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Tip of the week: Keep memory-impaired residents involved and engaged in stimulating activities

Contemporary Long-Term Care Weekly, November 6, 2008

The key to slowing down the progress of Alzheimer’s disease and other forms of dementia is to keep your residents’ minds active, says Susan Berg, AD, BS (COTA/L), the activity director at Hunt Nursing and Retirement Home in Danvers, MA.

“Focus on the abilities that a person still has rather than on what abilities he or she has lost,” Berg says. This is best done by getting to know the residents through talking to them, to their families, and to other staff members. Examining their chart can also provide useful information. The more you know about the residents and their preferences, the easier it is to engage those who are memory challenged in your activities program.

“Of course, I realize that someone’s interest or level of participation may change,” says Berg. “Some like a lot of different things, and some like the same thing all the time. It’s easiest if you get to know the resident.”

Follow the leader

The success of your activities can depend as much on the person leading them as on the program itself. “The activity leader, whether an activity assistant, CNA, volunteer, or other staff member, must be upbeat and excited about what they are doing,” Berg says. “They must use compliments and focus on the positives of a person.”

“Because emotions and feelings are the last thing to go in a person with Alzheimer’s disease or a related dementia, the residents can sense your feelings about what you are doing,” Berg continues. “In other words, it’s not so much what you do but how you do it.” The residents can sense whether you love what you’re doing and enjoy their company, and in turn, they will be genuine in their feelings toward you.

Berg recommends a hearty helping of compliments. In the early stages of dementia, residents often realize on some level that something is wrong, and compliments make them feel better.

“One group I do is called ‘Meet and Greet.’ Everyone in the group introduces themself, and then we all think of something great about this person, whether it’s a great smile, pretty hairdo, or beautiful singing voice,” she says.

For nonverbal or lower-functioning residents, Berg will introduce them and say something good about them. She may squeeze their hand and give them a hug or a kiss.

Berg believes that someone is a natural for the job if he or she is outgoing, upbeat, and animated, as speaking loudly and overdramatizing are often required. The ideal activity leader is a Pied Piper type, whom residents want to follow into a group activity. Patience is the greatest virtue.

A day in the life

Early in the day, when many residents are getting dressed and washed, Berg recommends some one-on-one sensory stimulation with lower-functioning residents. The sensory activities may relate to activities of daily living, such as brushing someone’s hair, putting on makeup, giving someone a manicure or hand massage, or assisting with dining.

Then, after breakfast, she likes to move on to group activities, which should be planned and set up well ahead of time. But whatever the activity is, she recommends that you make sure it’s failure free and success oriented. And always be prepared to make alterations as you go.

“Successful groups have great beginnings, meaningful middles, and excellent endings,” says Berg. Here’s how she structures group activities:

Great beginnings: Start off your group gathering by introducing yourself, saying how happy you are to be there, thanking everyone for coming, and telling everyone your favorite something—the something relating to the activity you have planned. Then ask the group members to introduce themselves and share their favorite something.

Meaningful middles: Be prepared by knowing the residents’ names, backgrounds, likes and dislikes, strengths and weaknesses, triggers for agitated behavior, and observed behaviors and preferences. Allow plenty of time for responses, and move around the room to make sure everyone in the group is included. Give assistance when it is needed, and repeat the answers to make sure that everyone heard what was said. Use liberal doses of compliments and humor.

Excellent endings: Thank everyone for coming, review the high points of the activity (“We sure had fun doing . . . ”), and tell the group members you’re looking forward to doing something else with them, “but first we have to [whatever is next on the itinerary].”

To break up the day, Berg recommends a physical activity such as a ball or balloon toss, kickball, simple sitting exercises, movement to music, or telling a story and having residents do simple movements as part of the story. Then she goes into small group activities, which could be anything from creative writing to arts and crafts to folding laundry or simple card games, depending on the preferences of the residents.

Bringing back memories

After lunch is a good time for a large group activity mixing residents from different units for musical entertainment, bingo, religious services, or parties. Obviously, not everyone will participate in the large group for one reason or another. They may stay behind for some sensory stimulation or some one-on-one time. They may also want to take a nap.

Music is an important component of any activities program because it can calm residents and bring back pleasant memories. Berg has found that nonverbal residents will sing most of the words to a song even if they barely speak otherwise.

After the large group activity, Berg suggests something she calls “quality time,” during which the activities staff members spend some time with each resident individually, even if it’s only joining them while they eat a snack.

“We never know exactly what a resident is going to want to do,” says Berg. “We can do almost anything and say it’s quality time, because as long as you’re engaging the resident, it is quality time.”

In addition to music, another useful technique for stimulating happy memories and good feelings in residents with dementia is showing them photographs, particularly baby pictures. Baby pictures almost always make people smile, and for residents with dementia, cute pictures can take them back to a pleasant time in their lives.

The mistake most people make, Berg says, is asking, “Do you know who this is?” when they show a memory-impaired resident a picture in the family album. This causes the resident to feel badly about not remembering. What is more constructive is an open-ended exercise to which there are no wrong answers and no need to remember a particular person or thing.

By the book

Berg has put together a book that uses her children’s baby pictures to stimulate discussion. Called Adorable Photographs of Our Baby: Meaningful, Mind-Stimulating Activities and More for the Memory Challenged, Their Loved Ones, and Involved Professionals, her self-published book features large, colorful photos of her children in a crib, in a high chair, in the tub, singing, and so on, captioned with a simple sentence in large print. On the opposite page of each photo are suggested questions to spark a conversation.

For example, a picture of her son taking a bath is captioned, “Now our baby is taking a bath.” Questions to ask the residents include “What is the baby doing?” “Is he wearing clothes?” “Is he having fun?” and “How can you tell?” There are also helpful suggestions such as providing each resident a bowl of warm water for sensory stimulation. This exercise is recommended for just before you want the residents to bathe or wash up. Another possibility is a discussion of fragrances and lotions, with samples available for the residents to smell and touch. Soon the discussion takes on a life of its own.

As another example, a picture of her child sleeping is captioned, “It is time for bed.” Questions to ask residents include “Where is the baby?” “Do you think his bed is soft?” “Is your bed soft?” “How does it make you feel to sleep in a nice, comfortable, soft bed?” and “Do you like soft things?” Other suggestions include singing a lullaby or reading a story. This is a good exercise when you want residents to relax and sleep.

“The pictures in the book are a springboard for discussion,” says Berg. “We start looking at a picture, and who knows where the conversation will take us? We get everyone involved in some way.”

By using tools such as Berg’s book and other mind-stimulating activities, as well as by having the right attitude, you can help keep residents with Alzheimer’s or related dementias diverted from the disruptive behaviors that often accompany the disease.

You can find out more about Berg’s book by visiting her Web site at www.alzheimersideas.com or by e-mailing her at alzheimersideas@gmail.com.

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