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Along the Journey  |  

Dementia and Its Theological Challenges: A Guthrie Scholars Reflection

I spent a very contented and fulfilling week at Columbia in May as a Guthrie Scholar.

I was particularly struck by how my area of study offered significant challenges to the practices and patterns of the Presbyterianism to which I adhere.

I hail from Scotland, often described as ‘the cradle of Presbyterianism’ and ‘the land of the book.’

Greater informality in wider society and positive ecumenical encounters have brought a certain level of change.

However, a strong focus remains on preaching the word or sermon as the high point of worship.

There is still a certain reluctance in respect of active congregational participation beyond singing which minimizes the sharing in the liturgy.

Visible faith symbols are limited in what remain unadorned sanctuaries, and there are parts of Scotland where communion is observed very infrequently.


As I sought to reflect on what might sustain the faith journey of those with dementia, I increasingly found that my tradition fell short in enabling those with memory loss to retain their intimacy with God.

I’ve observed Presbyterian worship services can be somewhat wordy and possibly more intense than that offered by many other traditions.

These components are often challenging for congregants with cognitive impairments such as dementia.

Kenneth Carder, a retired United Methodist bishop who has cared devotedly for his wife with dementia and now ministers as a chaplain in the nursing home where she resides, has thought carefully about pastoral care and worship leadership.

He leads short, simple but engaging worship services in his wife’s care facility and has concluded that “dementia challenges a theology that locates God exclusively or primarily in the confines of human intellect.”


One thing the mind tends to recall as dementia takes hold is the familiar and oft-repeated words of childhood and younger life.

Presbyterian practice includes the Lord’s prayer and possibly ‘the Grace,’ but other elements of faith that seem ingrained in mind, such as creeds and liturgies, are less part of our worship practice.

I was moved to hear recently that a friend’s elderly parent, who can barely manage a sentence or two with his wife, could freely repeat large elements of the Book of Common Prayer during a recent communion service led by his Anglican priest.


While verbal communication remains an element in dementia-friendly worship, it seems that the sharing of a story is far more effective than the delivery of a sermon.

Jesus, of course, was a great teller of relatable and accessible stories.

Stories can be told in many creative ways.

However, visual and interactive Godly Play works well in care home settings like primary schools.

The use of wooden characters and elements such as water and sand bring alive the biblical record and seems to allow some people with dementia to recall the core faith events such as creation or nativity.


Some reformed churches may have lingering suspicion of visual symbols, but my studies suggest that those with cognitive decline retain (at least to some degree) a sensory perception that makes this stimulus important.

We may have historically shunned these things;  holding a cross to feel a tangible grip on God’s love, using a candle to bring reassurance of God’s light and holding a prayer shawl for comfort and help with fidgety hands.

Yet influencers such as Tillich wrote extensively about how symbols can draw us closer to God.

An infrequent celebration of the Lord’s supper might deprive a person with dementia of participation in the act of tasting and seeing that the Lord is good.


In addition to GodlyPlay and interaction, song and praise are also key to incorporating those with dementia in worship. Strong evidence suggests the declining brain retains an appreciation of music and the uplifting or calming effects can have on memory loss.

People with cognitive impairment tend to live more in the heart than the brain, so the vibrant sharing of familiar hymns and even some form of body action can help sustain their bond with a loving God.

There is much that I will always treasure about my faith tradition but this time of study has certainly encouraged an openness to draw on what works in other traditions too.


Interested in applying for an opportunity of independent study? Click HERE.

David Pitkeathly

2022 Guthrie Scholar Participant

Along the Journey