Adapting Activities for People with Alzheimer’s Disease

(NIH) Doing things we enjoy gives us pleasure and adds meaning to our lives. People with Alzheimer’s disease need to be active and do things they enjoy. However, don’t expect too much. It’s not easy for them to plan their days and do different tasks.

People with Alzheimer’s may have trouble deciding what to do each day, which could make them fearful and worried or quiet and withdrawn, or they may have trouble starting tasks. Remember, the person is not being lazy. He or she might need help organizing the day or doing an activity.

Activity Planning

Plan activities that the person with Alzheimer’s enjoys in your daily routine, and try to do them at a similar time each day. He or she can be a part of the activity or just watch. Here are things you can do to help the person enjoy the activity:

  • Match the activity with what the person with Alzheimer’s can do.
  • Choose activities that can be fun for everyone.
  • Help the person get started.
  • Decide if he or she can do the activity alone or needs help.
  • Watch to see if the person gets frustrated.
  • Make sure he or she feels successful and has fun.
  • Let him or her watch if that is more enjoyable.

Try These Activities

The person with Alzheimer’s disease can do different activities each day. This keeps the day interesting and fun. Here are some daily activities people with Alzheimer’s may enjoy:

  • Household chores: Wash dishes, set the table, prepare food, sweep the floor, dust, sort mail and clip coupons, sort socks and fold laundry, sort recycling materials or other things.
  • Cooking and baking: Decide what is needed to prepare the dish; measure, mix, and pour; tell someone else how to prepare a recipe; watch others prepare food.
  • Exercise: Take a walk together, watch exercise videos  or TV programs made for older people, use a stationary bike, use stretching bands, throw a soft ball or balloon back and forth, lift weights or household items such as soup cans.
  • Music and dancing: Play music, talk about the music and the singer, ask what the person with Alzheimer’s was doing when the song was popular, sing or dance to well-known songs, attend a concert or musical program.
  • Pets: Feed, groom, walk, sit and hold a pet.
  • Gardening: Take care of indoor or outdoor plants, plant flowers and vegetables, water the plants when needed, go to school events, talk about how much the plants are growing.
  • Visiting with children: Play a simple board game, read stories or books, visit family members who have small children, walk in the park or around schoolyards, go to school events, talk about fond memories from childhood.

Going Out

People in the early stages of Alzheimer’s disease may still enjoy going out to places they enjoyed in the past. For example, the person might enjoy going to a favorite restaurant, park, shopping mall, swimming pool, museum, or theater. Keep going on these outings as long as you are comfortable with them.

Plan Ahead for Outings

Here are some tips to make outings fun:

  • Plan outings for the time of day when the person with Alzheimer’s is at his or her best.
  • Keep outings from becoming too long. Take note of how tired the person gets after a certain amount of time. Bring the person home before he or she becomes overtired.
  • Use a business-size card to tell others about the person’s disease. Sharing this information with store clerks or restaurant staff can make outings more comfortable for everyone. For example, the card could say “My family member has Alzheimer’s disease. He might say or do things that are unexpected. Thank you for your understanding.”

Eating Out

Going out to eat can be a welcome change, but it can also be challenging. Planning can help. Before choosing a restaurant, think about its layout, menu, noise level, waiting times, and the helpfulness of the staff. Ask yourself:

  • Does the person with Alzheimer’s disease know the restaurant well?
  • Is it quiet or noisy most of the time?
  • Are tables easy to get to? Do you need to wait before being seated?
  • Is the service quick enough to keep the person from getting restless?
  • Does the restroom meet the person’s needs?
  • Are foods the person with Alzheimer’s likes on the menu?
  • Is the staff understanding and helpful?

Before going to the restaurant, decide if it is a good day to go. If it is, think about the best time to go. Earlier in the day may be best, so the person with Alzheimer’s is not too tired. Also, the restaurant may be less crowded, and service may be quicker. If you decide to go later, try to get the person to take a nap first.

Before you leave home, gather what you need. Helpful items may include utensils, a towel, wipes, or bathroom items.

At the Restaurant

  • Tell the waiter or waitress about any special needs, such as extra spoons, bowls, or napkins.
  • Ask for a table near the restroom and in a quiet area. Seat the person with his or her back to busy areas.
  • Help the person choose a meal, if needed. Suggest food you know the person likes. Read parts of the menu or show the person pictures of the food. Limit the number of choices.
  • Ask the server to fill glasses half full or leave the drinks for you to serve.
  • Order finger food or snacks to hold the attention of the person with Alzheimer’s.
  • Go with the person to the restroom. Go into the stall if the person needs help.

Participating in Spiritual Activities

Like you, the person with Alzheimer’s may have spiritual needs. If so, you can help the person stay part of his or her faith community. This can help the person feel connected to others and remember pleasant times. Here are some tips for helping a person with Alzheimer’s disease who has spiritual needs:

  • Involve the person in spiritual activities that he or she has known well. These might include worship, religious or other readings, sacred music, prayer, and holiday rituals.
  • Tell people in your faith community that the person has Alzheimer’s disease. Encourage them to talk with the person and show him or her that they still care.
  • Play religious or other music that is important to the person. It may bring back old memories. Even if the person with Alzheimer’s has a problem finding the right words to speak, he or she still may be able to sing songs or hymns from the past.

Traveling Overnight

Taking a person with Alzheimer’s disease on an overnight trip is a challenge. Traveling can make the person more worried and confused, so it’s important to think ahead. Here are some tips.

Plan Ahead

  • Talk with the person’s doctor about medicines to calm someone who gets upset while traveling.
  • Find someone to help you at the airport, train station, or bus station.
  • Keep important documents with you in a safe place. These include health insurance cards, passports, doctors’ names and phone numbers, a list of medicines, and a copy of the person’s medical records.
  • Pack items the person enjoys looking at or holding for comfort.
  • Travel with another family member or friend.
  • Take an extra set of clothing in a carry-on bag.

People with memory problems may wander around a place they don’t know well. In case someone with Alzheimer’s disease gets lost:

  • Make sure the person wears an ID bracelet or something else that tells others who he or she is.
  • Carry a recent photo of the person with you on the trip.

After You Arrive

  • Allow lots of time for each thing you want to do. Don’t plan too many activities.
  • Plan rest periods.
  • Follow a routine like the one you use at home. For example, try to have the person eat, rest, and go to bed at the same time he or she does at home.
  • Keep a well-lighted path to the toilet, and leave the bathroom light on at night.
  • Be prepared to cut your visit short if necessary.

Visiting Family and Friends

Spending time with family and friends is important to people with Alzheimer’s disease. They may not always remember who people are, but they often enjoy the company. Here are some tips to share with people you plan to visit:

  • Be calm and quiet. Don’t use a loud voice or talk to the person with Alzheimer’s as if he or she were a child.
  • Respect the person’s personal space, and don’t get too close.
  • Make eye contact and call the person by name to get his or her attention.
  • Remind the person who you are if he or she doesn’t seem to know you. Try not to say, “Don’t you remember?”
  • Don’t argue if the person is confused. Respond to the feelings that he or she expresses. Try to distract the person by talking about something different.
  • Remember not to take it personally if the person doesn’t recognize you, is unkind, or gets angry. He or she is acting out of confusion.
  • Have ready some kind of activity, such as a familiar book or photo album to look at. This can help if the person with Alzheimer’s is bored or confused and needs to be distracted. But be prepared to skip the activity if it is not needed.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Adapting Activities for People with Alzheimer’s

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
1-800-438-4380 (toll-free)
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Alzheimer’s Association
1-800-272-3900 (toll-free, 24/7)
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

Alzheimer’s Foundation of America
1-866-232-8484 (toll-free)
info@alzfdn.org
www.alzfdn.org

Family Caregiver Alliance
1-800-445-8106 (toll-free)
info@caregiver.org
www.caregiver.org

Citation

https://www.nia.nih.gov/health/adapting-activities-people-alzheimers-disease

Content reviewed: May 18, 2017

National Institutes of Health

 

10 Stimulating Activities for Alzheimer’s Patients

(Alzheimers.net) Dementia can cause seniors to withdraw from activities, family and friends. But maintaining those relationships and interests reduces the effects of severe cognitive impairment, leading to a better quality of life.

The most common form of dementia, Alzheimer’s disease impairs behavior, memory and thought. According to the Alzheimer’s Association, Alzheimer’s accounts for 50-80% of dementia cases. While memory loss may start out mild in early stages, the disease worsens over time. Eventually, it can restrict a person’s ability to carry on a conversation or even respond to people or surroundings.

Activities Bring Pleasure to People with Alzheimer’s

Keeping aging loved ones active in hobbies and interests that gave them pleasure in the past is important after a disease diagnosis. These stimulating activities for Alzheimer’s help:

  • Stir memories
  • Foster emotional connections with others
  • Encourage self-expression
  • Lessen the anxiety and irritability that Alzheimer’s may bring
  • Make people with Alzheimer’s feel more engaged with life

What activities best suit people with Alzheimer’s? That depends on the individual. As AARP.org describes, it is important to create meaningful activities, not just ones that fill time. Consider interests they had in the past, knowing that some activities may need to be modified for safety or practicality. Keep in mind that Alzheimer’s affects behavior and senses in addition to memory. So, activities that a person once enjoyed may become overwhelming or even frustrating now.

Suggested Activities for Seniors With Alzheimer’s

Here are 10 activities to try with your loved one. Certain activities may work better at different times of day. Understand that the person’s level of interest or involvement may decline as Alzheimer’s progresses.

  1. Sing songs or play music.
  2. Do arts and crafts, such as painting or knitting. Keep tools and patterns simple.
  3. Organize household or office items, particularly if the person used to take pleasure in organizational tasks.
  4. Clean around the house. Sweep the patio, wipe the table, fold towels or try other household tasks that help the person feel a sense of accomplishment.
  5. Tend the garden or visit a botanical garden.
  6. Read the newspaper.
  7. Look at books the person used to enjoy.
  8. Cook or bake simple recipes together.
  9. Work on puzzles.
  10. Watch family videos.

Take a Flexible, Supportive Approach

If your loved one resists an activity, take a break. You can try again later, or ask your loved one how the activity can be changed to make it more enjoyable for them.

Remember to concentrate on the process of an activity and not the results. It does not matter if you never get the puzzle

Citation

http://www.alzheimers.net/2014-03-06/stimulating-activities-for-alzheimers-patients/

By Jennifer Wegerer

Copyright © 2000-2017 A Place for Mom, Inc.

 

Alzheimer’s Disease: Tips for Staying Involved and Active

(Alzheimer’s Society, UK) As a person’s dementia develops, it is likely to have an impact on their ability to carry out certain activities. This fact sheet looks at why it is important to remain active, including maintaining everyday skills. It gives tips to carers on how the person with dementia can continue to take part in everyday tasks, and suggests pastimes that might be suitable at different stages of dementia.

Meaningful activities should be enjoyable, and may be linked to hobbies or interests that the person enjoyed before the diagnosis of dementia. Activities such as taking a walk, cooking or painting can help preserve dignity and self-esteem. Some of the most beneficial activities can be simple, everyday tasks such as setting the table for a meal or folding clothes. They can help a person with dementia feel connected to normal life and can maximize choice and control. Some activities offer an emotional connection with others.

Benefits of Keeping Active and Maintaining Everyday Skills

Keeping occupied and stimulated can improve quality of life for the person with dementia, as well as for those around them. Activities can act as an opportunity for fun and playfulness. They can also encourage independence, social inclusion, communication or expression of feelings.

Benefits to the person with dementia

  • Activities can bring enjoyment and pleasure.
  • By remaining involved and active, a person with dementia can maintain their skills and independence for longer.
  • Activities can help people to express how they are feeling and relieve the symptoms of anxiety and depression.
  • Activities can increase social interaction and reduce isolation.
  • Sharing an activity with others may promote shared interests, increased interactions and understanding.
  • An activity may help a person feel important and valued because it relates to past roles and experiences, such as raising children or helping around the home.
  • Shared activity can promote a sense of belonging.
  • Leading a physically active lifestyle can have a significant impact on well being. Exercise is beneficial for physical and mental health and can improve the quality of life for people at all stages of dementia.

Benefits to carers, family and friends

  • Taking part in activities with a person with dementia can help maintain a good relationship.
  • Activities can offer a break from the everyday caring routine.
  • Shared activities can provide mutual enjoyment and companionship, which can support the relationship between the person with dementia and their carer.
  • Activities can encourage closeness between a person with dementia and people around them and improve feelings of comfort and security.
  • Engaging a person with dementia in meaningful activities may improve behavior that challenges.

Tips: Finding Suitable Activities

It is helpful to talk to the person with dementia about what they enjoy. Take clues from them and try to find creative ways to adapt activities, focusing on what can be done. Try not to worry about getting things wrong first time; this can lead to finding the right activity. The focus of the activity should be on whether someone is enjoying it and that it has meaning for them, not the ‘result’ of the activity itself. The following suggestions may be helpful.

Conversation

Conversation is a good example of a simple activity that is meaningful and beneficial for a person with dementia. It can take place in any setting, and with most people. It can be a good way for younger family members to engage with the person with dementia. This type of activity can have a positive impact on the wellbeing of the person with dementia.

Even if the person with is having difficulties with verbal communication, non-verbal communication (eye contact, gestures and touching) can be just as meaningful. The important thing is to have a connection through the social interaction.

It is important to involve the person with dementia in the conversation, not cutting them off or talking to others as if the person is not there. Do not assume that someone cannot contribute to a conversation just because they have dementia. Time and support can help the person with dementia make themselves understood and remain involved in the conversation.

Some ideas for aiding conversation can include using different prompts for conversation such as a past job or a favorite sports team, reading a newspaper or magazine together, or using technology such as online videos of old TV shows or events.

Exercise

Exercise could include gardening, walking or swimming. Exercising together will be beneficial to the person with dementia and anyone accompanying them. Some exercises are appropriate for people with limited mobility, for example chair aerobics or a seated game of bowls.

Exercise can still be beneficial in the later stages of dementia. Exercises at this stage could include changing position from sitting to standing, walking a short distance or moving to a different chair.

Creative pastimes

Creative pastimes can be enjoyable and relaxing for the person with dementia and those supporting them. These could include knitting, woodwork, and painting or drawing. If these pastimes start to become difficult for the person with dementia, it may be possible to adapt them, for example using an easier knitting pattern. If the person with dementia previously did an activity to a high standard, they may be frustrated at not being able to maintain this standard. It may be better to introduce a similar, but completely new, activity. For example, if someone used to enjoy cooking, they may now enjoy growing herbs.

Puzzles and games

People with dementia may enjoy activities that keep their mind active such as crosswords, jigsaw puzzles, cards, board games and electronic games. If the person with dementia struggles with these, it may be possible to simplify them, for example choosing easier card games. Some people also find electronic versions of some puzzles easier to manage.

Activities at home

Activities around the home and garden are very important to people with dementia. They help people feel involved, provide a sense of normality and can help a person’s self-esteem because it shows they can still manage useful tasks. These activities can be enjoyable and can be adapted to a person’s abilities.

It may be that they can be continued with the help of a family member, or with reminders about what needs to be done. There are lots of tasks both indoors and outdoors that can provide opportunity for meaningful activity, such as washing up, dusting, or potting and watering plants. Reading aloud to a person with dementia who enjoys books and newspapers can also be a good joint activity.

People may enjoy activities that reflect past interests and hobbies, and they can be a good way of retaining skills. Examples include cooking a favorite meal or helping in the garden. The end result may not be perfect, but this is less important than the sense of achievement and involvement.

Music

Even when other abilities are severely affected, many people still enjoy activities relating to music. Musical memory is often retained when other memories are lost. There are many ways to enjoy music, including listening, singing, following the rhythm and moving to the music.

Evidence suggests that music can improve someone’s mood, behavior and well-being. Physically responding to the music (through dance or movement to rhythm) can offer a chance for exercise and non-verbal communication. Favorite songs or pieces of music can also be powerful prompts for reminiscence.

Reminiscence (including life story work and memory boxes)

People with dementia can often remember the distant past more easily than recent events. Activities focusing on reminiscence can help improve mood and well being, and promotes social inclusion and seeing the person as an individual with a unique life experience.

It is a good way of helping relatives and friends stay connected as well. here are many ways to initiate conversation and participation in reminiscence, including using photos, creating a life story book or using technology, for example watching memorable events (such as the Olympics, a royal wedding or the moon landings) on a computer or handheld device.

Reminiscence should focus on the individual and their experiences; a person’s memories will have helped shape their present identity. However, it should be noted that not everyone will enjoy reminiscing about the past. The following suggestions for reminiscence activities may be helpful:

  • Involve the person with dementia. It is their life history and talking about it together will be beneficial.
  • Tangible items are an effective way of triggering memories. These could be photos or objects with significance to the person such as a football or quilt.
  • Make up a ‘memory box’, life story book or an attractive display board that captures important elements of the person’s life. Physically handling things may trigger memories more effectively than looking at pictures.
  • A visit to a favorite place might also prompt happy memories and provide another opportunity to get out and about.
  • Dementia damages the memory, and the thinking and reasoning parts of the brain, but emotions remain intact. It is not necessarily a bad thing if the person becomes emotional, although you may uncover painful memories as well as happy ones. Make sure you acknowledge someone’s feelings and allow them to express themselves.
  • Avoid asking very specific questions that require factual responses and could put the person under pressure, for example, asking where and when a photo was taken. The main aim is to enjoy the memories rather than to make the person feel tested in any way.
  • It is important to show a genuine interest in what the person is saying and value their story.
  • Stimulating all a person’s senses is important, as is using verbal and non-verbal communication.
  • Reminiscence may uncover other unknown activities or interests that the person has previously enjoyed.

Activities in the Community

There can be many opportunities for activity and engagement in the local community for people with dementia, their families, friends and carers. These can include art galleries, places of worship, museums and pubs. If the person has links to a community group it can be helpful to maintain these, as it will increase social interaction and provide an opportunity for activity. It may help to discuss the dementia diagnosis so that people in the community are aware of how they can offer support. However, this should only be done with the permission of the person with dementia and if it is what they want.

Groups

There are many pastimes that can be undertaken in groups which may help to prevent social isolation or loneliness. They can also create a sense of togetherness and belonging, for example singing or reminiscence groups.

Celebrations

Birthdays and seasonal events can be a good focus for activity and inclusion. They can help to bring people together and reduce social isolation, while helping to focus on the individual.

Involving others

Interactions with others, especially family members and friends who can offer emotional and practical support, are very important for people with dementia. It can be helpful for people other than the main carer to spend time with the person to do something they both enjoy. There are benefits to engaging other people, such as giving the main carer a break and allowing them to recharge their batteries. It gives the person with dementia more varied interaction and more social opportunities, which can lead to improved well being.

Touchscreen technology (such as tablet computers) has real potential to enhance interactions with others. For example, a person with dementia and their carer could use YouTube to watch an old film or play music together.

Applications for video calling (eg. Skype) can help people stay in touch with family and friends who don’t live nearby. The technology can also act as a link between younger and older generations.

Meetings with other people with dementia, and their families, can be rewarding for people with dementia and their carers. They give people the chance to share how they are feeling, offer support and a chance to meet with people in a similar situation.

Activities During the Later Stages of Dementia

As a person’s dementia progresses, they will still be able to carry out some tasks that are very familiar to them, but will probably be more interested in the process of doing the activity than in the end result. Activities can be simplified so they are still manageable.

Tips for finding an activity

  • Look for activities that are stimulating but that don’t involve too many challenges or choices.
  • Dementia often affects people’s concentration so they may not be able to focus on what they are doing for very long. It may be a good idea to do activities in short bursts.
  • Dementia can affect a person’s motivation. You may have to help them get started, but try not to be disheartened if they seem uninterested in the activity. It may be worth coming back to the activity later or trying a different activity.
  • Break instructions down and try to make sure each step of the task
    is simple.
  • Try to think of activities that involve an easy, repetitive action and simple steps, such as sweeping, dusting or watering plants.
  • People with dementia can sometimes crave a sense of structure, so folding or sorting things can be simple but rewarding tasks.

Sensory stimulation

Sensory stimulation is important for people with dementia, and can improve well being and quality of life. During the later stages of dementia, people often develop increased difficulties with reasoning and language, meaning that they may be unable to process information or communicate through words. They will still have some or all of their senses. There are various things you can do to stimulate these senses:

  • Encourage the person to touch or stroke pieces of fabric, dolls or cuddly toys.
  • Try giving the person a hand massage. This can be very soothing for those who enjoy touch. Some people may enjoy using a scented oil such as lavender, although not everyone will like the feel of the oil.
  • Continue to take the time to sit and talk to the person or to read out. Being with somebody sends out a powerful message that they are valued.
  • Help the person to position themselves so that they can see a fish tank, or a window with a nice view. This may have a calming effect.
  • Make sure the person has a regular change of scenery and the stimulation of fresh air and the outdoor environment.
  • If you are visiting a person living in a care home, you can help the person to feel included and active. You might like to take a short walk with them, even if it is just down the corridor, or to bring in something of interest from outside the care home such as flowers or a seashell.

Tips for Helping with a Task or Activity

If you spend time with someone with dementia, you can support and encourage them to do whatever they can for themselves, by only offering as much help as they need. This is not always easy – it can be frustrating watching something being done slowly when you could do it quicker and easier yourself. But even if the person is struggling with a task, try to avoid the temptation to take over. If you do, they may lose confidence and withdraw from engaging in activities.

  • If you do need to offer help, try to do things with, rather than for, the person. This will help them feel more involved and show that you are not taking over or questioning their abilities.
  • Focus on what the person can do rather than what they can’t.
  • Adjust activities as necessary based on a person’s interests and abilities.
  • Their concentration may be affected and they may find it difficult to follow instructions. Try to be patient and allow plenty of time for tasks. Take breaks if necessary.
  • Offer praise, reassurance and encouragement.
  • It is the sense of belonging and involvement that is important, not necessarily the activity itself.
  • Try breaking tasks down into sections. For example, the person may find it easier to continue dressing themselves if you put the clothes out for them in the order that they need to put them on. Or you could pass the next garment to the person, holding it out ready for them to grasp at the right place. You could also encourage them to put their vest on over their head before you straighten it down for them.
  • Even if the person can’t complete a full task, carrying out one or two steps of it – particularly the final step – can give them a sense of achievement.
  • Make sure that any reminders or instructions are simple. Use short sentences, with gestures and body language to add meaning.
  • Be tactful. Try to imagine that you are the person receiving help and speak in a way that you would find helpful if you were in their position.
  • Try doing things together, such as going for a walk, folding clothes or drying dishes.
  • Try to make doing things together a part of your daily routine.
  • Non-verbal communication is very important. Try gesturing, demonstrating, or guiding an action. For example, the person may be able to brush their own hair if you hand them the brush and start by gently guiding their hand.

Tips for Helping with a Sensory Impairment

Sight loss

  • Make the most of the person’s sight – make things such as a calendar or clock bigger, bolder (use contrasting backgrounds) and brighter (use good lighting).
  • If the person with dementia needs glasses, make sure they are the correct ones and that they are clean. It may help to label them.
  • Reduce physical and visual clutter and obstacles.
  • Good communication is important – describe what is happening, for example that you have just come into the room, or what they are eating.
  • Use other senses such as scent, sound, touch and movement. This could include massage, cookery and music.

Think about using versions of daily living items that have been adapted to make them more accessible such as:

  • audio versions of some newspapers, magazines and books
  • tactile and large-print games
  • audio guides (you can create your own) if going out and about
  • kitchen utensils and equipment.

Hearing loss

  • If the person with dementia needs a hearing aid, check that it works and encourage them to use it.
  • Communication is important. Make sure that the person can see your face clearly, get the person’s attention before you start to speak and speak slightly more slowly than usual but try to keep the natural rhythms of your speech.
  • Non-verbal communication is important. Use eye contact and use objects or pictures rather than just describing items.
  • In the physical environment, try to reduce any background noise and ensure that the area is well lit.

The following suggestions might help:

  • Think about where people are sitting.
  • Keep noise levels down.
  • Provide visual information – think about using both words and pictures.
  • As with sight loss use the other senses that the person still has.

Help the person to relax

There are plenty of things you can do to help the person feel calm and secure.

  • Ensure that the person is as close as possible to the people and things that give them pleasure.
  • A relaxing atmosphere could help the person feel calm and secure. This could be through music, people or familiar belongings.
  • Try to ensure familiar surroundings and a regular routine, as this may be reassuring.
  • Physical stimulation such as a cuddle or hand-holding can help the person with dementia feel valued and reassured.
  • Try to avoid too many conflicting sounds or large numbers of people, as this can add to a person’s confusion. If the person needs to concentrate on something in particular, take them to a quiet place.
  • If the person becomes upset or embarrassed by their declining abilities, give them plenty of reassurance. If things do go wrong, be tactful and encouraging. Keeping a sense of humor and having a laugh together can often help.

Memory aids

Memory aids and other reminders can help the person to remain active and use their skills. These may be of most help in the early to moderate stages of dementia when the person is better able to understand the aid and to act upon it.

Ideas include:

  • labeling cupboards and drawers, using pictures and words – for example, a photo of a cup and jar of coffee
  • a large calendar showing the day, month and year
  • a noticeboard for messages
  • notes stuck by the front door
  • a book containing named pictures of significant people such as home carers, or listing important contacts such as the day center.

There are assistive technology aids designed to help people with memory problems. For more information, see Alzheimer’s Society factsheet 437, Assistive technology – devices to help with everyday living.

Consider seeking professional advice

Help may be available if the person with dementia finds it particularly hard to cope with certain activities, either because of the dementia or because of other conditions or disabilities. An occupational therapist (OT) can assess the difficulties and can make recommendations that will aid the person’s independence, safety and confidence when doing certain activities. This may be by adapting the task, by doing things using a different approach or by using assistive technology. You can contact an occupational therapist through:

  • social services (look in the phone book under your local council)
  • your family physician
  • your local memory service (ask your local hospital for details)
  • the College of Occupational Therapists

If the occupational therapist recommends any changes, try to make them as soon as possible, to give the person the best chance of taking in the new information. The earlier you contact an occupational therapist, the more effective their solutions will be.

See also Alzheimer’s Society factsheet 429, Equipment, adaptations and improvements to the home.

Citation

https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=115

Reviewed by: Annette Purves, Specialist Occupational Therapist, Memory Services, Huddersfield and Mr Danny Walsh, Senior Lecturer, School of Health and Social Care, University of Lincoln

This factsheet has also been reviewed by people affected by dementia. A list of sources is available on request.

All content © 2016 Alzheimer’s Society.

 

Activities for Late Stage Alzheimer’s

(Alzheimer Society of Canada) As a person’s dementia advances, she will still be able to carry out some familiar tasks, but will probably be more interested in doing the activity than in the end result. If this is the case with someone close to you, look for “magic moments” throughout the day rather than trying to carry out sustained activities. Keeping your expectations realistic and enjoying these moments may help you at a difficult time of adjusting to the many changes in the person.

Finding an Activity

  • Look for activities that are stimulating but that don’t involve too many challenges or choices. People with dementia can find it difficult to process options.
  • Many people with dementia retain their sense of humour, so look for activities that the person with dementia, and those caring for him, will find entertaining. Having a good laugh will do everyone good. This might mean discovering your own playful or silly side.
  • Dementia often affects people’s concentration, so that they can’t focus on what they are doing for very long. It may be a good idea to do activities in short bursts.
  • Dementia can affect a person’s motivation. You may have to help her get started, but try not to be disheartened if she doesn’t become interested.
  • Break instructions into small, manageable chunks, and make sure each step of the task is very simple.  Give instructions one at a time, waiting for the person to complete each step before giving the next one.
  • Try to think of activities that involve an easy, repetitive action and simple steps, such as sweeping, dusting or watering plants.

Sensory Stimulation

During the later stages of their dementia, people often develop severe difficulties with reasoning and language, but they will still have their senses, such as taste, touch and smell.

To stimulate these senses, you can try the following:

  • Encourage the person to touch or stroke pieces of fabric, dolls or cuddly toys.
  • Give the person a hand massage, using a scented oil such as lavender. This can be very soothing for those who enjoy touch, although not everyone will like the scent or feel of the oil.
  • Continue to take the time to sit and talk to the person or to read out loud. Much anecdotal evidence suggests that a person remains able to hear you talking very late into the progression of the illness.
  • Enable the person to watch fish swimming in a fish tank, mobile or a window with a nice view. This may have a calming effect.
  • Make sure the person has a regular change of scene and the stimulation of the fresh air and the outdoor environment. If you are visiting someone living in a long-term care home, you can still play a vital role in helping the person feel included and active, even if it is only to take a short walk with her down the corridor or to bring in something of interest from outside the home.

 

Activities for Early Stage Alzheimer’s

(Alzheimer Society of Canada) People with dementia retain memory for some activities, such as reading, typing or playing the piano, depending on which part of the brain has been damaged.

People in the early stages of dementia will likely continue to enjoy activities they have enjoyed before diagnosis. If you are close to someone in the early stage, be aware of the danger of taking over jobs and tasks too quickly in an attempt to minimize your own stress. For example, if she washes the dishes, accept that it might not get done to the standard that you would normally like. Recognize that she will feel she has made a useful contribution, and that’s what is important.

General Tips

  • Encourage the person to enjoy activities on his own.
  • Provide encouragement and reminders.
  • Put any equipment in a place where the person can see it and reach it easily. If you leave a potato out with a potato peeler, the person might try using it.
  • When you suggest what to do, use short sentences.
  • Set aside time in the day when you are going to focus on doing something enjoyable for both of you, away from the normal routines of the day.

Involving Others

Consider inviting other people (including paid workers, family members or volunteers) to spend time with the person to do something they both enjoy, such as going for a walk or playing a game of cards. If you are the sole caregiver, you might find it hard to hand things over and trust others, but they may bring a fresh approach that the person may enjoy in new ways. When you are a full-time caregiver, it can be hard to have the energy to always give “quality time” to the person if you are exhausted and stressed.

Activity Ideas

  • Craft activities: These might include simple craft activities, such as creating collages from magazines, or knitting. Someone who has been a skilful knitter may still be able to knit squares for a blanket.
  • Puzzles: Someone who has enjoyed doing crossword puzzles may still enjoy a puzzle book.
  • Doing things together: The person may like to play cards or board games, or do some gardening, planning meals or baking together.
  • Activities around the home: Men and women alike can enjoy helping with washing and drying dishes, setting the table or making beds. Again, the end result may not be perfect, but it can give an important sense of achievement. The person might be surprisingly interested in odd jobs, such as sorting through a drawer or a toolbox.
  • Music: Even when other abilities are severely affected, many people still enjoy singing, dancing and listening to music. Record a collection of the person’s favourite pieces of music or songs for her to listen to, or ask a friend to help you.
  • TV and radio: Many people enjoy listening to the radio or watching television. Some people with dementia, however, lose the ability to tell the difference between what is real and what is on the screen, and can become distressed. They can also become confused by too much noise. Try watching television together, and choose programs with small sections of action or humour, rather than one with an involved plot. Some people have found using headphones can help them concentrate better.
  • Communal activities: If the person has a connection with an organization within the local community, whether it is a place of worship, a coffee  shop or a club, continuing to visit this place might be very important. It may help if a family member or caregiver has some gentle discussions with other attendees to encourage them to continue to welcome the person with dementia, and to minimize any embarrassment.

Some people with dementia enjoy social situations in a way that can surprise those close to them. Others become daunted by being away from the safety of their own home and avoid going out. If the person seems reluctant to join in, don’t always take the first “no” for an answer. People will sometimes just say “no” as the safest option and will actually enjoy themselves if pushed a little to take the step out the door. But don’t force him to do something that he clearly doesn’t enjoy.

 

Alzheimer’s and Music Therapy

(Alzheimer’s Foundation of America) Music has power—especially for individuals with Alzheimer’s disease and related dementias. And it can spark compelling outcomes even in the very late stages of the disease. When used appropriately, music can shift mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function, and coordinate motor movements.

This happens because rhythmic and other well-rehearsed responses require little to no cognitive or mental processing. They are influenced by the motor center of the brain that responds directly to auditory rhythmic cues. A person’s ability to engage in music, particularly rhythm playing and singing, remains intact late into the disease process because, again, these activities do not mandate cognitive functioning for success.

Music Associations. Most people associate music with important events and a wide array of emotions. The connection can be so strong that hearing a tune long after the occurrence evokes a memory of it.

Prior experience with the piece is the greatest indicator of an individual’s likely response. A melody that is soothing for one person may remind another of the loss of a loved one and be tragically sad.

If the links with the music are unknown, it is difficult to predict an individual’s response. Therefore, observe a person’s reaction to a particular arrangement and discontinue it if it evokes distress, such as agitation, facial grimaces or increasing muscular tension.

Top Ten Picks. Selections from the individual’s young adult years—ages 18 to 25—are most likely to have the strongest responses and the most potential for engagement.

Unfamiliar music can also be beneficial because it carries no memories or emotions. This may be the best choice when developing new responses, such as physical relaxation designed to manage stress or enhance sleep.

As individuals progress into late-stage dementia, music from their childhood, such as folk songs, work well. Singing these songs in the language in which they were learned sparks the greatest involvement.

 Sound of Music. Typically, “stimulative music” activates, while “sedative music” quiets. Stimulative music, with percussive sounds and fairly quick tempos, tends to naturally promote movement, such as toe taps. Look to dance tunes of any era for examples. Slightly stimulative music can assist with activities of daily living: for example, at mealtime to rouse individuals who tend to fall asleep at the table or during bathing to facilitate movement from one room to another.

On the other hand, the characteristics of sedative music—ballads and lullabies—include unaccented beats, no syncopation, slow tempos, and little percussive sound. This is the best choice when preparing for bed or any change in routine that might cause agitation.

Responses that are opposite of those expected can occur and are likely due to a person’s specific associations with the piece or style of music.

Agitation Management. Non-verbalindividuals in late dementia often become agitated out of frustration andsensory overloadfrom the inability to process environmental stimuli. Engaging them in singing, rhythm playing, dancing, physical exercise, and other structured music activities can diffuse this behavior and redirect their attention.

For best outcomes, carefully observe an individual’s patterns in order to use music therapies just prior to the time of day when disruptive behaviors usually occur.

 Emotional Closeness. As dementia progresses, individuals typically lose the ability to share thoughts and gestures of affection with their loved ones. However, they retain their ability to move with the beat until very late in the disease process.

Ambulatory individuals can be easily directed to couple dance, which may evoke hugs, kisses or caresses; those who are no longer walking can follow cues to rhythmically swing their arms. They often allow gentle rocking or patting in beat to the music and may reciprocate with affection.

An alternative to moving or touching is singing, which is associated with safety and security from early life. Any reciprocal engagement provides an opportunity for caregivers and care receivers to connect with one another, even when the disease has deprived them of traditional forms of closeness.

 How-to of music therapy:

 Early stage—

  • Go out dancing or dance in the house.
  • Listen to music that the person liked in the past—whether swing or Sinatra or salsa. Recognize that perceptual changes can alter the way individuals with dementia hear music. If they say it sounds horrible, turn it off; it may to them.
  • Experiment with various types of concerts and venues, giving consideration to endurance and temperament.
  • Encourage an individual who played an instrument to try it again.
  • Compile a musical history of favorite recordings, which can be used to help in reminiscence and memory recall.

Early and middle stages—

  • Use song sheets or a karaokeplayer so the individual can sing along with old-time favorites.

Middle stage—

  • Play music or sing as the individual is walking to improve balance or gait.
  • Use background music to enhance mood.
  • Opt for relaxing music—a familiar, non-rhythmic song—to reduce sundowning, or behavior problems at nighttime.

Late stage—

  • Utilize the music collection of old favorites that you made earlier.
  • Do sing-alongs, with “When the Saints Go Marching In” or other tunes sung by rote in that person’s generation.
  • Play soothing music to provide a sense of comfort.
  • Exercise to music.
  • Do drumming or other rhythm-based activities.
  • Use facial expressions to communicate feelings when involved in these activities.

For more information, connect with the Alzheimer’s Foundation of America’s licensed social workers. Click here or call 866.AFA.8484. Real People. Real Care.

Citation

http://www.alzfdn.org/EducationandCare/musictherapy.html

Contributed by Alicia Ann Clair, Ph.D., MT-BC, professor and director of the Division of Music Education and Music at the University of Kansas in Lawrence. “How-to” section contributed by Concetta M. Tomaino, DA, MT-BC, vice president for music therapy and director of the Institute for Music and Neurologic Function at Beth Abraham Family of Health Services, Bronx, NY.

©Alzheimer’s Foundation of America 2014. All rights reserved.

 

Alzheimer’s Recreational Activities: Creative Storytelling

(Alzheimer’s Foundation of America) Creative storytelling is catching on as a therapeutic tool for individuals with Alzheimer’s disease—and their families. It is increasingly being used in adult day programs and other group settings.

Pleased with the results, experts say families can adapt this technique for use in their home environments as well. Storytelling sparks memories, encourages verbalization and promotes self-esteem among those with dementia, according to healthcare professionals.

“Inevitably, storytelling is about memories, but it opens the rules to include imagination and to create something new that accepts who they are and where they are in the moment. That’s a great thing for families,”

noted Anne Basting, founder of the Milwaukee-based National TimeSlips Project. Renya Larson, a TimeSlips facilitator and the associate director of the National Center for Creative Aging, Brooklyn, NY, calls TimeSlips a “potent” tool designed for individuals in the middle to late stages of Alzheimer’s disease who can no longer communicate through conventional methods.

Participants can comfortably incorporate gestures, sounds and facial expressions into the story. For individuals still in the earlier stages, Larson suggested,

“Creativity may be threatening. They want to hold on to the true stories they still have.”

However, it may be possible to adjust the program by including more reminiscence and current events.

How-to of Creative Storytelling

  • Create the right scene. Eliminate background noise, like TV and radio, and set up in a dedicated space. Prepare a sketchpad, brightly colored markers and an image. Do storytelling during the “magic hour” for higher cognitive functioning—9:30 am to 11:30 am or right after lunch. Maintain eye contact.
  • Choose pictures carefully. The more unrealistic the picture, the better. Large, colorful pictures that are odd or include animals mimicking what people do spark creativity. While you might be inclined to use family photos, they raise the possibility of right and wrong answers, and a sense of failure. Instead, try a picture that triggers something from the past, but that is not too close so that it prompts the person to focus on remembering.
  • Learn questioning techniques. The wording of the questions is even more critical than the images. Questions that elicit yes and no, or direct answers will not work. Inquiries like “Who is this?” or “What is this?” are outlawed. These create a pressure cooker for an individual with dementia, and set them up for a wrong answer. Only open-ended questions are encouraged, such as: “What should we call the person?” “Where are they going?” “What could this be?” “What is going on here?”
  • Be persistent. If the method does not click one day, try again another day. It might take a lot of cajoling to get the person to respond. Engaging other family members in storytelling can stimulate more responses from the person with dementia, bringing the process closer to a group experience.
  • Keep a stiff upper lip. The whole idea is to open up the thought process. Responses may be negative, incorrect or resurrect family baggage. Individuals often voice their contrariness or use sexual or bathroom language. Still, echo whatever is said and make that the story. Otherwise, if you frown upon their answers, they will be afraid to participate. It is important to validate comments-however shocking, and move on.
  • Integrate music. Sometimes music will prompt responses even among individuals who are no longer verbal. Bring in music by asking open-ended questions, such as, “What might she be singing?” or “What music does the character like?”
  • Go with the flow. You do not have to write the story down if you feel it will distract from enjoying the moment. Consider using a tape recorder or involving a youngster as the scribe.
  • Redefine “story.” Creative storytelling does not have to have a beginning, middle and end, nor does it have to make sense. For example, a character can have three names and words can be nonsensical. Most of all, remember this is creative storytelling. Noted Basting: “It can be scary for people to let go of literal language. But if you can follow to where the person is, you can find a whole new way to connect to your loved one.”

Note: Experts caution that creative storytelling can be more challenging one-on-one than in a group setting. Families will need to jump over some hurdles, but, with that done, this technique can be successfully adapted to the home—and can be very rewarding all-around.

For more information, connect with the Alzheimer’s Foundation of America’s licensed social workers. Click here or call 866.AFA.8484. Real People. Real Care.

Citation

http://www.alzfdn.org/EducationandCare/storytelling.html

©2015 Alzheimer’s Foundation of America. All rights reserved