There are many different stages that a person with Alzheimer’s and Dementia will go through. It is very important to continue to provide quality of life at each stage. To do this it’s important to look at what a person can do instead of what they cannot do. In addition, look at the task that you want to provide and break it down into the simplest form so that the task may be accomplished.
In the last stages of Alzheimer’s, concentrate on the senses when providing stimulation. One other important area of activities is to remember that activities can be passive or active. A person may only observe or watch an activity. Other persons may participate in an active way.
Some activities may occur in a group situation or be done independently. For example, a person may sit quietly watching the birds outside a window. If you are going to provide group activities, you may need to offer the activities in a small group.
It is important to understand all the “participants” levels of functioning. If they can not all participate, consider adding parallel programming. While the main activity is going on, “cluster” residents who are of the same functioning level together and provide appropriate activities.
For example, you have ten residents on your unit and you will be offering a Sing Along. Four residents are unable to participate due to their functioning level. By clustering, you could place these residents at a table and provide tactile and sensory items.
The remainder of your group are able to participate in the Sing Along. It is also important to understand that activities are not just planned activities. Activities can include life skills which means participating in their daily living skills.
They are encouraged to help hold the tooth brush or wash cloth, or to choose an item of clothing. This could also include meal time activities. They could be encouraged to fold the napkins, set the table, clear the table, or wash the dishes. Also, allowing them to help with watering the plants, dusting, or folding the laundry. These are all “activities” and just as important as a game of bingo.
Activities can include all aspects of life, including social and religious activities. The two most important activities that you can provide are exercise and music. Here are some ideas for exercise and music.
You may wish to begin your day with exercise and end the day with exercise. This can be chair exercises in the morning and walking later in the day.
Walk: Take short walks if distance is a problem. Have a routine and a set time for walking. Make sure to dress your client in comfortable clothes and proper fitting shoes. Verify that shoe laces are tied. If you are not able to get outside, maybe you can utilize the hallway of the building. Exercise will aide in helping a person to sleep. A stroll in the wheelchair is great exercise, if the person is able to propel themselves.
Chair Exercises: Use props, such as streamers, maracas, batons, pom poms, canes, stretch bands, tambourines, clappers, top hats, scarves, or small hand held balls. (All can of these items can be ordered at wholesale prices through www.activitytherapy.makesparties.com). Face the person and have stimulating music playing with an easy to follow rhythm. You may wish to use music from their era, but it is acceptable to use any kind of music that elicits a positive response. Please remember their preference when selecting music. Design a routine that is repetitive and easy to follow. You may wish to start with 20 minutes and build up to 45 minutes as tolerated. Take lots of breaks. Hand held props held develop hand strength and provides a stimulating visual to follow the leader.
Music, Movement and Props are three key elements for a successful exercise program
Parachute: You may purchase a small parachute for a small group. But if you are working with a large group, you may wish to use a larger parachute. Again, use easy to follow music. Take lots of breaks and deep breathing. Please refer to our catalogue page that lists all the many catalogues for parachutes. You may wish to try S & S or Nasco. Routine and structure are very important when planning the day. Exercise and music combined will help in providing a calm and success oriented day. Routine may be boring to the care provider but not to the Alzheimer’s/Dementia Client.
We recommend that the TV be turned off and music played instead. Music may aid in calming, bring back memories and generally add to the quality of life. TV at this point in the illness offers too much stimulation and can be overwhelming. It’s too much information coming too fast for someone with Alzheimer’s and dementia to process. This may lead to agitation.
Some ideas for music: Use CD’s vs. Tapes. CD’s last longer, usually an hour. Tapes require that you are there to turn the tape over when it reaches the end. For those residents who are now bed bound, it would be very important to have a product with a longer duration.
Sing Alongs: Several catalogues have a wonderful selection of sing along music. The Eldersong catalogue has a wonderful product called Sing-A-Long with Eldersong, Volumes 1, 2 & 3. The Beautiful Music Company has a large assortment of music from the 30’s, 40’s and 50’s. They also carry current tunes. Look for short catchy tunes that are easy to follow. You may wish to take the song books and write the tunes in large letters on poster board and hold these cards up for the residents to follow. For many, the ability to read will be lost. Its not important that they use the right words, only the joy and satisfaction they get in their level of participation. They may tap their finger to the beat, shake an instrument, hum along or even sing along.
We recommend that you use instruments with the sing alongs. Use the same instrument when working with a group, otherwise, it will sound like a bunch of noise. Instruments are available at www.activitytherapy.makesparties.com at wholesale prices.
Name that Tune: Use short catchy tunes that will be easily recognized or remembered. Example: Take Me Out to the Ball Game. You can purchase a CD or you could even just hum the song. See if they can guess it. If they are unable to do this, it may not be an activity to try again. You do not want them to feel bad because they are not able to recall the song.
Relaxation Music: Good for meal times and towards the end of the day. You could play angel, classical or new age music. Try to pick pieces that have an even tempo and something soothing without words. If you use the same music everyday as part of the routine, this may signal that the day is ending and time to start getting ready for bed. We recommend that you do not use nature tapes, ocean music or stream music. For example, to someone with Alzheimer’s and dementia it may not conjure up a memory of a stream running but simply some running water that needs to be turned off.
Activities for Individuals with Early or Middle Stage Alzheimer’s Disease
The following suggestions are recommended for those in the early and middle stages of Alzheimer’s Disease. Many of these activities will spark a memory and may even lead to conversation. PRAISE, PRAISE, PRAISE FOR THEIR EFFORTS
Kitchen/Food Related Activities
Mash Potatoes: The individual may not be able to read the directions but may be able to hold the fork and whip the potatoes. They may also be able to add the premeasured ingredients as directed by you.
Make Pigs in a Blanket: Ingredients needed are Pillsbury Crescent Rolls, American Cheese Slices and Mini Hotdogs. On a baking dish, assist the individual in taking one cheese slice and placing it on a crescent roll. Add the mini hot dog. Assist the individua in rolling the dough. Repeat until you have used up the container of rolls.
Peel Apples: Use an apple peeler that attaches to your table. Attach an apple. Let the individual peel the apple.
Shuck Corn: Simple task that is easy to do and smells great.
Snap Beans: Simple task to do.Simple cake, muffins, cookies, brownies and pudding mixes
Let them be involved in their day to day routine. It does not matter if its done right, only the act itself.
Provide meaning. Let them touch activities that were a part of their past. This will provide them with a sense of self worth and add to their “Quality of Life.” You may want to drive around in the spring and summer to the many garage sales, thrift shops and rummage sales. Look for items from their past. Old girdles always spark a smile, along with old time irons and products from their past. Let them show you how the products were used. For example, old aprons, are something the generation from the 40’s, 50’s and 60’s used. But not necessarily used in the 90’s.
- Fold Laundry
- Help you in the kitchen
- Put groceries away
- Stuff Envelopes
- Wash Their Face and Hands
- Put on Make up
- Button Clothes
- Roll Yarn
- Polish Silver: Use a little cooking oil instead of polish.
- Fold Napkins
- Set the Table
- Clear the Table
- Water Plants
- Make the Bed
- Put Clothes Away
- Polish Silver
- Sort a Tray of Silverware
- Brush the Animals
- Walk the Animals
- Use a Feather Duster
- Use a Spray Bottle with Water on plants
- Dust furniture
- Make their Beds
- Organize and Clean Purses and Wallets
- Sort and Clean Jewelry Boxes
- Clean Out a Drawer
- Make No Bake Recipes: For Example: Fruit Salad, Peanut Butter on Apples/ Crackers
- Make Potpourri
- Pick Flowers and Press Into a Book
Intellectually Stimulating Activities
If you are caring for a loved on in your home, you may wish to include a medical adult day care program. If you feel your loved one may refuse to go, you might want to say that they are volunteering at the adult day care center. You as the care giver may need a break several times a week in order to get errands completed. You may also just need to take some time for yourself.Get involved with a senior center that is open to providing additional programs for your loved one.
Sing Alongs, Music Appreciation and Movement to Music: may all spark a memory.
Bingo, Animal Bingo, Food Bingo: If they can not handle the activity of picking up the bingo chips, try having them point to each thing as it is called.
Reminisce: Life Story Review. For example, we are going on a picnic, what would we bring in the picnic basket? Where would we go for the picnic? Some suggestions would be:
- A day at the beach
- A ride in the country
- 1st day at school
- Getting married
- Other Reminisce ideas might be the use of
Sensory Boxes: There is a great book out called “Wake Up” that can be ordered through Activity Products International. Please see our catalogue page, www.activitytherapy.com/catltc.htm. Develop theme sensory boxes. Fill the box with as many items as you can find that are associated with the theme. Bring the items out one at a time and describe them. Have the resident touch the items. Have something to eat or drink that is related to the theme. Have a song that ties the theme together. Have a simple craft to go with the theme. These boxes would be used to stimulate memories and begin conversations. Ideas are endless but here are some suggestions:
- Babies & items associated with babies
- A day at the beach
- Colors: Red, Blue, Green, Black, etc.
Simple Word Games, Trivia, Gestures
Social Functions: Please involve the individual as much as possible in parties, social gatherings and children’s events. We suggest planning the day. If you are taking the resident to a function off the unit. Offer encouragement while you are walking. Just the short walk to the dining room to see an entertainer can be frightening. If you are taking your loved one out of the home, have them use the restroom before you leave. Dress them comfortably and sit in an area that is not confining. Some may not be able to travel at all. They may be too confused or anxious to enjoy this.
Activities for Individuals with Middle Stage Alzheimer’s Disease
The following suggestions are recommended for those in the middle stages of Alzheimer’s Disease.
Sorting items is a great way to provide a meaningful and purposeful activity. Please make sure that all items provided cannot be easily swallowed. Let them do what comes natural. The point is to spark an interest.
- Sort by Color Dominoes: These can be purchased from Nasco Catalogues. Place an assortment of colored dominoes on a tray. Provide several containers and place one color in each box for cueing. Help them get started.
- Sort Socks: Provide several colors of socks and ask them to sort the colors for you.
- Other sorting ideas would be: buttons, cards by suit, wooden spools, large nuts and bolts, colored plastic milk jug tops, spoons by size and many other ideas.
Roll Yarn: You would be surprised but men like to do this as well. Provide yarn and start rolling it into a ball, then place this in the residents hands and they should continue on with this task. You may need to sit in front of the resident or side-by-side and do the same thing. They should begin “mirroring” you.
Play with Jewelry Boxes: Provide a box with many pieces of large jewelry. Empty the contents and have them place the items back in the box
Play with Tool Boxes: Provide a tool box with many “safe” items found in a tool box. Empty the contents and have them place items back in the box.
Look at Picture Books: Often times, the resident may no longer be able to read or may not recognize loved one pictures. Instead offer picture books. To make these, simply take a thin 3-ring binder, and on construction paper, glue pictures from magazines onto the paper. Make each book a theme. Ideas are endless but some suggestions are, cats, dogs, children, flowers, houses, trains & cows.
To keep the pages nice, you may want to insert the pages into plastic sheet protectors. If you have a resident who mentions a certain topic over and over, you may wish to develop a them book for that topic. For example, he was a farmer and speaks repeatedly about his cows, why not develop a picture book of cows and farm tools.
Cook: Many residents will still enjoy helping with the cooking. A tips or suggestion would be to have everything ready before you begin. Preparation is very important.
Activities for Individuals with End Stage Alzheimer’s Disease
At this stage, the individual has most likely lost the ability to communicate, walk, or feed themselves, and is totally dependent for all their care needs. Even at this stage quality of life is very important. Look at what they still have . . . their five senses. Senses are Vision, Hearing, Touch, Smell and Taste. Some suggestions would be:
Visual – Eyes
- Bird Feeders at the Window
- Fish Tanks or the Fake Fish Tanks
- Fiber Optic Lights and Black Lights
- Wind Chimes, Wind Socks and Pennants
- Interactive Art Works and Pictures
- Wall Clocks – even if you feel they cannot tell time
- Mobiles for Their Rooms
Tactile – Touch
- Pet Therapy (i.e. dogs, cats & rabbits to touch)
- Pat Mats
- Dolls & Stuffed Animals (comfort items)
- Afghans (comfort items)
- Activity Aprons and Activity Pillows
- Jewelry Box, with very large pieces, broaches, watches, belt buckles, etc.
- Fabric Books, Wall Paper Books & Picture Books
- Hand Massage with Scented Lotions
- Touch often: Their souls can still feel love.
- Lots of hugs
- Pray with them.
Hearing – Auditory
Music, Wind Chimes, Rain Machines, Sound Machines: It is recommended that you use CD’s vs Tapes because they last longer. We recommend that you do not use the radio or talk radio stations. It is too much stimulation and will have no benefit. Advocate that your loved one is taken to music programs if residing in nursing homes. If you feel reading to them will provide stimulation, then please try this. You may wish to use short stories that can be found in Reminisce Magazine. Please refer to the catalogues page for the phone number and information.
- Aroma Therapy, lavender recommended
- Scented Candles – unlit
- Scented Hand Lotions
- Smell of Cooking Bread and Pies
Taste – Gustatory
Please be very careful what you place in a residents mouth. If they have trouble swallowing, please consult the nurse or physician before placing and food items in their mouth.
Some suggestions for taste: Lollipops for comfort. Sometimes if a resident is crying out or screaming, a lollipop may work as a diversion.
Ice Cream & Ice Pops: Puddings and Jello. Often times, using these types of suggestions can add to the quality of life. A suggestion would be to use these tips during activities of daily living. (Bathing, Dressing, Turning, Toileting, Changing Clothes)
|1. Vacuum2. Iron
3. Bake cookies
4. Read paper
5. Invite children to visit
6. Read a letter out loud
7. Listen to music
8. Parachute game
10. Make lemonade
11. Wipe off table
12. Weed the garden
13. Make Pigs-in-a-Blanket
14. Spelling bee
15. Readers Digest
16. Fold clothes
17. Pet visit
18. Cut out cards
19. Wash silverware
20. Bake bread
21. Sort objects
22. Sing Christmas songs
23. Life Review
24. Put silver away
25. Make a Valentine’s collage
26. Sing songs
27. Take a ride
28. Make a pie
29. Read a poem
30. Dye Easter eggs
31. Sort socks
32. Take a walk
33. String fruit loops
34. String cranberries
35. Sensory Stimulation
36. Look at photos
38. Clip coupons
|39. Sort poker chip40. Count things
41. Fold towels
42. Afternoon Tea
44. Play a game
t46. Cut out paper dolls
47. Identify states and capitols
48. Make a family tree
49. Color American Flag
50. Cook hot dogs
51. Grow magic rocks
52. Water house plants
53. Reminisce – first kiss
54. Play horseshoes55. Dance
56. Sing a hymn
57. Make ice cream
58. Plant bulbs
59. Make cards
60. Sort cards by suit
61. Write a letter
62. Dress in team colors
63. Pop popcorn
64. Name the U.S. Presidents
65. Give a manicure
66. Music, Movement & Props
67. Plant a tree
68. Make a may basket
70. Finish a famous saying
71. Feed the ducks
72. Mold dough
73. Picture books
74. Put a simple puzzle together
|75. Sand wood76. Rub on hand lotion
77. Decorate place mats
78. Arrange fresh flowers in a vase
79. Remember famous people
80. Rake leaves
81. Make a fruit salad
82. Sweep the patio or room
83. Talk about famous events
84. Nursery Rhymes. You start
85. Make sandwiches
86. Dust furniture
87. Cut up paper/ Tear paper
88. Take care of bird cage/fish tank.
89. Trace/cut leaves
90. Simple trivia questions
91. Finish Bible quotes
92. Paint with string
93. Cut out pictures
94. Read/listen to a short story
95. Put coins in a jar
96. Sew sewing cards
97. Put seed in bird feeder
98. Clean out pumpkin
99. Roll yarn
100. Reminisce about vacation
101. Make a cake