While there is no cure for Alzheimer’s disease, long term and post-acute care (LT/PAC) providers have an opportunity to enhance the quality of life for residents living with the disease.Resident-centered activity programs, led by compassionate and trained staff, can provide solace, comfort, and relaxation and, one hopes, lessen symptomatic behaviors. Inclusive programs that utilize family members or resident peers can enhance community life for everyone.
November is National Alzheimer’s Disease Awareness Month, an appropriate time to review the center’s policy for providing resident-centered activities for those with dementia. A few questions to consider:
- Are activities meaningful, engaging, individualized, and appropriate for the resident’s stage of dementia?
- Do staff understand the communication challenges associated with cognitive impairment, and are they trained to intervene?
- Are there opportunities for family members or fellow resident volunteers to participate?
- Are staff assessing the actual abilities of the resident rather than making assumptions about inabilities?
Elements of a Successful Activity Program
Successful programs are part of a resident’s overall routine and can be adapted for safety and a resident’s capacity, current mood, behavior, and ability to stay focused. Well-trained staff can direct physical guidance and prompts, are flexible in approaching and optimizing the resident’s sense of success, and can validate what the resident is saying while preserving function and minimizing agitation.
Consider inclusive programming. As an example, Covenant Retirement Communities’ SAIDO Learning® program has been shown to improve the symptoms of Alzheimer’s and other dementias. It is one of many resident-centered activities offered to residents with dementia, yet it is unique because leading the sessions are unlikely volunteers: family members, resident peers, employees, and members of the local community.
When planning activities, keep in mind the varying stages of dementia and how each impacts a resident’s cognitive function and ability to participate in and benefit from certain activities. Consider using a multisensory room to create an enjoyable, failure-free experience for residents. And, review the information below to help guide activity planning.
Activities for Residents with Dementia
For residents in mild- and moderate-stage dementia, activities should focus on maintaining or improving a resident’s functional and cognitive abilities. Oftentimes, residents in the mild stage are aware of and embarrassed by their memory loss. Finding the right words, learning new things, abstract thinking, and decision making may be difficult. Activities may take them longer, and they may require cueing to aid in their memory process.
Residents in moderate-stage dementia exhibit increased deterioration in cognitive function, including profound memory loss and disorientation; decreased language abilities; loss of safety awareness; a need for reminders, redirection, verbal and visual cues; and direct physical guidance to complete tasks.
For residents in severe-stage dementia, cognitive function has deteriorated significantly and is not likely to improve. Activities should provide stimulation, comfort, solace, and relaxation.
Changes in a resident’s mood and behavior are obvious—for example, yelling or calling out, shadowing, agitation and anxiety, paranoia, and changes in sleeping habits.
Understanding how a resident’s behavior is a form of communication—a symptom of an unmet need—can help staff identify problems and create a care plan with activities that serve as interventions.
For residents with limited response or abilities, offer environmental and sensory stimulation that is specific to a resident’s individual needs and interests. Residents in this stage require constant direction and supervision. Build on any retained abilities no matter how small, and provide comfort care.
Multisensory Rooms: Stress-free and Stimulating
Specialized dementia programming offered in a multisensory room provides group, one-on-one, and individual activities in an environment that is success-oriented, failure-free, purposeful, engaging, and meaningful.
Access to multisensory rooms is 24/7. The room is most effective when used prior to a resident becoming significantly agitated and when staff are properly trained so they understand the benefits of the room and how to conduct activities that are beneficial to each specific resident.
Communication Challenges
Verbal and nonverbal communication with residents who have dementia presents a unique set of challenges for staff, caregivers, and family members. Approach each interaction with these principles in mind:
- Correct any hearing or visual problems and remove distractions;
- Get to eye level and approach the resident calmly and cheerfully in an adult fashion;
- Avoid overwhelming the resident physically or verbally; and
- Presume comprehension on some level, and remember nonverbal communication becomes more important as the disease progresses.
- During activities with a resident:
- Use the KISS method: Keep It Short and Simple;
- Talk slowly, distinctly, and use concrete phrases;
- Explain what staff are going to do before they do it; offer simple choices;
- Ask one question at a time and allow 30 seconds for a response; and
- Provide praise and reassurance; validate feelings.
Nonverbal Communication Cues
Residents can pick up on a person’s attitude and mood. Consider these key points for nonverbal communication:
- Use nonthreatening postures and gestures;
- Demonstrate desired actions;
- Convey a positive/supportive attitude;
- Stand or sit at residents’ level and move slowly;
- Use touch and allow them to touch the staff person/hold the staff person’s hand;
- Watch for their nonverbal messages as clues to problems;
- Demonstrate desired actions;
- Encourage communication with nods, smiles, and eye contact; and
- Try to understand residents’ feelings behind their confusing words.
Residents with dementia require special care, activities, and safety considerations. They benefit greatly from living in a community with a robust policy for providing resident-centered activity programs and inclusive programs that involve family members, caretakers, or members of the community.
A cure for Alzheimer’s and dementia may not yet be within reach, but every day LT/PAC providers have an opportunity to enhance the lives of those living with dementia.
Jillian Thomas is director of assisted living operations and oversees SAIDO Learning at Covenant Retirement Communities, the nation’s sixth largest not-for-profit senior services provider. She is the co-author of the book, “The Big Book of Senior Living Activities,” from which portions of this article have been adapted. She can be reached at jlthomas@covenant retirement.org.