I returned from a medical conference overseas. As I entered the living room, I could see the small walnut side table my wife emailed me about while I was away. It was placed in front of the gas fireplace, next to my favourite "relax" chair and was the perfect colour and size to fit there, waiting for a cup of coffee, a portable phone and the controller for the small stereo next to it. I marvelled at the shape and fine workmanship reflecting that even after less than one term in a College course in industrial woodworking my son Eytan, whose primary love is playing the electric guitar with his heavy metal music band, was able to do such lovely work. His taking a college course in woodworking was part of his desire to have some other skills beyond music for the future and working with wood has always been attractive to him. Three months later at the end of his second term as a gift he made two small tables for our sun room out of extraordinary Walnut with Olive Ash Burl (Figure 1).

Figure 1. Walnut with Olive Ash Burl Tables

The quality was very impressive but most important when I asked him how he did it he was able to go through all the steps with hand drawings to illustrate. Clearly for him the wood, the design and the hands-on experience were very meaningful.
Of the many reasons I was so delighted with his handiwork was the associations I had with woodworking. I attended New York's unique Brooklyn Technical High School because during my early teenage years I wanted to be an engineer like my late father. I loved building and fixing things and had ability in math and physics, therefore, it seemed a natural career path. "Tech" as the school was called by the students was a fantastic educational experience. Beyond a vigorous general curriculum we averaged an extra two hours a day of technical skills and processes which ranged from working with the various metals and wood. I recall vividly my woodworking teacher who was demonstrating how to use a chisel properly. It was from him I learned that a sharp tool is much safer than a dull one as you do not have to apply as much pressure which can lead to poor tool control. I recall how after he chiselled a piece of wood and before it was actually sanded he let us all feel the surface and said something which then would have been considered a bit risqué, "see, smooth as a baby's aaaarm", at which we all sniggered, knowing what "a" word he really meant.

I changed career plans at the end of high school and decided on medicine which was the perfect choice for me. I have however always maintained my love and respect for working with wood. When I did my military service in Israel I had access to a large "hobby shop" which had all the woodworking machines and tools I learned to use at "Tech". With ample supplies of rough wood from the crates in which new General Electric airplane engines were shipped to replace original French engines in reconfigured old French fighter planes I was able to build kitchen shelving and cabinets and furniture for our future Jerusalem apartment.

I once saw a house for sale in which the husband as part of his retirement project renovated it using hand turned and carved and stained wood wherever there was an opportunity to do so. The project according to his wife, kept him sane, healthy and active for the fifteen years since his retirement. His experiences with woodworking are echoed by many patients who have pursued "hobbies" or "pastimes" from their younger years and use them as a focus of their creativity to give meaning and passion to their post-retirement years.

There is a body of evidence and knowledge that supports the concept that working with wood can be a very meaningful activity for those living with dementia, especially if their past experience included working with wood as part of their employment life or one of their hobbies. There is often an exaggerated concern that using the tools necessary to work with wood might be potentially dangerous for those living with dementia depending on their degree of residual capability. It is known that skills from the past are often preserved even as the degree of cognitive impairment progresses. Choosing what types of tools or machines might no longer be within the realm of safety would be a prerequisite for designing woodworking programs of seniors living with dementia. An example of one such program describes the program of "Easy Woodworking for seniors with Dementia". In it is described the parameters for success, "Though long-term care residents with dementia may have short-term memory impairment, wooden craft kits are a good way to provide sensory stimulation and creative outlet without requiring a high degree of skill or even memory. From picture frame kits to wind chimes, bird feeders to Christmas ornaments, these wooden crafts can be painted and assembled in one or two sessions with the help of volunteers or even grandchildren who participate in the fun." (http://www.ehow.com/info_8508900_easy-woodworking-projects-elderly.html)

In an academic study on "Tailored Activities Program (TAP) it was determined that if the correct steps are taken to assess and implement activities according to the individual person's cognitive and physical abilities and past history of interests many activities (including woodworking) can be designed that will provide the individual with a meaningful and satisfying activity while at the same time decreasing care-giver burden and decrease the level of neuropsychiatric behavours. In their article published in the 2008 American Journal of Psychiatry "Tailored Activities to Manage Neuropsychiatric Behaviors in Persons with Dementia and Reduce Caregiver Burden: A Randomized Pilot Study" the authors, Laura N. Gitlin LN, Laraine Winter L, Janice Burke J, et al., concluded the following: "In summary, this study provides compelling evidence that a tailored approach that taps residual abilities and previous roles and habits improves life quality in dementia patients. This study identifies a process for customizing activities to abilities and training families in use of activities in daily care. Teaching caregivers activity use has added value by reducing their objective burden and enhancing skills. Given that pilot studies tend to yield large effect sizes, and that the control group did not evince benefit in all areas as the experimental group after treatment receipt, it is important to test TAP on a larger scale, validate it with diverse dyads, and examine the underlying physiological mechanisms by which symptom reduction occurs."http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803044/

Conclusion
What does the finding that woodworking, whether started in one's early years or not, can be employed to promote a sense of well-being and creativity and accomplishment in individuals living with dementia mean for those designing programs for those in need of long-term care or those attending day programs in the community? Is woodworking unique among a range of creative activities that require the use of manual dexterity, multi-tasking and a degree of problem solving or is it like other similar activities in the realm of arts and crafts. Does the challenge of creating an adequate space with the necessary tools and proper supervision required for woodworking to occur preclude most facilities or community programs for offering such activities to those inclined to take it on? It would seem that considering the potential and real benefits from woodworking as part of the spectrum of creative activities it should be part of the agenda for recreational coordinators or planners to consider when developing programs for those living with dementia.

From my own experience and from what I am observing from the reaction to woodworking in my son, wood resonates for many because of its historical associations in one's life as well as for its marvellous textures and smells. Whether it is painting, ceramics, knitting, quilting, photography or woodworking, the satisfaction of working with one's hands and brain is wonderful for the mind and the soul.

Dr. Michael Gordon is currently medical program director of Palliative Care at Baycrest, co-director of their ethics program and a professor of Medicine at the University of Toronto. He is a prolific writer with his latest book Late-Stage Dementia: Promoting Comfort, Compassion, and Care and previous two books being Moments that Matter: Cases in Ethical Eldercare followed shortly on his memoir: Brooklyn Beginnings-A Geriatrician’s Odyssey. For more information log on to www.drmichaelgordon.com

When just getting started with woodworking, it can be challenging to know where to start or find a project that is actually suitable for beginners. That's why I spent time researching, pulling together, and creating a go-to guide focused on 50 simple DIY woodworking projects that are perfect for new woodworkers: 50 Small, Simple, & Easy Beginner Woodworking Projects

Originally published in December 2012 on the Baycrest.org

A National Post story (Nov. 8) reported that New Brunswick was the latest province to move in the direction of offering patients more choices about end-of life-care, beyond the standard “do or do not resuscitate” policies.

Fast on the heels of this article was a story in The New York Times (NYT) on Nov. 24 about end-of-life care. The NYT reported that when advance care planning is done well “there is good evidence that…it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.”

What I found surprising about the National Post article was that one would think after reading it that offering dying patients more choices in their end-of-life care was a novel idea. As the NYT article pointed out, the history of so-called advance care planning dates back several decades. Canada has played a strong role historically in the development of the idea of the “living will” – a document used for the process of stating one`s wishes and values for end-of-life care, which can be expressed verbally or in writing. In Ontario it is supported legislatively through the province`s Health Care Consent Act.

The NYT story states, “Many people sign living wills that specify the care they want as death nears and powers of attorney that authorize relatives or trusted surrogates to make decisions if they become incapacitated”. As part of a nation-wide American project, Physician Orders for Life Sustaining Treatment have been created to ensure that a patient’s wishes are followed and not misplaced or too vague for family members to be sure what a comatose patient would want. According to the NYT article: “With these physician orders, the doctor, or in some states a nurse practitioner or physician assistant, leads conversations with patients, family members and surrogates to determine whether a patient with advanced illness wants aggressive life-sustaining treatment, a limited intervention or simply palliative or hospice care.”

With the shift toward giving patients more choices about their end-of-life care beyond do or do not resuscitate, we need to be careful of the real risk of developing a quick and cheap fix – that is, relying on a simple form in which people select from a menu of categories of choices for their final phase of care. This process has been shown by many in the field of ethics and end-of-life care to be too minimalist to capture the nuances and emotional complexities of expressing end-of-life wishes. Many would say the important part of the process is not a “form” that is filled out, but a robust conversation with those that you depend on to respect your values and wishes and interpret the potential treatments offered when the time comes to agree to or reject a treatment.

Pre-planning one’s future is never easy and can lead to unexpected and unwanted consequences if not done with careful thought and planning. The importance of the National Post and NYT stories is that they support the importance of having the conversation with close family members or those you might expect or appoint formally to carry out your wishes when you are no longer able to do so. This personal responsibility must be supported by public policy initiatives that promote education and training of those who ultimately will be responsible for assisting individuals and their families in tackling this challenge.

Dr. Michael Gordon is currently medical program director of Palliative Care at Baycrest, co-director of their ethics program and a professor of Medicine at the University of Toronto. He is a prolific writer with his latest book Late-Stage Dementia: Promoting Comfort, Compassion, and Care and previous two books being Moments that Matter: Cases in Ethical Eldercare followed shortly on his memoir: Brooklyn Beginnings-A Geriatrician’s Odyssey. For more information log on to www.drmichaelgordon.com