Our faith is often called on in difficult times. When someone is diagnosed with Alzheimer's disease (AD) the persons with AD and their families often have questions about hope, faith and God. We often search for why something is happening. People express their faith through religion, prayer, church services and rituals.

Alzheimer's disease is the most common type of dementia. Dementias are a set of illness that cause a gradual loss of memory, the ability to think of words, the ability to concentrate, the ability to problem solve and judgment. Diagnosis of Alzheimer's or another type of dementia is made by a physician after a battery of tests. During this time families often find strength in their spiritual faith and faith family.

For many individuals with AD traditional religious practices have become part of long-term practice and memory. Preserved are rituals, prayers, and hymns. It helps to recognize what role the church played in the life of the person with AD. Did the person attend church regularly? Did she have a particular role in church? Was it important to serve others in some way? Our sense of who we are is often linked to the role our faith plays in our lives.

Traditional religious practices can involve long-term or distant memory. Many people are members of the same church or denomination throughout their lifetimes and numerous aspects of religious practice may be firmly preserved in the affected person's long-term memory.

The structured and predictable order of worship used in churches may be comfortingly familiar to a person with AD who has trouble handling spontaneous situations. Participating in religious activities should be encouraged if this is meaningful to the individual. Church services may need to be shortened for those with dementia because of a shorter attention span.

Persons with AD can connect with their faith. For individuals with AD the emotion and feelings will last into the disease process, even when the person with AD cannot talk about what is going on around him. The following are ideas about how to involve the person throughout the disease process and the gradual decline. Family members can give specific insight into how to involve the individual.

Early Stage
In the early stages the person can still draw on memory and the things he can still do to participate. Participating provides a sense of community from being with other members of one's faith. It is important to value the moment and the experience with the person. Connection can be made in several ways:

• Faith symbols such as a Bible, cross, basin and pitcher, prayer covering can bring back emotions and feelings of previous experiences
  
• Rites such as communion can be very fulfilling and comforting experiences
  
• Families should be encouraged to continue attending services and programs in which they are involved, have a backup plan in case the family member needs to step out of the service
  
• Look at what roles the person can continue in his church community; can these roles be modified to continue in some way
  
• Songs and hymns
  
• Reading and reciting scripture
  
• Prayer
  
• Provide opportunities to feel useful
  
• Reminisce about holidays, rituals such as communion, weddings, and other ceremonies
  
• A family member or deacon may need to address the loss and grief that the person may be experiencing if they become sad
  
• Provide visual cues with Bibles, religious pictures, banners, hymnals, holiday foods
  
• Maintain attendance at church
  
• Accept offers of assistance from your faith community
  
• Educate your faith community about AD. Contact your local Alzheimer's Association or eldercare provider for information
  
  
  

Middle Stage
Further decline occurs in memory, thinking and physical abilities. The person with AD may no longer recognize friends at his church. The person may also experience mood swings, confusion or restlessness. These impact the ability to participate in service. Bringing someone to a church service may not be easy, but it can be done. Educate your faith family about behaviors and actions they may otherwise seem disruptive. Some suggestions:

• Explain to members that the person has a disease and cannot control the behaviors
  
• If there are multiple services the person with AD and his family may choose to attend when fewer people are present to decrease the stimulation; this should be their decision
  
• Do not talk about the person in front of him, this is demeaning
  
• Arrange for a friend to assist if an intervention is needed
  
• The family may choose to attend the part of the service that the person can still participate in, hymns, prayers, liturgies; then move to another room if the person with AD feels more comfortable doing so; provide assistance so the family member can attend the whole service at times
  
• Arrange for visits at home for Bible studies, scripture readings or prayer by the pastor, deacon or someone else from the church
  
• Read familiar scriptures; some people retain the ability to recite passages with some cueing when they have lost other verbal skills
  
• The need to "serve others" can be addressed by special projects, such as folding bulletins, stuffing envelopes or acting as a greeter
  
• Validate feelings expressed during the service and after
  
• Provide familiar symbols that the person may hold and touch, even if he can no longer name or tell you the significance of these; they invoke feeling connected
  
• Music and hymns that are familiar
  
• Offer to assist the family in some way during the service
  
• Some churches will allow a member to maintain a title or job and provide an "assistant" so that the person with AD does not lose the sense of being useful and belonging.
  
  
  

Late Stage
The person with AD becomes dependent for all care. While the person can no longer participate verbally, he can do so emotionally. Spiritual comfort can be provided in many ways:

• Continue familiar scripture readings
  
• Prayers
  
• Familiar music
  
• An object such as a Bible, New Testament or Hymnal may be held for comfort
  
• Maintaining contacts with the church family is important for the person with AD and the caregiver
  
• Offers of help will be appreciated
  
  
  

Familiar Bible Passage and Hymns to Include in Worship Services

Bible Passages
Some individuals prefer the King James Version of the Bible. This should be considered in planning worship services. If you are having one-on-one time with a person with AD, find out from the individual or the family if one is preferred. Some passages to consider:

Old Testament
Genesis 1:1-3 "In the beginning God created the heaven and the earth"
Exodus 20:2-17 The Ten Commandments
Ecclesiastes 3:1-8 "To every time there is a seasons"
Psalm 23 "The Lord is my shepherd"
Psalm 95 "O, come let us sing unto the Lord"
Psalm 118 "This is the day that the Lord hath made"

New Testament
Matthew 5:3-12 The Beatitudes
Matthew 6:9-13 The Lord's prayer
Matthew 23:36 "Thou shalt love the Lord your God"
Luke 2:1-14 The Christmas Story
Luke 22:1-20 The Last Supper
The Easter Story
John 3:16 "For god so loved the world"
1 Corinthians 13 Love chapter
Revelations 21:1-4 "And I saw a new heaven and a new earth"

There are many others passages that can be used; these are some suggestions.

Familiar Hymns
Many individuals will maintain their ability to remember hymns and sing after they have lost the ability to speak. This is because of the areas of the brain affected by the disease. Singing brings great comfort to the individual. The following are recommended and there are others that can be included.

• What a Friend We Have in Jesus
  
• Amazing Grace
  
• Brethren We Have Met to Worship
  
• Move in Our Midst
  
• Standing on the Promises
  
• Tell Me the story of Jesus
  
• Tell me the Old, Old Story
  
• It is Well with My Soul
  
• Wonderful Words of Life
  
• All Hail the Power of Jesus' Name
  
• This is my Father's World
  
• Stand Up, Stand Up for Jesus
  
• Rock of Ages
  
• God of Grace and god of Glory
  
• Love Lifted Me
  
• They'll Know We are Christians
  
• The Old Rugged Cross
  
• Just a closer Walk with thee
  
• Blessed Assurance
  
• Holy, Holy, Holy
  
• I Come to the Garden Alone
  
• Softly and Tenderly Jesus is Calling
  
• When the Roll is Called up Yonder
  
• Shall We Gather at the River
  
• Revive Us Again
  
• Jesus Loves Me
  
  

Information on how churches can support families and persons dealing with AD is available. An excellent book is My Journey into Alzheimer's Disease by Pastor Robert Davis. He tells his personal story of dealing with Alzheimer's disease. Chalmer Faw is quoted on the book jacket as recommending it as reading for anyone in a church body looking for insight into this disease. Other resources on dementia include:

Gentlecare, Moyra Jones
Alzheimer's Early Stages, Daniel Kuhn
Dementia Care Programming, Rosemary Dunne
Creating Moments of Joy, Jolene Brackey
Care That Works, Jitka Zgola
Best Friends Approach to Alzheimer's Care, Virginia Bell and David Troxel
Doing Things, Jitka Zgola
Counting on Kindness, Wendy Lustbader (while not dealing with just dementia, this is an excellent book on understanding how we help those around us)

Mayo Clinic web site
Alzheimer's Association web site



Written by Heddie Sumner