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Awkward Apathy in the Dementia World

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As both a family and a professional caregiver, apathy has been my Achilles heel. Trained as a recreation therapist, a classic left-brain extrovert, I work hard to get positive feedback. Apathy is one of the top four behaviors present in dementia world.

Apathy is the care partner who doesn’t leave his recliner, his bed, who has lost all interest in participating. Different from depression, apathy is defined as diminished motivation that is not attributed to emotional distress.1 Depression involves emotional distress.2 No distress, simply flat.

Environment is one key to addressing apathy. Person-environment fit is the research term used. One study validated the importance of specifically the indoor environment.3 Another study within a nursing home sample found the overall quality of environmental stimulation was associated with lower apathy levels.4 In particular, individually tailored environmental stimulation was associated with lower apathy. So not just music, but music which the individual with apathy had enjoyed in the past. A meta-analysis of non-pharmacological interventions on apathy in patients with dementia found multisensory stimulation, music therapy, cognitive stimulation and pet therapy were great strategies in addressing apathy.5  

So how do we translate the research to our couch potato? Consider the sensory preferences of your care partner in the past. How might you enhance a meal, an aroma? Maybe a weighted blanket for the recliner? Or consider adding a pet to your environment. Perhaps a dog, a cat or even a fish. Maybe an animatronic pet or an MP3 player loaded with his/her favorite tunes.

From my experience, apathy allows you plenty of time to experiment. This can take a good deal of reflection and trial and error. Enroll friends or family in the process. Have Aunt Mary send over the pie she once loved. Ask Tim to bring over the old fishing tackle they once used. Take note of the flicker of a smile or the change in engagement as you experiment with tailoring the environment. Your measure of success may be met in a smile or a brief conversation probably not fireworks and a parade. Let’s face it, fireworks and a parade would probably not have good person-environment fit.

Byline: Cate McCarty, PhD’s background in nursing, activities and admissions has given her a passionate commitment to quality of life for the individual and family with dementia. Her business is Dr. Cate, Dementia Coach. Cate is currently the care partner for her spouse who has early-stage dementia of the Alzheimer’s type.

Footnotes

1Marin RS: Differential diagnosis and classification of apathy. Am

J Psychiatry 1990; 147:22–30

2American Psychiatric Association: Diagnostic and Statistical

Manual of Mental Disorders, 4th edition. Washington, DC,

American Psychiatric Association, 1994

3Jao YL, Liu W, Chaudhury H, Parajuli J, Holmes S, Galik E. Function-Focused Person-Environment Fit for Long-Term Care Residents With Dementia: Impact on Apathy. Gerontologist. 2021 Apr 3;61(3):413-424. doi: 10.1093/geront/gnaa111. PMID: 32833010.

4Jao YL, Liu W, Williams K, Chaudhury H, Parajuli J. Association between environmental stimulation and apathy in nursing home residents with dementia. Int Psychogeriatr. 2019 Aug;31(8):1109-1120. doi: 10.1017/S1041610219000589. PMID: 31241031; PMCID: PMC6734555.

5Cai Y, Li L, Xu C, Wang Z. The Effectiveness of Non-Pharmacological Interventions on Apathy in Patients With Dementia: A Systematic Review of Systematic Reviews. Worldviews Evid Based Nurs. 2020 Aug;17(4):311-318. doi: 10.1111/wvn.12459. Epub 2020 Aug 7. PMID: 32767834.