Return to childhood? Against the infantilization of people with dementia

Abstract

The idea that dementia is essentially a return to childhood and those affected must somehow be similar to children constitutes a deeply rooted and pervasive cultural trope. While such tropes may be helpful in making sense of an otherwise elusive and inscrutable state, they can at the same time promote inadequate understandings of dementia and hence also influence our attitudes and behaviour towards those affected in several problematic ways. In the present work, we provide a detailed account of the origins and implications of the idea that people with dementia are somehow similar to children. In order to spell out the normative significance of this trope and to analyse its shortcomings, we will rely on a life-course perspective. We will point out that the second-childhood trope does not do justice to the particularities of the life phases of both children and people with dementia. This lack of biographical sensitivity brings about undignified treatment of and harm to those who have previously lived more autonomous lives. In conclusion, we will argue that people with dementia should not be equated with children as they are at a different point in their lives. This critical analysis of the second-childhood trope shows the usefulness of a culturally and biographically sensitive theoretical framework for bioethical reflection. In particular, it provides reasons to reject infantilizing attitudes and behaviours and instead take seriously the personality, values and preferences shaped throughout the course of an individual's life.

How do people living with dementia perceive eating and drinking difficulties? A qualitative study

“…‘in between the present and the end’ such as commonly encountered difficulties with swallowing, recognising food, using utensils and behavioural changes [ 1 ]. Difficulties in the later stages may be over-looked at their earliest manifestations since they could give rise to feelings of being treated like a child and needing more help [ 1 , 9 , 29 , 30 ]. It is difficult for others to introduce discussions on eating and drinking problems to people with mild dementia who have limited or mixed awareness of the problems because this can result in frustration, embarrassment and shame [ 31 ].…”

“…However, at the advanced stage of dementia, these interventions require time from carers supplemented by good homecare services [ 19 , 30 ]. In line with fears of being treated like a child, notions of ‘role reversal’ of spousal and parent–child relationships may create anxiety in people with dementia and fears of being burdensome to family [ 9 , 29 , 32 ]. ANH was also deemed unacceptable by participants in this study; however, in previous studies some carers and professionals might perceive ANH was unavoidable, or want to try every available option [ 15 , 19 ].…”

A Tale of Two Capacities: Including Children and Decisionally Vulnerable Adults in Biomedical Research

“…Our comparison identifies morally relevant similarities and distinctions between decisionally vulnerable populations that can inform the design of research regulation and governance. For adults “who have previously lived more autonomous lives,” safeguards should be sensitive to life-course considerations and biographical context (Jongsma and Schweda, 2018). For children, it is important to avoid implying that normal states of development are pathological, or alternatively that mental capacity is synonymous with maturity (Jongsma and Schweda, 2018, 417).…”

“…For adults “who have previously lived more autonomous lives,” safeguards should be sensitive to life-course considerations and biographical context (Jongsma and Schweda, 2018). For children, it is important to avoid implying that normal states of development are pathological, or alternatively that mental capacity is synonymous with maturity (Jongsma and Schweda, 2018, 417). While it is tempting to think of capacity as exercised at a particular moment in time, Jeremy Waldron has convincingly argued that giving equal value to each human life requires us to consider life as a whole, across a developmental trajectory (Waldron, 2017, 233).…”

Vestibular Physical Therapy in Individuals With Cognitive Impairment: A Theoretical Framework

“…56 PT's should utilize positive social reinforcement, as this has been shown to encourage IwCI, 57 while being conscious of not infantilizing the patient. 58 It is important to establish consistent therapy routines whereby the patient works with the same therapist, at the same location, and at the same time of day. 59 Learning in IwCI is facilitated by the use of constant (versus variable) and blocked (versus random) practice schedules.…”