Pastoral Care and Dementia: A Research Based Perspective on What Remains

Dementia is often described in terms of loss—memory, independence, communication. But research across neuroscience, psychology, and pastoral studies paints a fuller picture. While certain cognitive functions decline, many emotional and spiritual capacities remain intact far longer than previously understood.

Pastoral care, grounded in presence and spiritual support, plays a unique and evidence-informed role in affirming dignity and enhancing quality of life for both individuals and their families.

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1. What Research Tells Us About “What Remains” in Dementia

Emotional Memory Endures

Neuroscience studies show that while hippocampal damage affects verbal and episodic memory, emotional memory—stored in the amygdala and limbic system—often remains functional.

This means that individuals may not recall events or names but retain emotional responses connected to people, places, prayer, or music.

Families often observe: “She doesn’t remember the moment, but she remembers the feeling.”

The Social and Relational Self Persists

Research in cognitive psychology shows that the “relational self”—the part of a person shaped by connection and belonging—remains stable across all stages.

Even in advanced dementia, individuals often respond to familiar voices, gentle touch, warmth, and tone of voice.

Spiritual Awareness Often Remains Accessible

Studies in gerontology and pastoral theology indicate that spirituality is not only resilient but may become more pronounced as dementia progresses. Rituals, prayer rhythms, and familiar Scriptures can evoke recognition and calm even when language skills weaken.

This aligns with findings that procedural and implicit memory, which support long-learned habits, remain active longer than short-term memory.

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2. How Pastoral Care Supports Individuals Living With Dementia

Providing Presence Over Cognitive Demands

Pastoral care emphasizes presence, relational connection, and nonverbal communication—exactly the areas where research confirms individuals with dementia can still connect.

A calm, attuned presence reduces agitation, lowers anxiety, and increases feelings of safety.

Engaging Remaining Abilities

Pastoral interventions align closely with known retained abilities:

Music: Research consistently finds that musical memory is highly preserved. Hymns, prayers, and familiar melodies can reduce distress and increase engagement.

Touch: A hand held or gentle touch activates the limbic system, supporting emotional regulation.

Short prayers or blessings: Simple, predictable spiritual practices can anchor a person emotionally.

Pastoral care works with the brain’s remaining strengths, not against its losses.

Creating Meaningful Spiritual Moments

While theological understanding may fade, spiritual experience does not. Research shows that individuals may experience deep peace, comfort, or connection to God during prayer, worship, or quiet presence, even without cognitive comprehension.

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3. How Pastoral Care Supports Families and Care Partners

Helping Families Understand the Changing Brain

Families often interpret behavioral changes as intentional or personal. Research-informed pastoral care reframes this by explaining:

Which abilities have diminished

Which abilities remain

How to communicate in ways the brain can still process

This reduces caregiver stress and improves relationships.

Affirming the Personhood of Their Loved One

Studies in dementia care emphasize that when families shift from “what is lost” to “what remains,” caregiver well-being improves.

Pastoral care helps families see:

The emotional self is still present

Their loved one still experiences love, safety, and spiritual connection

Their presence still matters deeply

Providing Grief Support Throughout the Journey

Dementia includes ongoing or “ambiguous” grief. Pastoral caregivers support families by:

Creating safe spaces to process emotions

Offering spiritual grounding in moments of transition

Helping families hold both sorrow and meaning

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4. A Research-Aligned Model of Pastoral Care

Most pastoral-care frameworks for dementia emphasize:

1. Relationship-centred care – focusing on connection over cognition

2. Emotion-focused support – aligning with the brain’s preserved emotional pathways

3. Spiritual reminiscence – using long-held spiritual memories

4. Nonverbal communication – supporting presence when words fade

5. Ritual and routine – engaging procedural memory systems

6. Family support and education – strengthening the care network

These align with current evidence in dementia neuroscience, spiritual care research, and palliative-care best practices.

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Conclusion: What Research Confirms—and Pastoral Care Embodies

The progression of dementia brings undeniable challenges, but research consistently shows that the core of the person—emotionally, relationally, and spiritually—remains accessible long into the disease.

Pastoral care honours this by offering presence, compassion, and spiritual grounding that meet individuals exactly where they are.

For families, pastoral care reframes the journey: instead of seeing only decline, they begin to notice what remains—connection, emotional responsiveness, and the enduring spiritual identity of their loved one.