Student Reflections

This past school year, a group of students from Havergal College in Toronto, Canada have continued their volunteer work at a local nursing home – similar to their experience last year. During these weekly visits at Briton House, we spend time with seniors with dementia to engage them in conversation and brain-stimulating activities. While we initially began our volunteer work with the intention of helping individuals with dementia, we have actually benefited tremendously from the experience ourselves. In working with these residents, we have deepened our understanding of the disease, formed strong intergenerational friendships, and furthered our compassion, patience, and interpersonal skills.

Although some of us had never worked with seniors with dementia before, we learned to communicate and interact with a person with dementia, thanks to our amazing mentors – Professor Nathan Herrmann at Sunnybrook Health Sciences Centre and University of Toronto and the staff at Briton House.

Our time at the nursing home has been filled with many highlights, along with some challenges along the way. Each of our visits have been very memorable, whether it be the fun we had making scrapbooks with the residents, having holiday parties, or just relaxing and conversing over a cup of tea and a good book.

We have been fortunate to meet seniors who have shared life lessons and stories from their childhood with us. Each of the individuals we have interacted with are extremely unique; one of them was part of a team in the Canadian Armed Forces that decoded bombs during the war, another one was previously a physician, and another resident used to attend our school. It is through these interactions that we have discovered the beauty and brighter side to dementia, because we learn as much from these individuals as they do from us.

Below are individual reflections from some of our student volunteers. 

Carolyne You:

When I first entered Briton House, I wasn't sure what was going to happen. I've never interacted with people who have dementia and after reading multiple articles about how to do so, I was very anxious. For the next two weeks, it was the only thing I could think about. "What if I say the wrong thing? What do I do?" were constant thoughts I had. When we arrived at Briton House for our tour, I encountered this wonderful woman in the theatre. She was so delightful and full of joy; it was contagious. I thought to myself, "I hope my partner is as lively as her". Soon enough the following week, I found out who my partner was going to be for the next few months. Coincidentally enough, it was the woman I met in the theatre. My heart soared. I knew that I was going to get along with her. Over the next few visits, I got the opportunity to learn about her - what her hobbies were and even about her childhood. Every visit, I bonded with her more. Our conversations were easy going and surprisingly enough, I talked about more personal things with her than I do with my own mom. These visits every Wednesday was the highlight of my week. It felt so nice to see her because I knew that not many people come to see her. Whenever I saw her, her face would light up. I knew that just by coming to visit her, it made her day. Just knowing that it made her day is all that I needed. Every now and then, she looks lost or not there, which breaks my heart. Now I realize that for her, all I need to do is just be there.

Ariana Seyedmakki:

After learning about different diseases and how to treat patients through my extra-curricular activities and hobbies, I became interested to work with dementia patients in a residential home. I was surprised to get a good friend out of the experience; a resident at Briton House has become a great friend of mine over the past few months. We meet every week, write letters, engage in mind-stimulating games and complete art activities. Through these activities, we complement each other - I hope to comfort her and potentially ease some of her symptoms, while she uncovered in me the skill of being present and patient with someone inflicted by dementia. Thankfully, she enjoys our encounters just as much as I do and tells me that looks forward to our weekly visits. In order to be able to interact with her in the most effective way, I am in contact with Dr. Herrmann, a dementia specialist at Sunnybrook Hospital, to update him about my visits and ask questions.


Overall, it has been a privilege to work with these seniors with dementia every week. We would like to sincerely thank Professor Herrmann and the staff at Briton House for mentoring us this year. As well, we want to thank the residents for letting us into their lives and for befriending us. We are so honoured to hear how much they look forward to our visits every week, and we hope that together, we can restore some of what dementia takes away.

Research Update: Sleep and Dementia

Sleep is an extremely important health-related factor that is often overlooked. Sleep deprivation is known to increase the risk of cardiovascular disease, diabetes and causes irritability, fatigue, and more. However, the risk of developing dementia is also related to sleep. In February 2018, the Journal of the Alzheimer's Association published an article exploring the relationship between sleep and dementia. The research was conducted in the United States, and the study was conducted over a time period of 15 years.

The way that sleep was measured was through polysomnography. Polysomnography is a type of sleep test that uses a device to measure different sleep stages through brain waves, heart rate, temperature, and more. Participants were also asked to describe their sleep patterns and duration to complement the tests. The following conclusions from the study were drawn:

It was found that severe obstructive sleep apnea (OSA) increased the risk of dementia from all causes. Obstructive sleep apnea (OSA) is a condition where the airway becomes completely or partially obstructed during sleep. This condition, characterized by snoring and episodes when the person appears to stop breathing, leads to short periods where there is no air intake, thus the body does not get oxygen. The reasoning behind this may be because OSA can cause cardiovascular problems such as hypertension and atherosclerosis. Hypertension (high blood pressure), and atherosclerosis (plaque build-up in arteries) can both cause dementia by restricting the blood flow to the brain.  

Similar to OSA, sleep duration increased the risk of dementia. Specifically, sleeping less than 7 hours compared to 8-9 hours increased the risk of dementia. While the results of this study were intriguing, the authors of the study explain that more research is needed to further support the claims relating sleep duration and risk of dementia.

For more information on the study, visit: http://www.alzheimersanddementia.com/article/S1552-5260(17)32522-0/fulltext#sec2.1

Ask the Expert: How are people with dementia who have aggressive behaviours treated? Should they be restricted in confined hospital units?

Aggression in patients with Alzheimer's Disease and other dementia occurs in about 10-20% of individuals, but can be more common in the later stages of the disease and can be particularly common in patients who have required placement in a nursing home. There are many "causes" of the aggressive behaviors, including biological, psychological, and environmental causes. Some researchers have focused on "unmet needs" as a cause, while others have taken a more biological approach examining the brain changes (structural and functional, chemical, etc.) that distinguish Alzheimer's patients with aggression from those who are not aggressive.

Treatment of aggression always begins with investigations to determine if there is an obvious cause: a change in their medications, a new medical illness (e.g. infection), pain, a change in the way their caregiver is providing assistance, or a change in the environment (e.g. moving to new home, change in primary caregiver, etc.). Treatment would then start with environmental and behavioral approaches which are often helpful at reducing the behaviors. Medications used to treat aggression should only be used if these non-drug approaches are not good enough, and/or if serious aggression puts the patient, or those in the environment, at risk of imminent and serious physical harm. The reason for this is that many of the drug treatments of aggression are associated with significant side effects, including sedation, falls, stroke, and even death.

To answer the specific question - the hospital is the last place an agitated, aggressive dementia patient should be placed in. Hospitals are noisy, frenetic environments that are not designed to care for patients with dementia, can be terrifying for them, and may make their behavior worse. Avoiding a hospitalization should be a key goal of treatment, which means getting professional help with this behavior earlier, rather than later, is essential.

Professor Nathan Herrmann

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair in Geriatric Psychiatry
Head, Division of Geriatric Psychiatry

Sunnybrook Health Sciences Centre

Ask the Expert: With regards to physician-assisted suicide in Canada, can patients with dementia who are competent to make decisions choose this as an option for the future when the disease significantly worsens?

At the present time, people with dementia would not be eligible for "medical assistance in dying" (the official name for physician assisted suicide) for a number of reasons. First, the person requesting medical assistance in dying must be capable at the time the request for assistance is made, as well as the time the assistance will be administered. This would likely rule out many patients with dementia who might maintain capacity to make the decision early in the disease, but will almost certainly lose capacity as the disease progresses. Secondly, in order to be eligible, the person requesting medical assistance in dying must have a "grievous and irremediable" condition. While Alzheimer's disease and most other dementias would certainly be considered irremediable (in other words irreversible and for the most part untreatable), the term "grievous" would likely not be met. "Grievous" has been defined as "unbearable physical and mental suffering" and for most patients, since insight into their deficits and disabilities is lost early in the disease, there is neither mental, nor physical suffering in dementia.

The process of arranging for medical assistance in dying does vary from province to province, and every case may be different, so it is always worthwhile to discuss future planning with your physician. There are also many alternative care options that can help ease suffering at the end of life and might be preferable to medical assistance in dying. Finally, while the discussion above applies to the current Canadian legislation (which also requires that individuals be at least 18 years of age to request medical assistance in dying), this could change in the future depending on legislation and/or supreme court rulings.  

Professor Nathan Herrmann

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair in Geriatric Psychiatry

Head, Division of Geriatric Psychiatry
Sunnybrook Health Sciences Centre