Activity key to a Dementia sufferer’s well-being

January 10, 2011

MINNEAPOLIS, MN, January 10, 2011/ Troy Media/ – “That’s enough of this” Mary Ann tells me. MaryAnn, one of my occupational therapy clients, is working on one of the 100 piece jigsaw puzzles that she has enjoyed doing for many years.

But it isn’t her words so much as her expressions and demeanour that lets me know that she is frustrated that she can no longer do the puzzle, due to the effects of her dementia. She would rather just sit quietly in a chair than submit herself to activities that blatantly show how confused she is.

Inactivity for persons with dementia

Dementia, which impacts a person’s ability to engage in occupation or everyday activities due to the symptoms, which include memory loss, difficulty planning, and decreased initiative, threatens their well-being and personhood. They need to rely on others to create periods of engagement. Dr. Richard Taylor, a psychologist diagnosed with dementia and author of Alzheimer’s from the Inside Out says persons with dementia “cannot by themselves redefine a new sense of purpose for themselves.  . . . They will need others to find/create activities of daily living that lead them to a sense of self-fulfillment or their sense of purpose. . . .Persons withdraw prematurely because it is easier, safer, and they don’t know what else to do.”

Studies have shown nursing home residents with dementia spend 70 to 80 per cent of their time with nothing to do. “I’m dying of boredom” was the statement made by a gentleman living in an Alzheimer’s care unit to Wendy Wood of Colorado State University Head of Department of Occupational Therapy.

According to research conducted by Wood and published in the American Journal of Occupational Therapy in May 2009, the remaining cognitive, social, and emotional capabilities of persons with dementia living in Alzheimer’s units were rarely tapped into, promoting “excess disability” or disability beyond what is directly attributable to the disease itself. This could lead to a more rapid decline.

Activity-centered care

Because concerns about the use of certain medications to manage behaviours in persons with dementia are being raised, new approaches – such as music, dancing, art, and storytelling – are being tested and have been found to be effective in the care for persons with dementia.

The common element in all of them is engagement – or doing. Even routine tasks are beneficial for persons with dementia. Having the person help with dressing, setting the table, getting the mail, or answering the door are all tasks that can be assigned, as long as directions are also given. Targeted care incorporating daily engagement is key and has many benefits.

Among them, according to numerous research studies, include cognitive stimulation, improved sleep, better social connections, reduced anxiety, and increased quality of life and self-identity. In addition, activity engagement decreases caregiver burden and may help to manage behaviours without medications.

How to engage persons with dementia

Engaging the person with dementia in activity may be a challenge for the caregiver, who might be a family member, home health aide or other facility staff. The caregiver may not know how to go about it or may have limited time to do so.

From my knowledge and experience, I can offer three key elements you need to engage persons with dementia. Remember the “3 R’s” of education – Reading, ‘Riting, and ‘Rithmetic? Let’s replace those with these 3 R’s – Routine, Reduce, and Reassurance.

Routine

Persons with dementia do best with routine. To help bring some order to a confusing world of forgetfulness and disorientation, the person needs the same activities done in a typical order and at the same time each day. What works best for you may not be what works best for him or her. Usually, going with their flow will make the day easier for both of you.

Think of incorporating different types of activities into each day – for instance, self-cares, such as dressing or bathing. Even if the person needs help, let him do the few steps that he can, like wash their face after you get them started with the motion. Other types of activities include something social, such as eating breakfast together; something physical, such as taking a walk; and something sensory, such as smelling the garden flowers or listening to music. Consider the person’s past interests and roles when choosing activities, as these are familiar and distinctive to the person.

Reduce

Persons with dementia have short-circuits in the way their brain works. They need things to be reduced, so that they can work their way around the short-circuits, such as a reduction in the number of steps of the task, a reduction in the directions given for the task, and reduction in the level of abstractness of the task. The level of reductions that need to be made will vary, depending on the extent of the deficits, or short-circuits, the person has.

Examples of how to reduce include using multiple choice instead of open-ended questions, playing a game with only matching involved, and using short, simple directives when guiding the next step.

Reassurance

Persons with dementia may at times be reluctant to participate when you ask them. This may be due to a simple fear of failure. A more reassuring way to ask them to do something is to ask for their help. This often is more successful.

Offer reassurance throughout, and after, the activity “You are doing great! Thanks for your help!” gives the person pride in that moment, a feeling that can last long after the activity is done. This was shown true in an April 2010 University of Iowa study that showed that even though the activity or joke might be forgotten, the emotions that were elicited were retained.

As any good occupational therapist would do, I did not leave MaryAnn to sit in her chair, unengaged. I modified the activity to meet her needs. MaryAnn could do puzzles with less pieces and less detail in the picture. MindStart-Activities for Persons with Memory Loss offers some good options. She once again was able to do what makes her who she is and use the abilities she still has.

Monica Heltemes, OTR/L, is a practicing occupational therapist and owner of MindStartâ„¢. MindStart designs and produces activity products specifically for persons with memory loss. They can be used in private homes, nursing homes, memory care units, and adult daycare programs. These adapted activities include User Guides and can be used by staff, family members, friends, and volunteers to help keep persons with dementia engaged. Monica can be contacted at info@mind-start.com.

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