For People With Dementia
To find appropriate
activities to meet individual needs of a person with dementia requires
creative thinking. As in other areas of dementia care, family caregivers
are called upon to be resourceful in seeking meaningful recreation.
for lost abilities;
- promote self
residual skills and not involve new learning;
- provide an
opportunity for enjoyment, pleasure and social contact;
- be culturally
No two people
with dementia are the same. So, each caregiver will need to draw
upon different experiences when planning activities for the person in their
care. Some basic guidelines which are known to be helpful are:
- This means
knowing the person's former life style, work history, hobbies, recreational
and social interests, travel, significant life events (eg. migration, war),
spiritual and cultural preferences, family dynamics and relationships,
and celebrations. An ongoing cognitive and functional assessment will reveal
strengths and limitations in every area of daily living--mobility, showering,
dressing, eating, seeing, hearing and communication. Humour is an important
consideration, knowing the person's favourite funny stories, comedians
and entertainers. It is also important to know a person's fears, eg. travelling
on a train through a tunnel.
should re-establish old roles.
- Make use
of habitual, overlearned tasks. Examples include buttering bread, washing
up, drying dishes, watering the garden. Utilise old skills, such as playing
the piano or pianola. Activities provide a sense of purpose through being
useful, eg. dusting, folding clothes, polishing brass or silver, clearing
the table after meals, sweeping the patio, raking leaves, emptying the
grass catcher, rubbish to the "otto" bin, hosing the car, washing
and drying vegetables for salads and bringing in the washing. Encourage
an area of responsibility no matter how small. In view of the person's
changing abilities, the carer must be prepared to adapt and to create something
of a lesser responsibility when considering realistic expectations for
the person in care.
of this include unloading the car, carrying parcels, wheeling the shopping
trolley, feeding the dog, birds, cat.
need to know what has contributed most to a person's self esteem and how
they might continue this.
this is loving and accepting them for who they are. In the area of personal
care, if the person has always been immaculately dressed, continue this.
Encourage the person her to clean their own shoes with clear boot polish,
pamper with a manicure, pedicure, hair set, after shave lotion, a preferred
perfume, favourite dress or suit. If appropriate, the person with dementia
should be encouraged to maintain fastidious care of teeth, dentures, glasses
and hearing aids.
should give relaxation and pleasure. These do not require memory, eg. a
person with dementia may enjoy an outing but not know where he/she has
been. They may respond to a rhythm but not know the tune. The person may
enjoy a spa bath but not recollect why it felt so good. It is important
that the moment is enjoyed although the experience may soon be forgotten.
must have a meaning to the person. A person with some loss of carpentry
skills, can still assemble and screw together a pre-cut project with pre-drilled
holes such as a spice rack. He needs to see a sample of the completed spice
rack first to relate the parts to the whole and touch and smell the spices
and herbs within the jars. Carers could perhaps arrange with a carpenter
or TAFE instructor to provide small projects such as plant troughs, children's
toys, stools, bread board or a gift for a relative or grandchild.
should be dignified. A person who retains bowling skills may well enjoy
playing carpet bowls or skittles. Seek out your TAFE College wood turning
instructor or students to make your own set of timber skittles.
should be simple and unhurried. Particularly at meal times, focus on one
thing at a time. Communicate one instruction at a time, eg. peel these
hard boiled eggs, shell these peas- demonstrate, praise and encourage.
Break down activities into simple, manageable steps.
may be involved as part of assembly line cooking eg. preparation of pizzas,
spread tomato paste, grate cheese, wash and dry parsley, capsicum or mushrooms.
- Prepare a
safe work area. Ensure it is uncluttered with a minimum of distractions
and noise. Good lighting without glare, individual seating preferences
and correct work height are also important. Break down the activity into
stages reinforcing what is happening and about to happen. eg. a person
who retains some card skills may play a simpler game without any new learning
must not reinforce inadequacy or increase stress. Abilities fluctuate from
day to day. Activities can be adapted and tried again another time. eg.
watering the garden. Options include allowing a fixed length of hose; replacing
a jet nozzle with a fixed gentle, fan shaped spray; watering when clothes
are not on the line; securing removable hose fittings and containing the
scope of the person watering by offering a watering can, in place of the
should be done at a time to suit the person's best level of functioning.
Examples of this are walking in the morning or the quiet time of early
afternoon. If possible, they should be structured to the same time frame
each day. Routine is security and is more reassuring than variety.
find that short walks become part of the routine many times a day. Some
benefits include a reduced level of stress and agitation, and improved
sleep. The best time for walking may be when his/her behavioural need is
greatest. eg. sundowning, or when the day seems long and meaningless.
should not overstimulate. Be selective with outings. Avoid crowds, constant
movement and noise ie. shopping centres at peak times, sports arenas and
popular times at clubs, which can cause withdrawal. A ferry ride can be
calming. An outing to the library can be quiet and meaningful. There can
be quiet times at church for prayer during the week or arrange for a minister,
priest or rabbi to visit the home at a regular time.
family and friends allow sociability, flexibility, in a setting suited
to the needs of a person with dementia, provided there is the same amount
of comfort outside as inside.
should allow an emotional outlet. Music, including the use of percussion
instruments, or contact with babies, children and animals provides positive
feelings of joy, tenderness and laughter.
should include sensory experiences. These require little interpretation
to be fully appreciated, eg. hand, neck and foot massage, brushing hair,
smelling fresh flowers or pot pourri pillows, using essential oils and
fragrances, the aroma of freshly cooked apples, stroking an animal, the
aroma of bees wax or floor polish. Visit a herb farm, a flower show, or
stores like the Body Shop for ideas.
- A sense of
movement and rhythm is retained longer than most other abilities. Try having
the person sit in a rocking chair or hammock low to the ground with sand
underneath. Hire an exercise bike or a walking machine for rainy days.
Be a spectators or participants at a ballroom dancing class or walk the
reminiscence. Capitalise on remote memory. Visit a museum. Recollect with
coloured slides. For some, a good stationary image is more easily interpreted
than a reminiscence video or TV "classic" because the movement
and messages of these may be too fast moving to be processed. Old newspaper
cuttings, diaries, letters of recognition or significant relationships
and experiences, photo albums can be comforting when prompting remote memory.
If reading skills have deteriorated, make individual audio tapes enabling
a response to a calm, familiar carer's voice. Record from a favourite novel
or prayer book, poem or music. Many benefit from a walkman and individual
is related to former life style. As this varies from one person to another,
it is suggested that carers write out an activities care plan, if respite
care will be provided by different carers. This will enable consistency
of approach and care with ideas for recreation suited to the needs of the
person with dementia. Recreation may include an adapted version of a game
of cards, seeking answers together for crosswords, residual craft skills,
collage, outings to the zoo, walking barefoot along the beach, visiting
an art exhibition or taking a train trip.
play a significant part in the prevention and intervention of challenging
behaviours. Know what can be effective in calming or diverting, particularly
at "sundowning". Again this is very helpful information for a
respite caregiver. Sometimes it can be something very simple, eg. holding
onto or stroking a fur fabric pillow, a net bag with marbles or coins,
guidelines are based on abilities characteristically retained. Only the
caregiver, through trial and error, can be specific in offering appropriate
activities. The caregiver has an intimate knowledge of their person with
dementia and what are realistic expectations for that person and an appreciation
of his/her individuality.
was written by Elizabeth Wright, former Coordinator of the Association's
Family Visiting Area.
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