Transcript File - Chaplain Miller Ministries

Activities for the
Dementia/Alzheimer’s Patient
Objectives
The participant will be able:
 Discuss the Montessori-approach to activities and
dementia patient
 Understand as families, caregivers, other members
on planning & implementation of activities
 Facilitate improvement in patients, families, and
caregivers daily lives through the use of activities
 Instruct families on challenges to be faced when
planning & implementing activities
 Discuss resources for activities
What we know today about activities &
the dementia patient:
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The relationship to activity to the course of
dementing illnesses is not clear.
Many studies are on-going in this area
Activity has many benefits and is preferable to most
individuals
Inactivity can often be associated with behavior
problems
When an activity is initiated, we walk a fine line
between providing meaningful activity &
overstressing the person (be careful!)
The typical day for Alzheimer’s patient
is often filled with…
boredom
 obstacles
 mistakes
 failures
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…all due to memory lapses
People with dementia..
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May lose the ability to entertain themselves
May not be able to organize everyday ADLs
The caregivers of the patient, with all they are
expected to do, may not have time or energy
to organize activities…day care centers,
other family, friends, or paid caregivers may
be needed.
Activities help…
Raise quality of life
 Increase self-esteem
 Relieve boredom
 Reduce restlessness
 Raise self-awareness
 Increase alertness
 Decrease agitation
 Decrease depression & anxiety
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To be effective, activities must…
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Draw on remaining abilities &
knowledge
Provide cognitive & sensory
stimulation
Contain adult level activity as long
as possible
Be simple but entertaining
Be short (20-30 minutes)
Most Alzheimer’s patients
are aware of their memory
loss, and failing in a simple
activity will only add to
their frustration.
Montessori-based approach
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Dr. Cameron Camp, research
psychologist pioneered use of
Montessori methods with
Alzheimer’s patients
Built on no-fail methods with
emphasis on repetition and
learning through the senses by
manipulating materials
Montessori-based approach (cont)
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The individual is considered as a whole
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physical
emotional
social
aesthetic
spiritual
Cognitive needs & interests are
inseparable and equally important
Dr. Cameron Camp says…
“We can’t stop cell death from
Alzheimer’s. But at any stage
of dementia there is a range of
capability. If you give a person
a reason to get out of bed,
activities that engage them and
allow them to feel successful,
they will be at the top of their
game, whatever it is.”
A true story…
Dr. Camp was visiting an ALF
and observed a 70-year-old
woman. He gave her a book on
Gene Kelly, the dancer. He
asked her to read a page. “She
took the book and read aloud—
clear as a bell.” A shocked staff
member called it a miracle—she
didn’t know the woman could
speak.
Adapting Montessori exercises
to older people with dementia
The Objective: Tailor activities to
patient’s background & interests
The Benefit: This draws the “person”
out of the “patient”
Another true story…
A research participant with
Parkinson’s and dementia who
was confined to a wheelchair had
loved woodworking and fixing
things. He was brought a small
box to paint, nuts and bolts to put
together, and puzzles.
Where he used to sleep all day, he
would smile and talk as he
worked on his “projects”.
“People with Alzheimer’s ‘live in the
moment’, and our job is to give
them as many good moments as we
can.”
-Dr. Cameron Camp
Reading
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Studies have found that reading is one of the
very last skills to fade away
Reading is automatic—almost a reflex,
according to Dr. Camp
Print should be large & bold
Activities should be
meaningful—things that call on
the person’s past.
Boredom will result if the activity
isn’t challenging or interesting.
It is unrealistic to expect a person to
learn new, complex skills; however,
some individuals can learn simple
tasks or facts if repeated enough
times.
Teaching others…
One particular facility has
Alzheimer’s patients
teaching some simple
activities they have learned
to preschool children.
The result is dignity, purpose,
and fun as the elder
interacts with the child.
The patient who sees himself as a
“helper” will have increased self
esteem.
Asking the patient to “assist” you is
most likely to met with positive results.
Intellectual skills are not all lost at
once…assess what person can still do
and make the most of remaining
abilities.
Most patients can participate in some
way—whether stirring lemonade or
participating in a conversation.
Assessment of remaining abilities
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Can the person
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Read
Sort
Categorize
Manipulate objects
Customize activities based on
these skills
Simplify activities so that patient
can be involved in some way
For example…
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One patient loved
baseball, so the staff had
him sort pictures of
baseball players into
American and National
leagues
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Another patient who loved
opera sorted titles into
operas by Puccini and
operas by Verdi
Research shows…
…that people who engage in activities tend to
exhibit fewer signs of agitation, depression,
and anxiety.
It can also improve the morale of the caregiver,
knowing they are doing something useful for
the patient.
Other advantages of activities
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Maintenance of the motor skills necessary to
feed themselves or button buttons
Triggers memories & conversations that can
connect patient with caregiver
Decrease risk of boredom & resulting
negative behaviors
Risk for mistakes on part of patient &
caregiver—try something else
The most important thing is the
enjoyment of the activity…not the
correctness of the activity.
Warning:
Too much stimulation, activity, or pressure to
learn may upset the confused person, may
upset the caregiver, and may accomplish
nothing.
Withdrawal may be a person’s way of
coping…insisting on participation may have
catastrophic reactions.
“What we try to do is let the
person you remember shine
through the disease, even if it’s
only a few moments a day.”
-Dr. Cameron Camp
Walking
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A 10-15 minute walk is good exercise and
reduces anxiety
May help prevent other illnesses &
infections
Allows person to interact with nature
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Bird feeders & bird baths
Insects & animals
Plants & flowers
*safety note: make sure walkways are level, plants
are non-toxic, etc.
Plan the outing
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Maintain some of the routine of the day
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Some behavioral medications make person
more sensitive to warm weather
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Meals
Medication schedules
Keep fluids and fruit available
People with Alzheimer’s may not realize it’s
too hot
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Coach them to drink fluids
In a recent exercise program
conducted at the University of
Arizona, patient’s moods were found
to improve just as surely as their
fitness.
Sun exposure, for only 15 minutes per
day can…
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Help a person sleep
better at night
Increases Vitamin D
absorption which
strengthens bones
Gardening: engage the senses
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Simple, effective & meaningful activity
Connects person with nature & life
Active participation or observer of nature
 sights
 Sounds
 Smells
 Physical sensations
Beneficial to spiritual, psychological,
social, & physical health
Music
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One of the best, most effective ways to
create a calm, soothing environment
Provides enjoyment
Patients can participate with instruments or
their voices
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It is not uncommon for a patient who played the
piano most of his life to be able to play entire
songs perfectly, yet not remember how to tie his
own shoelaces.
On the other hand, if he/she is unable to play
without mistakes, it may lead to frustration.
Did you know?
A recent study found that
Alzheimer’s patients who
listened to big band music
every day were happier and
more alert—even had better
memory—than patients who
didn’t listen to music.
Conversation
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Encourage talking while actively listening
Ask opinion-type questions to reduce risk of
erroneous answers
Accept whatever answer you are given
Do not argue with the person
One-to-one time is essential in creating a
connection
Do this for as long as patient is able to
converse
Alzheimer’s patients may feel boredom
as deeply as anyone else. They can no
longer plan their own activities, and
boredom can turn into frustration.
This can lead to wandering and
agitation.
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Provides a connection with everyday activities of life
Provides sense of purpose & accomplishment as
they assist with family chores
Examples
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Sorting & folding clothes
Dusting furniture
Setting table
Assist with meal preparation
Cutting coupons
Shredding old bills
If the person enjoys a job, try to let
him do it as often as he wants. It
won’t hurt a towel to get folded 50
times in a day.
Art Projects
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Modeling clay
Canvas & paint
Stringing large beads
Sanding / painting wood
Making collages
Flower arranging
Crocheting a potholder
Scrapbooking
Games
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Play games together
Avoid children’s games such as Candyland
Simple counting games or matching games
with cards or dice (in early stage of
Alzheimer’s)
Playing catch with a balloon or foam ball
Reminiscence
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Vocal or silent recall of events in a person’s
life
Can produce a positive, adaptive function
when reviewing one’s past
Highlights the dementia patient’s strengths
since long-term memory remains intact
longer into disease
Can increase verbalization, alertness, humor,
responsiveness to self, & social interaction
Pet Therapy
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Must be a docile, well-trained dog or cat
Studies show pet-therapy can:
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Lower blood pressure
Reduce stress & anxiety
Encourage vocalization & social interaction
Increases survival rates following heart attack or major
surgery
Can decrease aggressive or hyperactive behavior
Can relieve depression & disorientation
Improve morale, self-esteem, self-confidence, and
self-respect
Pet Therapy
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Provides a non-threatening environment for
play & self-expression
Provides opportunity for positive non-verbal
communication
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Physical contact & gentle touch may be
something patients may be lacking in day-to-day
life
Can help patients recall happy memories
Other simple activities
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Hiding coins in a big bowl of uncooked rice
Sorting nuts & bolts, buttons, beads
Rolling yarn into balls
“Snapping” green beans
Shredding paper
Making greeting cards
Dancing
Anything that is safe and “fail-proof”
**Simple activities can be just as enjoyable
as more complex ones.
It is the opinion of Jolene Brackey,
author of Creating Moments of Joy,
that we often take too many things
away from dementia patients.
We fear they might hurt themselves.
Sometimes, we need to try activities
and just see…
When all else fails…
(many confused people enjoy riding in a car)
…………………………………….
Unfortunately…
…what works
today may not
work tomorrow
(be flexible & creative!)
Tips for initiating activities…
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Try beginning the activity then asking them to join in
or
Use the Tom Sawyer approach to overcome their
fear of failure…start working on task and tell them,
“Don’t mind me. I have to get this done. Pay no
attention to me.” Then, intentionally make a mistake
and see if they correct it. This allows them to
observe and not feel threatened or overwhelmed.
Observation is a form of engagement
Tips
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If a patient stops a task after a few minutes,
instead of urging him to go on, focus your
attention on what he has accomplished.
A patient may increase the amount of time
spent on an activity as days go by.
Arrange activities for success.
Conclusion
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Don’t overlook the importance of activities for
the dementia patient
Benefits both patient & caregiver
Involves creativity & flexibility
Assess the patient’s remaining abilities,
interests, & plan activities for success
Be patient…it may involve trial & error
Have fun!
“We can’t stop cell death from
Alzheimer’s. But at any stage of dementia
there is a range of capability. If you give a
person a reason to get out of bed,
activities that engage them and allow them
to feel successful, they will be at the top of
their game, whatever it is.”
-Dr. Cameron Camp