It is best to start each session in a low-key manner, with the introduction of more physical activities for the middle of the session, the a gradual return to less demanding activities as the session grows to a close.

You can begin by welcoming everyone with coffee or tea and perhaps cookies, which will give the appearance it is more "party-like". During this time, staff and participants can sit around a large table with magazines, photo albums, simple puzzles etc. There is general conversation as staff members and volunteers greet participants individually.

Many people with Alzheimer's are unaware of the date and hour, and may not express much concern about information, so participants can be cued by means of a large wall calendar, a listing of the day's activities and prominently displayed important dates. Date and time reminders can also be communicated by discussions with participants concerning the weather and changing seasons, or mention of upcoming holidays, weekends, and activities.

Staff and volunteers, often with advice from caregivers, should determine which activities participants respond to with the most enthusiasm and then make these a regular part of the schedule. This schedule should be modified from time to time so the participants can enjoy a variety of programs. Allow for large and small group interaction and keep sessions flexible enough so that participants can engage in them at their own level of functioning. Most of all, keep interaction stress free. All activities should promote feelings of good will, self worth and independence.

After the inital welcoming period, you can move into more group-orientated experiences. Stress-free activities that allow participants to interact without feeling any pressures to perform are best. There are song sheets available that feature "oldies", ethnic tunes and hymns, and participants seem remarkably adept to recalling melodies, and volunteers invariably enjoy eliciting responses from the group. Song sheets photocopied and handed out will help all participants recall familiar melodies. Popular standards such as "You are my Sunshine", "Let me call you Sweetheart" and others of that era evoke warm memories of bygone days and will be a comfort to many participants.

If a staff member or volunteer plays a musical instrument such as piano or guitar, let that person lead the music session. Staff and participants can enhance the fun by providing background rhythm with tambourines, maracas, or small drums. Encourage whistling when the words of a song are difficult to verbalize or remember.

Even if some of the participants cannot fully participate in all activities and must rely on the assistance of a staff member, they will have a sense of being part of the group.

Exercise is a welcome addition to the daily routine, providing both mental and physical stimulation for all involved. Gentle calisthenics will get one's blood moving and one's organs toned, though you may have to work hard to keep participants attention focused on the job at hand.

One way of doing this is to accompany exercise sessions with music. Marches, waltzes, and polkas are all effective in this regard, serving both as nostalgic sounds from the past and as rousing music for the moment. When the same music is played consistently every day, moreover, these tunes can be used to cue participants to exercise time and ease them through the transition from one activities to the next.

Gather everyone in a circle and lead them in a non-strenuous round of toe touches, arm rotations, stretching arms and legs, shrugging shoulders, rotating head and neck, extending arms up over the head and to the side. Encourage deep breathing and full range of motion movements. Participants should be encouraged to assist those who cannot recall certain exercises or who need help in coordinating movements. Some mutual support will promote group cohesiveness. Allow members of the group to suggest their own exercises too. If some participants are confined to a wheelchair, try playing catch with two or three balloons instead of balls, while staff and participants are seated at a table.

Dancing can be a good choice too. Aside from being an effective form of exercise and a lot of fun, dancing encourages social exchange among participants along with much needed physical contact. Staff can join in by dancing with participants and by encouraging them to dance with each other. The entire group can dance in a circle and take turns trying simple dance steps. Dances which we associate with weddings and parties, are perfectly appropriate in these settings.

Familiar games such as bowling, golf, ring toss, and horseshoes are easily adapted to the program setting. Indoor versions are available at department and toy stores and generally constructed of safe substances such as plastic or rubber. You can divide praticipants into two groups and let the first group play while the others watch and serve as "rooters", then switch so that all participants gets a turn. Even participants who are functioning at a fairly limited level will try these games and enjoy them.

It is a good idea to follow this series of physical activities by serving juice. Then, if time allows, you can go back to the large table, where checkers, dominoes, safety scissors, paper and drawing implements are laid out. These relaxing activities allow staff members to engage in conversations with participants on a one-to one basis. You can also conduct a reminiscence session or also schedule celebrations, such as birthday or holiday parties, in this part of the session.

This can also be a good time to go for a walk and for other quiet activities. The structure of this program depends on the number of hours your session will run and what time of day it is held.

Here are some suggestions for other activities:

Penny pitch can be especially popular as a group activity. Each player is given 10 pennies and encouraged to throw the coins onto a large cardboard decorated as a target. When the coin makes it into the target the group cheers and small prizes are awarded.

Balloon toss is a simple activity that can quickly turn into a spirited "volleyball" game with participants tapping the brightly colored "balls" across the table from one side to the other.

Paper and pencil games are fun for participants who still remember simple children's games like Connect the dots, Squares, coloring, or Tic Tach Toe, although you must be careful not to infantilize or offer activities they feel are condescending to them.

Puzzles that are interesting and colorful. They keep participants quietly and independently involved for short periods of time. Be sure to have a variety of puzzles available for people with different levels of ability and avoid puzzles with figures.

People with Alzheimer's may not be capable of engaging in rigorous life-review sessions or extended explorations of their background. However, you can develop activities that invite them to share brief glimpses of their upbringing or cultural heritage. Through the display of maps, vintage photographs or holiday scenes, a participants memory may be jogged, and she or he may be inspired to recreate a compelling childhood memory. This activity works best at casual moments of the day, perhaps during a morning break or at lunch time. While staff members or volunteers are leading these sessions, they can bring up "windows-of-reminiscence": phrases that relate to the past and which trigger topics for conversation. Typical examples include phrases like "the family car", "life during the depression", and "a baseball game". Holidays are always a good topic to trigger memories.

Current events discussions can also be held, but it is best to frame these in relation to the past. Participants may be reminded of an upcoming election day and encouraged to recall elected officials they remember or to reminisce about the first time they voted. News items such as labor strikes, tax rates. school crises, or a debate over new neighborhood services can evoke discussions about how things have changed, or possibly about how things have stayed the same.

Objects also trigger memories. Items such as cinnamon sticks, and pinecones have fragrant and tactile qualities that will appeal to the hands, nose and eyes. Such objects evoke memories of home cooking, whisks in the forest and childhood parties and may lead to spontaneous discussions among the group.

You can also try poetry writing. To do this, staff members suggest a subject and encourage participants to mention phrases or words about a subject. These poems are written on a blackboard or large piece of paper in front of the room and become a kind of record of the thoughts and feelings expressed by the group. They may be recorded and given to family members when they arrive for a visit. Cooking is an activity that is enjoyed by participants and volunteers alike, as the group handles ingredients that are appealing to the senses and are safe, and the end product can be shared.

Cooking activities can include making soups, cookies, and cakes, as well as preparing things that don't need to be baked, such salads and instant puddings. To keep the cost down, the staff might consider asking family members to contribute ingredients as well as their time for these projects.

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