Happiness and Dementia

Happiness and dementia. Rarely do you see these two words used in the same sentence, let alone in a title. Dementia is a devastating disease that can produce terror at diagnosis, anguish in managing the disease, despair in the final stages and death might provide little respite for the caregiver. So where is the happiness in this vortex of human tragedy?

The work of Heather Urry of Tufts University and James Gross of Stanford University have examined why older adults report feeling happier than younger cohorts. It seems like a paradox,  although older adults are more likely to be physically weaker and socially less mobile than their younger cohorts, yet they report feeling happier.

What we are beginning to understand is that older adults are more adapt at regulating their emotions. Older adults are more sensitized to interpreting happy moments in a situation, while they are less concerned with negative events--they see these as fleeting events. The older we get the more that we seem to regulate our emotions. This ability to manage emotions is further supported by research that shows that older people are better at predicting how a certain situation will make them feel. They manage their environment and how they respond to it.

In psychology this management strategy is known as SOC--Selective Optimization with Compensation theory. Older adults learn to deal with a changing environment. The way we do this is by selecting our environment more carefully. We then optimize what we are good at and for those few failures we compensate by using other skills and attributes.

The older we become the more that we use SOC in our emotions. We become more careful in selecting situations that make us feel good--Selection. We also see the good in situations more and if there are negative events we tend to diminish their permanence--Optimization. If we have very little control over these two factors--as is the case with people suffering from dementia who have lost their independence--then we compensate by comparing ourselves to others in the same situation--Compensation. This final process is reflected in the seemingly morbid interest some older adults have with newspaper obituaries. You are always better off than someone who is dead.

Older adults with dementia seem to follow these strategies as well, especially compensation. Despite what we would expect, older adults with dementia do not focus on the disease when talking about their happiness. What we have learned with other groups as well is that how healthy we feel is very different from how healthy our doctors tell us we are.

In all studies where people with mild cognitive impairment or early dementia participated in some form of prescribed mental exercises, half of the participants report some improvement in behavior and thinking.  But whether you improve or not, nearly all participants reported feeling better after the exercises. Becoming engaged in activity improves how you feel about yourself.

In contrast, such improvements in wellbeing have not been shown in studies looking at medication alone. Medication does not bring about happiness. It is the social interaction that improves how we feel, whether we have dementia or not. Some people with dementia suffer from mood and personality changes, but their experience of happiness remains firmly grounded in their social relationships.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com