Adele Cosgrove-Bray is a writer, poet and artist who lives on the Wirral Peninsula in England.
Activities are Important for People Living with Dementia
I have worked as an Activity Co-ordinator in nursing and care homes since 2010 and have gained many relevant professional qualifications along the way, including two different NVQ Level 3 qualifications based on my work. I genuinely enjoy my job, and have developed lively, purposeful and diverse activities for people who have various forms of dementia, from the early stages through to advanced conditions, and into palliative care.
With this article I aim to share ideas for activities with others who are perhaps new to a career as an Activity Co-ordinator, or who work in other roles within the care sector, or who are supporting a loved one in the family home.
A Diverse Job
An Activity Co-ordinator's job is complex and diverse. It is a job which is far more demanding and mentally taxing than is often assumed to be. You need to be a great communicator and be able to encourage and inspire a entirely diverse range of people whose self-confidence may have taken a hammering.
You need the practical organisational skills of an office administrator; be able to handle a tight budget and run fund-raising events; make events bookings; be a party planner; have a sense of humour, a thick skin and endless patience. You have to have empathic qualities, PR skills, and a genuine empathy for people. You will share laughter and tears, and face unexpected challenges.
Yet this can also be a highly rewarding job and I never tire of seeing people - especially those who imagined the good times were over following their diagnosis - thoroughly enjoying themselves.
You also need to have a solid understanding of person-centred care principles; of the principles of diversity and equality; of your employer's codes of practice; Care Quality Commission requirements; and of the legal requirements of the Mental Health Act, Data Protection Act, Health & Safety, Safeguarding, Deprivation of Liberty, etc. (These are British laws but your own country may well have its own similar laws.)
Not Just Fun & Games!
If any person does not with to take part in any activity, that is 100% their choice to make and their choice should always be respected. Activities should be simple enough for service users to complete without being in any way patronising or infantilising.
Activities play a vital role in maintaining a sense of purpose and of personal identity, and help to ward off depression which can have a negative impact on overall health. Activities enable people living with dementia, even those with very advanced conditions, to improve the quality of their daily lives right until the end of their life.
A quality activity program aims to support the independence and personal identity of each dementia sufferer. Previous interests and community contacts should be supported and encouraged. The program should enable people to feel that they still have valuable, practical skills to contribute.
Activities should be safe for that individual to carry out in accordance with current risk assessments for each participating individual.
How all this is achieved will vary, and the Activity Co-ordinator's approach will need to adapt as each individual's dementia progresses.
Purposeful Activities for Dementia Care
What is Dementia?
There are around 100 different causes of dementia. "Dementia" is merely an umbrella term for a collection of symptoms. These symptoms will vary between individuals, and will change as the underlying causes for that individual's dementia progress.
Causes include Alzheimer's disease, Lewy body dementia, vascular dementia and frontotemporal lobe dementia, but there are many other types. Also, some conditions, such as Parkinson's disease or Down's symdrome, cause the sufferer to be more prone to developing dementia.
Common symptoms of dementia include confusion, short-term memory loss, and a decrease in balance and eye-hand co-ordination. This means that an individual's previous activities can't always be maintained, or at least not in quite the same way. However, there are many easy and economical ways around this issue.
Purposeful Activities for Dementia Sufferers
There are many useful, practical things that people living with dementia can still do. An Activity Co-ordinator needs to experiment to learn what works with each individual, and understand that each person's needs and abilities will change over time.
Keeping a sense of independence, of social activity, of participation in a club, and of maintaining physical strength and mental agility is believed to slow the progression of dementia.
Weeding, hoeing and tidying the garden is excellent outdoor exercise. Bending down or movements which require balance may be problematic, so try raised beds. If they are outside your budget, cover your dining table with a layer of old curtains or thick blankets to protect the wood from marks, then use a plastic table cloth or tarpaulin to work on, and grow things in pots. Growing edible plants is another great way of providing a distinct end purpose to the activity.
A person with dementia can help to clean and refill bird baths, or help to refill bird feeders. Attracting wildlife to your garden gives the person a specific focus. Try making a simple chart to log which birds have been seen on a particular day.
Setting the table or helping to clear up is a practical activity which can help the person living with dementia feel they have contributed something useful. They can make their own bed or help straighten cushions, hang damp laundry on a washing line, or fold dry laundry.
If you are working in a care home, there is probably a pile of socks in the laundry which need putting into pairs, and this is another easy yet meaningful activity. I have known some residents who enjoyed doing dusting, polishing brass, and washing dishes.
Always praise a person's help and thank them for it, as this boosts their often diminished sense of feeling valued by others. Everyone likes to feel appreciated, after all.
Shopping is an ordinary activity that it helps to keep a feeling of normalcy. Provide opportunities for making independent choices by encouraging the person living with dementia select some grocery items. They could help choose which dessert to buy, or which type of apple. Selecting favourite items helps to maintain independence and sense of personal identity.
Dementia can change a person's palette, so foods which were once enjoyable may no longer be so, and vice versa.
All people should aim to be physically active for at least part of every day. Exercise boosts mood, helps stave off depression, can help to boost immunity and maintain mobility.
If a person has been a golfer, swimmer, tennis player, or a member of the bowling club, it is good to maintain this activity for as long as it is safe to do so. The service user's doctor can advise about the specific needs of the individual involved, and the current risk assessment should always be referred to.
When mobility is an issue, try armchair keep-fit or armchair yoga.
Easy Seated Exercises for Elderly People
Music is an incredibly powerful tool in dementia care. Even those whose perceptions of life have been almost completely diminished by advanced dementia, to the point where verbal communication has ceased almost entirely, still derive great pleasure and reassurance from listening to music.
CDs made up of music by various artists are great, as if the person listening to it doesn't like one song, the chances are they may like whatever plays next. If you don't know what kind of music that individual likes, observe how they respond to different pieces. Ask their family and friends what this person likes and document this information.
Hearing music can trigger many associations - such as dancing, courting, parties - and these can be valuable subjects to talk about.
Don't assume that because a person is of a particular age that they will like a particular type of music. It's not all Elvis and Vera Lynn! People living with dementia are just as individualistic as any other person.
Photographs provide excellent visual prompts for reminiscing about family life, working life, where a person has lived and what they have done with their lives. There are many local history books, highly illustrated, which can be useful. The internet is a seemingly infinite resource for similar images.
I encourage families to provide photocopies rather than the original photographs, in case they are damaged through use.
Memory Boxes and Memory Books!
Collect together images and items, and use these as a personalised resource for reminiscence. Keep these in a box, or fill a scrapbook full of meaningful images specific to that person or to a subject - such as 1950s clothes, domestic items, famous faces, major news events, etc.
Some people living with dementia develop a habit of putting things into their mouths, which can present a choking hazard. For this reason, small items should not be included in the memory box, especially if that box is to be left unattended.
"This Is Me!"
A short biography about the person living with dementia can be of great help both to the service user and the professionals who care for them. It can serve as a reminder of self-identity for the service user and as a personalised introduction for others, and as such is an aid to maintaining person-centred care. If the service user goes into hospital or changes care homes, a copy of this document can go with them.
They are quite easy and economical to make. You might use a scrapbook or slim folder, or create it as a Memory Box, for example. Use large print in a clear font to aid the service user in reading their biography. Illustrate it with prints of photos or other mementos which help to describe that person's life from childhood onwards. Try a simple family tree, pictures of where they worked or of the cars they've driven or the homes they've lived in. Clearly label each image to aid recognition, both for the person living with dementia and the staff member who might be looking through it and talking about it with them.
How to Make a Memory Box for Dementia Sufferers
Reading can be difficult when short-term memory is impaired. For many, as their condition progresses, even the plot of a short story can become impossible to follow.
Try offering flash fiction instead, as these are very short stories sometimes of no more than one or two paragraphs in length, yet which still tell a complete story.
Poetry is a great way of offering a word-based activity. I recommend choosing poems of no more than twenty lines in length. This can be a reading activity, or you might use audio recordings.
Many older adults were expected to learn popular poems by heart as part of their education, and it can be surprising how many dementia sufferers can still recall some of the classics.
I've used contemporary poetry also, and found this works well to encourage people to talk about similar experiences from their own lives. The weekly poetry session is a very popular activity in the care home where I work.
Puzzles and Games
Scrabble, crosswords, word search and simple anagrams can be enjoyed by people in the early stages of dementia. These games stimulate memory and help remind people of how much they still know despite their disability or disease.
I made one word game simply and economically by typing out a list of well-known sayings, such as "A bird in the hand is better than two in the bush", and "An apple a day keeps the doctor away", and so on. A large font size makes these easier to read if eye-sight is weakened due to age. I put together two pages of these old sayings, printed and laminated them, then cut each saying in half. The game is to put the right half of each saying together again. As an activity it works well, although one lady had more fun deliberately mispairing the sayings to make her own versions of them.
Some dementia sufferers might like to keep a diary. This can help them to recall what they've done with their time, who has been to visit, what they've eaten, and so on. Others like to make a more personal an account of their experience of dementia to share with loved ones.
Keeping a diary can help with reality orientation and with maintaining a sense of identity.
Jigsaw puzzles offer visual and mental stimulation, and offer a quiet activity which can be done sitting down. Jigsaw puzzles made from 100 or less pieces may be best as the dementia progresses, but do make sure the images aren't childish.
You could try making your own very simple jigsaw puzzles by cutting photocopied pictures into large pieces. The photos could be of anything, but if you select local scenes or familiar faces this can also introduce an element of reminiscence into the activity.
Google Street View
This is a great way to revisit places once familiar to people, such as the town where they grew up or the house where they once lived, especially if they now live a long distance from these places and can't visit in person. Talking about how things have changed in appearance stimulates memory, also.
"Name that Face! Name that Place!"
A series of pictures of old film stars, singers, politicians and other media figures can be used as a tool for reminiscence. I make a game of it, encouraging people to put names to the faces. I also do a similar game with well-known places both locally and around the world.
Going to the cinema was an important part of many ordinary people's lives years ago, much more so than it tends to be today. Many people who are now elderly did not have access to a television when they were children. Instead they listened to the radio - or "wireless" as it was then called, and attending the Saturday Children's Matinee at their local cinema was the high point of their week.
Watching old hit shows of the silver screen can be a great comfort to people with dementia. The films may yet be remembered, and so provide a soothing sense of familiarity as well as be entertaining for their own sake. Musicals from the 1950s have proven very popular with the care homes where I have worked.
Arts & Crafts
Creativity can be highly therapeutic. Art therapy is a recognised and valuable part of contemporary health care The good news is that anyone can apply the ideas developed by art therapists just by using a little imagination.
Knit and Natter!
Many older ladies knitted clothes for their babies. Some kitted socks and gloves for soldiers during WWII. Others kept on knitting long after cheaper modern fibres made home-knits almost redundant simply because they enjoyed the craft for its own sake. Knitting is good exercise for fingers, wrists, and eye-hand co-ordination. It can also be a good social activity if a group of people sit together and have a good chat while they knit.
If some elderly people find short-term memory problems making it difficult to follow a knitting pattern, try knitting colourful squares for a patchwork blanket.
If knitting itself has become too difficult due to arthritis or poor eye-hand co-ordination, or a short attention span, try making colourful pompoms. Hang the finished pompoms off walking frames, wheelchairs or door handles. Or make a great pile of them and string them all together like bunting.
Thick wax crayons and poster paints are easy to use even when sight has weakened and hands find it hard to grip smaller items. Colouring in can be soothing and calming, and brings back memories of similar childhood activities. Ensure the crayons are non-toxic, in case someone puts them in their mouth mistaking them for bright sweets.
There are hundreds of colouring in books on the market now which are aimed at adults. However, many of these are too intricate for people living with dementia - too many lines, too much happening on the pages for them to process. However, the internet is a vast resource for simple colouring-in pages.
If a person has been an artist in the past, there is no reason why they cannot continue to express themselves through art. As their dementia progresses, their art is bound to change and this can potentially be a source of great distress. The media which they used to use, such as oil paints, may become problematic for them. Be aware that many oil paints are toxic, if the service user has a tendency to put things into their mouth, or that turps might be mistaken for a drink. Once this stage has been reached, the risk needs to be reassessed.
Non-toxic, washable paints are readily available to buy at an economic price.
Creating collages can be a fun thing to do. You could make themed collages, such as seasonal ones, festival ones, colour-schemed ones, etc. Some dementia sufferers are not safe using ordinary scissors, so try "safety scissors" which allows them to participate directly.
Collages can be made from anything - photos from old magazines, or leaves collected on a walk (in itself, providing another activity). Craft shops sell pre-cut printed images for scrapbooking, but you can improvise with cheaper versions if you wish - for example, using potato printing to create patterns.
Did you find this page interesting or useful?
- Dementia Care: How to Make a Twiddlemuff!
Keep hands warm and restless fingers engaged with a Twiddlemuff! Designed for people with advanced dementia, Twiddlemuffs are easy to make even if you're not great at knitting or crochet.
© 2016 Adele Cosgrove-Bray