A Common Challenge
The tragedy of dementia is common and will become more so in the future. It is estimated that over 30% of the average church congregation will die with some form of dementia. That represents an enormous challenge in pastoral ministry. I would suggest that one of the metrics by which a pastor’s ministry can be assessed is how well the saints are prepared to face this test in a way that glorifies God.
To meet this challenge it is necessary for a pastor to first learn as much as possible about dementia. It is also essential to recognize that dementia is not a tragedy outside of God’s control. God does not waste his time and has purposes in dementia that we need to recognize. His purpose may be in the life of the victim. I recall a friend named Bob, who was too fiercely independent to recognize his need for a savior, turn to Christ as he saw his own abilities begin to decline. God’s purpose may be in the life of the caregiver whose ability to trust is increased when faced with the near impossible task of being responsible for someone with dementia. Finally, God’s purpose may be in the life of the church community, struggling with what personhood means in the context of dementia and how to love someone unable to reciprocate. It is estimated that over 30% of the average church congregation will die with some form of dementia.
A pastor must proactively equip his flock with a biblical understanding of God’s sovereignty over the difficulties of life. Christians must have a large enough view of God that they can trust him even when life does not reward them as they might choose.
When faced with dementia, will they respond in trust and, through dependence, draw closer to God? Or will they respond to God by saying, “If this is how you treat me, I will no longer believe you are good and powerful?”
In addition, the saints must understand what it means to be made in the image of God. It is not a description of our intelligence or capacities. It is true of all human beings and is both the design by which we were made and the eventual destiny of all God’s people. The image of God was not lost in the fall and imparts to all humans, including those with dementia, a dignity that deserves our full respect.
A faithful shepherd will also need to be reactive when dementia strikes in the congregation. Early in the course of the disease, accommodation may be necessary for those with dementia to attend services and opportunities to serve will need to be creatively provided. The congregation must be mobilized to provide practical support for the patient and caregivers.
Later in the course of the disease—when the victim, and possibly caregiver, cannot attend services—the pastor must make sure that help is provided in the home. It will become increasingly important for the caregiver to get out for worship and fellowship. Trained volunteers will need to provide necessary care for the patient to allow for that. Pastoral care will also be required in the home, allowing for spiritual encouragement for both the caregiver and the one with dementia. It will also allow the church leader to observe how things are going practically and provide appropriate assistance and counsel.
Leading the saints to experience how God can be glorified in the face of dementia may challenge you as a pastor, but it can be a wonderful opportunity to serve “one of the least of these.”
John Dunlop (MD, Johns Hopkins University) serves as an adjunct professor at Trinity International University and practices geriatrics in New Haven, Connecticut, where he is affiliated with Yale School of Medicine. Dunlop is the author of Finishing Well to the Glory of God: Strategies from a Christian Physician and Wellness for the Glory of God: Living Well After 40 with Joy and Contentment in All of Life.