For the person affected by Alzheimer's disease, the day is often filled with failures, mistakes and obstacles. These occur as a result of a reduced capacity in many areas, brought about by changes in the brain. During the early stages of the disease especially, the inability to remember and communicate things is a terrible source of frustration and stress. Without adequate memory and a capacity to know and interpret everyday happenings, the world for the victim becomes a frightening and threatening place to be. As the disease advances, the opportunity for success and a feeling of self-worth is further limited. Failure becomes an all-too-familiar experience; even in little things, the Alzheimer's patient fails repeatedly. And every caregiver knows the frustration and helplessness that ensue.

The aim of this document is to offer simple activities which help reinforce the patient's self-esteem while relieving boredom and frustration at the same time. This, for the caregiver, involves being alert to the preserved abilities of the patient, and helping her develop and use the skills she still has. The more involved Alzheimer's patients remain with the world around them, the more resourceful they become at finding ways to keep that world from slipping away.

The activities described here may be used by who come in contact with the Alzheimer's patient: the family caregiver, the companion, the nurse's aide or the occasional visitor. They are described as failure- free activities because they are adapted to suit the needs and capacity of the person with memory loss, and are to be used in a way that will enable the person to succeed.

Used appropriately, activities provide moment-to-moment satisfaction and raise self -esteem. They help nurture the person by removing focus from the disability onto preserved abilities. By allowing the patient to have a meaningful role, be it washing the dishes, dusting, or singing along to old tunes on the radio, the patient's self-confidence is built up.

Caregivers can help slow the consequences of the disease by allowing the patient perform a her fullest potential. This involves recognizing whatever skills and interests are retained and helping the patient to capitalize on these. The emphasis is on assets rather than deficits, and the patient is helped to use the abilities which remain. Chores and simple activities can be sensitively set at a level which does not place the person in a position of failure.

Which activities work best?

Only time and experience will show which of the activities described in this book are the most suitable for your relative. Since there is very little evidence to suggest which activities work best, a trial-and-error approach, with adjustments based on observations, is essential.

The findings of one survey, however, may be worth keeping in mind as you set about planning activities at home. Nancy Mace surveyed 346 day-care centers nationwide and reported that the most successful activities with victims of memory loss were those which:

ò Take advantage of old skills

ò Offer social interaction (sing-alongs, pets, visits from children.)

ò Allow considerable physical activity (physical exercise, active games, walks and outings)

ò Support cognitive functions (reality orientation, reminiscence, and listening to music. In the survey, the following specific activities were identified as being most successful (those which participants seemed to enjoy most):

ò Sing-alongs

ò Active games

ò Physical exercise

ò Outings

ò Walks

ò Listening to music

ò Reminiscence

ò Reality orientation

ò Visits from children

ò Visits from pets

The centers surveyed reported that the above activities were more successful than quiet games (e.g. bingo), and activities that require fine motor and language skills (e.g. crafts and current events discussions).

Features of Activities

The choice of activities is extremely important. Most A.D. patients are aware of their memory loss and failing in a simple activity will only add to their frustration. The following guidelines then should help family members in their use of the activities described in this book:

ò Simplicity The activities in this book are short, simple and have few verbal instructions. When using them bear in mind that their simplicity is the key to their success. Keep them simple!

ò Duration Because the person with A D. has a reduced attention span, the optimum time for any activity is from twenty to thirty minutes.

ò Distraction If the patient becomes frustrated or upset, discontinue or switch to another activity.

ò Flexibility Be creative and flexible in your approach. If one activity doesn't work, try another tactic.

ò Level of activities: Keep on an adult level for as long as of possible, but bear in mind that as the disease progresses, childrens' picture books and games may be useful.