Some time ago I interviewed Teepa Snow, a nationally renowned dementia care expert, about how to plan activities to engage people with Alzheimer's. Teepa is an occupational therapist with more than 30 years of clinical experience in the field of geriatrics and dementia care and also had the personal experience of providing care to family members with Alzheimer's.
She has developed numerous educational DVDs for family and professional caregivers and is on the road nearly 300 days per year, presenting seminars for both families and professionals who care for people with dementia.
"It's an exhausting schedule," she says. "I can only do it because I am passionate about helping dementia caregivers."
Several years ago she entered into a partnership with Senior Helpers, a nationwide in-home care company that provides extensive training for its employees about how to care for people who have dementia. As part of this partnership she helped develop "Senior Gems," a system that classifies dementia patients into six categories, each named after a gem. The "gems" table shows the basic characteristics of people at each level and provides tips for interacting with them. Two examples from the table are:
"Diamonds - in an early stage of the disease - like to feel competent and valued. It's also important for them to feel comfortable and in control. Rewarding activities include things like having lunch or dinner at a familiar place, attending a concert or play, or just going outside to get some fresh air"
"Pearls are in the latest stage of the disease. They like pleasant sounds and familiar voices. They also like to feel warm and comfortable. For people in this category it's beneficial to read or talk to them about good memories, bring an extra soft blanket or sweater for them or brush their hair."
According to Teepa, the single most important thing for family and professional caregivers to keep in mind is to "Provide more than just entertainment. People with dementia can become tired or overstimulated if they have too much entertainment. It's important to balance the day, also including productive activities (that the person can realistically to expected to be able to achieve), leisure time, fitness activities and, finally, rest and relaxation."
Productive Activities: Ms. Snow says that productive activities are those which impart a sense of value and purpose. These could be as simple as making, sorting, or fixing things. Other activities in this category include helping another person with a task, cooking/baking, or completing community tasks.
Leisure Time: "It's important to carry out activities in which the person can have fun and interact with others," Teepa told me. Examples include things such as participating in sports, games, dancing, singing, and working on hobbies.
Self-care and Wellness: Ms. Snow states that personal care of the body and brain is critical for the well-being of people with dementia. "These include activities such as walking and tasks focused on strengthening, coordination, balance, flexibility and personal care."
Restorative Activities: Last but not least she says, "restorative and re-energizing activities include ones such as taking naps, rocking in a chair, swinging in a porch swing, listening to or attending a worship service, or stroking a pet."
When I asked Teepa what people should avoid when planning activities she told me, "It's crucial to be sure the activities are not too hard or, at the other extreme, too boring." She also advises against mixing people at different stages of the disease because their behaviors may bother each other.
In addition she stresses that your expectations need to change as the person progresses through the stages of dementia. Activities that work well with those in the early stages will not necessarily be successful for those in the mid- to later-stages.
Contrary to popular opinion, Teepa says that people in the earlier stages of dementia may actually be more difficult to engage than those in the later stages. "This is because they are still lucid enough to know something serious is wrong with them and many are angry and/or frustrated by that."
Although it's generally thought that it can be nearly impossible to connect with later-stage patients, Teepa believes that almost all people with dementia can be reached. For late-stage people she advises using children or infants (or even doll babies), pets, music or art. "These are the activities most likely to help you engage them."
Marie Marley is the award-winning author of the uplifting book, Come Back Early Today: A Memoir of Love, Alzheimer's and Joy. She is the co-author, with neurologist Daniel C. Potts, MD, FAAN, of Finding Joy in Alzheimer's: New Hope for Caregivers. Her website, ComeBackEarlyToday.com, contains a wealth of information for Alzheimer's caregivers.
This is a revised version of an article originally published on the Alzheimer's Reading Room.
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