role than I had experienced. Helping my mother helped me. I used to think she knows better, no matter what the situation. I let go of my expectations of who and what she was before and accept who she is now. 
(John Zeisel, “I’m Still Here,” page 227)

THE GIFT OF REALIZING LIFE IS PRECIOUS
Every day that I come to work I learn so much from all these people living with Alzheimer’s. Every day I touch someone on a certain level. I see someone gaining ground in how to do something – even a simple task. When I come to work I could be in the best mood, or the worst. Now I live in the moment. I realize that no matter how long a person may seem, there is still a person there. I have learned that life is precious.
(John Zeisel, “I’m Still Here,” page 228)

THE GIFT OF CAPABILITY
When my mother got ill I found myself being very responsible and necessary. The sense of being needed was and is still very intense. I had a tremendous sense of obligation and duty. I never thought I could toilet my mother or clean her up after she was incontinent during the night. I learned I was personally capable of so much more than I thought I was.
(John Zeisel, “I’m Still Here,” page 228)

THE GIFT OF REVISITING
Since my mother started living with Alzheimer’s I revisit old things and experiences in new ways. I am more balanced about them, more tolerant, more understanding. It is somewhat cyclical looking at the past this way, but I get a smile from it.
(John Zeisel, “I’m Still Here,” page 228)

THE GIFT OF TAKING RISKS
Every so often my dad says, “Kill me.” But every day they learn something new about the disease. I take more and more risks every day as a result of my dad’s illness. I am glad to be alive now.
(John Zeisel, “I’m Still Here,” page 229)

THE GIFT OF UNDERSTANDING BASIC TRUTH
My husband told us he was worried about something he had forgotten to do. My dad said, “That’s okay, that what I do half the time around here.” We were talking about the quality of the caregivers here. My said dad, “They have a good team here. Well, there are times you wish you were someplace else. But that’s true anywhere.” We all laughed at the basic truth of my dad’s way of seeing the world.
(John Zeisel, “I’m Still Here,” page 229)

THE GIFT OF VALUING OTHERS
II never thought I’d be taking care of my parents. I never thought I’d be changing my mother’s clothes. I have had to develop a lot of patience, scheduling taking care of my parents along with taking care of my four kids. What I have gained is appreciating the value of others in my life. 
(John Zeisel, “I’m Still Here,” page 229)

THE GIFT OF THE ZEN MIND
My relationship with my father has become incredibly direct. The illness has led to our narrowing things down – to a state of grace, to the Zen mind. Whereas before we might have analyzed everything and even fought about how we saw things, now it’s just about “Ow, it hurts!” and “Oh.”
(John Zeisel, “I’m Still Here,” page 229)

THE GIFT OF CONTROL
I’m grateful that my father and I have grown in our relationship. He is a new person. That “old” person of my childhood wasn’t so easy. He always had to be in control and I distanced myself. Now he feels good that I am in control and so do I.
(John Zeisel, “I’m Still Here,” page 230)

THE GIFT OF CONVERSATION
Whenever I realize how little I talked to my dad in my life, and that I can no longer have those conversations, I appreciate conversations more. I think about my friends and say appreciatively to myself. “I can have a conversation with you!” It makes me want to talk more – to call up friends I haven’t talk to for a while.
(John Zeisel, “I’m Still Here,” page 230)

THE GIFT OF GIVING AND OF GIVING UP
Before my mother lived in this special place, there was such a dependency on the amount of support that I needed to give. Now that I don’t have to provide that support I have inner peace, knowing that her basic needs are being met in a thoughtful way. This has released me to be “ha-ha! hee-hee!” with her. It’s amazing how much you get by giving up. But you know, even though it was a lot of responsibility I kinda miss it.
(John Zeisel, “I’m Still Here,” page 230)

THE GIFT OF QUALITY TIME
I have gained a better sense of time in my own life. When you see them – the people with Alzheimer’s – you realize that time really is fleeting. You really know what quality time is.
(John Zeisel, “I’m Still Here,” page 230)

THE GIFT OF KIDS COMING TO VISIT
My kids were always afraid of visiting grandfather. They didn’t know how to deal with his illness. One thing that is so helpful for them, that is a real eye-opener, is the warmth that staff and families exhibit toward my father and everyone here. Seeing this has made them much more willing to come visit.
(John Zeisel, “I’m Still Here,” page 231)

THE GIFT THEY TEACH US
In sum, people living with Alzheimer’s teach us to have open hearts and minds and to become better people. What we learn – the gifts we receive – helps us not only in those relationships, but also in all the relationship in our lives.
(John Zeisel, “I’m Still Here,” page 231)

BE HAPPY
Be happy in the moment, that’s enough. Each moment is all we need, not more. – Mother Teresa
(John Zeisel, “I’m Still Here,” page 232)

MEDITATION: STRESS REDUCTION
Stripped of its religious context, mindfulness meditation is simply learning to have an open and accepting attitude towards whatever arises in one’s mind. This very simplicity makes it useful as a stress-reduction technique.
(John Zeisel, “I’m Still Here,” page 233)

TIMELINES
The line of time that most of us experience comprises:
1) the past about which we hold many “what if” regrets,
2) the present that is always fleeting – we never have “enough” time,
3) the future that we worry about because we can’t predict which of the infinite alternative things that might happen will actually occur. We believe a clearer vision of the future would help us make better decisions in the present moment.
(John Zeisel, “I’m Still Here,” page 233)

POINT OF TIME
People living with Alzheimer’s tend more and more to experience a point of time rather than the time line. It is as if past experience and the future have drawn together with the present as one; much like how our unconscious minds combine several dimensions of time and place when we dream. The present moment represents all moments. People who meditate regularly strive to be in the present moment.
(John Zeisel, “I’m Still Here,” page 234)

THINKING ABOUT THE NEXT MOMENT
In our daily lives our minds are always churning with thoughts, as we think about things other than what we are dealing with at the moment. When we are washing the dishes we think about a conversation we had earlier in the day or about something we plan to tell someone the next day. The next day when we are with the person, we think about next months’ vacation. When our bodies are in one place and our mind in another we don’t truly experience the present moment.  Medication plays a role in more self-improvement, spiritual, and religious practices by bringing the anxiety of the past and future together with Alzheimer’s point in time. So we can be more understanding of each other.
(John Zeisel, “I’m Still Here,” page 235)

THE IRONY
Those who experience “normal” time as a line, work hard to forget the regrets they have about the past, and put aside their worries about the future that they cannot control. At the same time they often urge those living with Alzheimer’s to replace their experience of time as a “point in time” by searching for past memories and thinking about the future. Awareness of these capacities provides us with peace of mind and with important insights for finding the key to connection with those living with Alzheimer’s.
(John Zeisel, “I’m Still Here,” page 236)