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Activities professionals are vital team members in nursing homes for providing holistic care for individuals with dementia. Their work is important for caring for the enduring spirit / personhood in dementia and providing quality of life. Introduction Secular western psychological theory has suffered from “hyper­ cognitivism” tying personhood to cognitive ability in a utilitarian framework [1,2]. History has shown that this has to potential to lead to horrific outcomes [3]. A counterbalancing spiritual view holds that humans have innate worth, an enduring spirit / per­ sonhood, independent of cognitive ability, and that caring for the disabled elderly is of prime importance [4,5,6,7,8] Graboys, a retired physician coping Parkinson’s disease and Lewy body de­ mentia, describes how his soul has remained intact and his ability to find meaning in life is unbroken despite suffering other losses [4]. Downey, recounting her experiences running music activities, states that from what she has observed, Alzheimer disease can’t steal the spirit [9]. Thus holistic care involves the spiritual as well as physical needs. Older adults often experience many losses [10].Those with dementia face the loss of a former place in society, independence, health, and mobility [4]. In addition dementia can be confusing for the individual experiencing it, causing agitation [11,12]. It has been asserted that spiritual memory and emotion are well preserved in dementia and that individuals with dementia respond best to holistic care that considers their spiritual and emotional needs as well as providing for their physical care [9,13]. Thus a goal for holistic care is to facilitate the older adult feelings of connection, self­worth, acceptance, and serenity [10,9]. Activities staff and other healthcare professionals can assist in creating a calmer, more peaceful, more comfortable, and person­centered environment for individuals with dementia [9,11,14, 12]. This review of the literature will look at how palliative care professionals can provide holistic care that includes spiritual needs, with a special focus on care provided by Activities professionals. Soothing Surroundings Connecting with the marvels and beauty of creation can facilitate serenity. Enjoying the outdoors can be soothing for individuals with dementia [15]. Reflecting on life, while gazing at a garden scene, can bring back memories and can be filled with spiritual significance [16]. Gardens provide a harmonious multi­sensorial experience delivering a feeling of peace and tranquility that can suggest something sacred. The “fresh air” of the outdoors and plant­derived “green odor” have been cited as stress­reducing aspects of spending time outdoors [17,18,16]. A visual tableau of water, flowers, trees, and sky can be invigorating [16]. Listening to the sounds of nature – the songs of the birds – can yield a sense of connection with the world. Activities professionals can provide outdoors Activities [19]. In climates not conducive to spending time outdoors, Activity professionals can bring aspects of the natural world indoors. Such is the case with “the Eden Alternative” model, which allows the elderly to be closer to the rhythms of the natural world [20,21]The Eden Alternative features an environment with biological diversity by advising nursing homes to incorporate potted plants and companion animals. Individuals with dementia can find purpose in life by helping to care for the plants and animals. They can also gaze at the seasonal views from their windows [21]. Joyce Simard, founder of Namaste Care for individuals with end­stage dementia, recommends incorporating aroma therapy with lavender scent in creating a soothing environment [22]. Human Connection Connection and relationships are an important need toward the end of life [10,23, 9,24]. Cognitive neuroscience tells us that the need for human connection is one of the most fundamental human drives throughout life [25]. Our brains are wired to be social [25]. This need for human connection and belonging persists in dementia[9,26, 12].The literature recounts how Activities professionals and other healthcare workers, who interact extensively with individuals with dementia, find that even individuals with advanced dementia seek connection and a sense of belonging [9,12]. The interaction between healthcare workers and patients with dementia can retain

Bioethics and the Need for Activities Programs in Holistically Caring For the Enduring Spirit / Personhood in Dementia