How to Have Fun and Not Get Hit--Successful Activities for Persons with Dementia

Kim P Petersen MDSpring Green, WI

kim@dementiaeducation.com

Is This How You Feel Working with Dementia Residents?

How to Have Fun Activities with Persons with Dementia

FIRST--Start with Understanding the Person with Dementia

Personhood A feeling, human being who is is not limited

to memory, problem solving, or ability to perform activities of daily living

A person with a disability, not a terminal illness

A person who is valued and respected for who they have been and who they are at this moment

A person whom we must learn to understand and know.

Personhood DeniedConsequences of denying personhood:

Cognitive and Functional Decline Disability

Victimization (AD victim)

Dehumanization

Isolation and Alienation

Personhood DeniedTerror

Depression

Non-support

Shattered life

Personhood Denied US THEM

Sound of Mind DamagedContributing DeficientWhole Without ValueCognizant No Contribution

Treachery & deceptionDisempowermentInfantilizationIntimidationLabeling StigmatizationOutpacingInvalidationBanishmentObjectification

IgnoringImpositionWithholdingAccusationDisruptionMockeryDisparagement

Personhood

LOVE

Attachment

Comfort

Inclusion

Occupation

Identity

Tom Kitwood, Dementia Reconsidered: The Person Comes First

SECOND—Understand Their Pre-Dementia Intelligences

IntelligenceHoward Gardner’s Definition:

VerbalMathematical/ LogicalVisual-SpatialMusicalMotor NaturalistSpiritual/ExistentialInterpersonal Emotional Intrapersonal Intelligence (Daniel Goleman)

You May Need to Get This Background Information from the Family

Verbal Intelligence

Likes to read, write, do crosswordsEnjoys conversation, public speakingEnjoys puns, jokes, wordplayLoves to tell storiesEnjoyed English, social studies,

history, foreign language, speech, drama, forensics in school

Mathematical/ Logical Intelligence

Good with numbersEnjoys playing cardsLikes sports statisticsFollows the stock marketLikes to find patterns, logical sequencesEnjoyed math, science, law classes

Visual-Spatial Intelligence

Is artisticLikes to draw or paintEnjoys sewing, knitting, woodworkingGood at home decorating and repair- is

“handy”Likes color and designLikes to take photosEnjoyed art, home ecc,

mechanical arts classes

Motor Intelligence

Enjoys playing sportsLikes to danceIs graceful and coordinatedEnjoys physical exerciseLikes working with handsIs mechanicalEnjoyed phys ed, home ec,

mechanical arts classes

Musical Intelligence

Likes to sing or play a musical instrument

Enjoys listening to music

Knows a lot about a musical era

Enjoyed band, chorus, orchestra, dances

Naturalist Intelligence

Loves the natural world: animals, plants, natureWould rather be out of doorsCares for pets, birds, the environmentLikes to gardenEnjoyed science, botany,

biology, ecology, geology classes

Spiritual/ Existential Intelligence

Is religious or spiritualPractices meditationContemplates “the big questions”Enjoyed philosophy and religion classes

EmotionalIntelligence

Is self-reflective and insightfulGood at interpreting personal needs and those of

othersIs a “people person”Good listener, empatheticFun to be around/ good sense of humorEnjoyed psychology classes, drama, social

events

Emotional Intelligence- Humor

Loves jokes, wordplayIsn’t afraid of looking sillyEnjoys comedies, funny booksSees life’s silliness and “fabulous realities”Uses humor in difficult situations, laughs

in the face of adversitySought out by other people for sunny

outlook on life

Aging Underwear

Assessing Cognitive Strengths of Persons with Mild-Moderate Dementia

What type of jobs have you had?What skills have you developed for your job?

Tell me about your schooling. Did you have a favorite class or classes?Did you have any subjects that you didn’t like at all?

What are your hobbies?What keeps you busy now?What have you always wanted to learn or do?When do you feel happiest, most satisfied,

creative?

Improve YOUR Communication Skills

General Communication Principles

Set the StageQuiet environmentEven bright lighting

Avoid strong backlightsReduce clutter and distractionTurn off the television!

Disasters portrayed on tv may seem real and immediate

General Communication Principles

Earn attentionMake eye contactUse touch, if appropriateSit if the person is sitting

Be at the same levelSmile genuinely Greet the person Use the person’s preferred name Introduce yourself

Be willing to come back, if this isn’t a good time

General Communication Principles

Vocal QualityLower pitchCalmSlow downDon’t use Elderspeak

Sing-songy voice, childish intonation and language, “Imperial we”

If a person is hard of hearing, consider using a pocket talker or other assistive deviceA loud voice may be perceived as angry or cross

General Communication Principles

Non-Verbal Cues “Center” and collect yourself, so your body

language will be calm, positive, openSmile with the eyes, as well as the mouth-

mean it!Open, non-threatening stance, hands relaxed,

visibleBe aware of each person’s personal space

comfort zone

Keep Language Simple

One step at a timeAdd descriptors and gestures:

Please sit down in this chair right hereThis blue chairThis blue rocking chair

Don’t argue or confrontNEVER SAY NO!

Positive Language Negative Language

Let’s explore the garden.

I’m sorry, I must have bumped the table and spilled your juice.

Let’s us early-birds have some coffee.

Let’s go freshen up.

Don’t go out to the street!

Oops, you spilled your juice all over!

You can’t get up now- it’s 4 a.m.

I need to clean you up, you had an accident.

The Art of Questions

1. Who is this?• Open-ended question

2. Is this a picture of John Wayne?• Question that gives the

answer3. Gee, John Wayne looks

serious here, don’t you think? • Make a commentary

4. How do you feel when you see this picture of John Wayne? • Creative question, with

no right or wrong answer

Responding

“Give me the ……..the…..you know…”It must be really frustrating when you can’t find the

word you’re looking for.“I was in the Navy on an aircraft carrier…”

What an interesting story– I love to hear you talk about being in the navy!

“I want to go home…I want to go home..”I wish I could take you home

Responding

“Please don’t leave me, stay here…” I hate to leave, but I’ll look forward to seeing you

tomorrow.“Nobody loves me or wants me…”

I cherish your friendship, love.“I don’t want to go back in…let’s stay outside.”

I had so much fun watching the squirrels play in the yard. Thank you for sharing this time with me.

THIRD—Use Tested Activities for Persons with Dementia

Reminiscence and “Life Review”

Process, not product“Just do it!” -- Don’t worry about grammar,

spelling, mechanics“Life Story Books”TR- Bios (Therapeutic/ Restorative

Biographies- Gene Cohen)“Making Memories Together” game- GENCO

GAMES

TimeSlips- Creative Storytelling Project

Developed by Anne Basting, PhD, the TimeSlips project has generated hundreds of stories and plays. The creative processes promotes communication, connection and joy in elders who are

living with dementing illnesses. www.TimeSlips.org

Music Therapy in DementiaMeta-analysis of Study Results

Persons with dementia can continue participating in structured music activities into late stage

Instrument playing and dance/ movement are most preferred live music activities

Singing participation declines in late stage dementia

Modeling of expected responses helps to maintain participation

Music Therapy in DementiaMeta-analysis of Study ResultsIndividual or small groups (3 - 5) are optimumSocial and emotional skills and communication

are enhancedMusic can enhance cognitive skills such as

memory Information presented in a song context enhances recall

and recognitionEffective alternative to medication for behavior

management

Music Therapy Resources

Alicia Clair, Therapeutic Uses of Music with Older Adults

David Aldridge, ed. Music Therapy in Dementia Care

Oliver Sacks, Musicophilia: Tales of Music and the Brain

Here’s A Neat Idea !!

Adding a “Spark of Life” to Your Programs

Jane Verity- Dementia Care Australiawww.DementiaCareAustralia.com

Goals for Participants:To have their self-esteem boostedTo be creativeTo be the leaderTo express themselves in their own

unique wayProgram called “The Sunshine Club”

Adding a “Spark of Life” to Your Programs

Rules of the Sunshine Club program :One roomTwo facilitatorsThree club levels

Everything is rightNothing is wrong

Sunshine Club Format

Minimum of 1.5 hoursInviting Ritual:

Hello. I’m so pleased to invite you to come to our Sunshine Club meeting!

Walk with person to club roomGreeting and welcoming ritual

Hi George, I’m so glad you’re here. Beginning ritual

May be a song “You Are My Sunshine,” motor activity, snack

Sunshine Club Format

Middle Theme – May be seasonalPotential Themes, written on the back of a

game:AffirmationsLife wisdomsProverbsJokes“Did you know?” Information, not quizzesNursery rhymes, when appropriate

Use black writing on a white backgroundUpper and lower case letters with serifsLarge print: minimum 26 Bold

Sunshine Club Format

Ending RitualRecap special moments from the

daySing a song- “Good night ladies”Thank each person for comingPromise to meet again on the next

scheduled day“We’ll meet again on Thursday.”

Club LevelsClub 1- Those needing highly focusing

activities 4 – 6 membersStimulation through use of large, colorful moving

objectsMay use giant balloons, dice, parachutes, flagsLater stage dementia persons

Communicate primarily non-verballyCan concentrate for a few minutes when attention is

focused on someone elseCan contribute to the group with smiles, caring for others,

expressive movement or sounds, touch, eye contact

Club LevelsClub 2- Those needing focusing

activities: 6 – 8 membersUses stimulation through a mix of verbal

communication and large, colorful moving objects.

Middle stage dementia persons:Can respond to and initiate conversationCan express themselves verbally when given

timeCan concentrate for up to 15 minutes

Club LevelsClub 3- Those needing least focusing

activities: 8 membersStimulation through use of objects and verbal

communicationSharing thoughts, feelings, life experiences and

wisdomChoices often made by members themselvesEarly stage dementia persons

Initiates spontaneous verbal conversationCan concentrate for 15 minutes of longerCan verbally validate and support one another

Sample Club 3 Activity

Bring in a bunch of old kitchen and workshop toolsAsk each participant to choose oneAsk: “What do you think of when you see this

old bit and brace/ meat grinder/ rug beater?”Encourage everyone to share their ideas.Allow the conversation to drift– you don’t have

a “plan” you need to follow

Sample Club 2 Activity: CollaborationTree of life game

Draw a large tree trunk on a posterMake brightly colored autumn leaves out of

cardboardPut a number 1 – 6 on the front of each leafIn large print, type a proverb on the back

Have each participant roll the dice and take a leaf with that number on it

Ask the participant to read the proverb on the back

Ask: “What does this make you think of?Clap and have the participant put the leaf on

the tree

Sensory Stimulation- All 5 senses

Tactile toysQuilts/ fabricBubble pipeScarvesBalloonsFountains, envirascapesFavorite perfumes/ aftershaveMusical Instruments to play

Sample Club 1 ActivitiesGreeting or ending ritual with large balloonTheme: First snowfall

Gather cold weather items: mittens, scarf, longjohns, hockey jersey, ice scraper, earmuffs…

Fill a (new) wheelbarrow with Styrofoam balls, hiding the winter items underneath the balls

Have each participant dig in the wheelbarrow, find and item and do with it what they will. Wear it Comment on it– Ask “What do you think when

you see these earmuffs?Praise each participant

Other Ideas for Late-Stage Dementia Activities

Montessori Based Activities for Late-Stage Dementia Residents

Activities to maintain or regain tactile sensation, auditory, temperature and scent discriminationMatch the smell of an orange with the

orange itself, eat the orange or drink orange juice

Sort sandpaper-covered blocks according to the coarseness of the sandpaper, from roughest to smoothest

Scooping activities: using a spoon to transfer ping pong balls from a plate into the wells of a muffin tin

Creative Adaptations for Persons with Severe Disability of Dementia

Seek non-verbal creative tasks music, art, movement

Procedural memory often remains for most of the dementia journeye.g. the motions for knitting, sanding a wooden piece

Break task into small component partse.g. sorting fabric by color for quilt pieces

Remember: process, not productAdaptations of activities for persons with severe

disabilities from dementia challenge your creativity!

Reminiscence Therapy for Behavior Management

Bath-time reluctance Old-fashioned apron Reminisce about Saturday night bath routine Peanut butter sandwich Getting dressed up to go out on a date or to a dance Aromatherapy- favorite moisturizer, cologne or aftershave

I want to go home- My mother’s waiting for me Draw me a picture of your favorite room or place at home Look at Life Story Book

Agitated Behavior- Use large muscle groups Tearing sheets and rolling bandages Sanding wood blocks Polishing candle sticks, wood tabletops

Rummaging Sort “quilt fabric” by color and pattern Put nuts onto large bolts Handbag rummage Sorting socks, baby clothes sprinkled with baby powder

Collaboration-Working Together

“Life savers”Fanny pack

Grocery/ hardware store listHankies/ scarves to foldPeppermintsJewelry to sortHand lotionBandanaStuffed animal

Collaboration- Working Together

Job BoxToys to sand Fabric for bandagesCandlestick to polishOld milking machineLedger books/ grade books/ restaurant order padsCross stitch hoopsLarge knitting needles, crochet hooksOld post cards to sortFishing bobbers to sortSoda bottle with birdseed/ objects to find.

Multi-Sensory StimulationCreate a Spa:

Decorate the room like a resort with palm trees, umbrellas, beach posters, etc.

Facials, make-up, manicures and pedicuresHair careMassage and aromatherapySoothing music or environmental soundsJuice barDo “Color profiles” Take and develop photos of persons after their

“Make-Over”Exercise- yoga, tai chi, etc.

Life Story Book

Involve many family members in gathering mementos, pictures, etc.

Many facilities and ADCs request that a Life Story Book be made when the person moves in or joins the group

Use a three-ring binder and plastic sleevesFile folders make durable pages for picturesUse copies of precious picturesMay also make a Life Story box with 3-

dimensional items

Spirituality

Beloved religious items: Bible, rosary, Koran, Menorah

Magazines from faith organizationsSacred musicDesignated place for meditation Outside meditation garden

Humor and Play

Early Stage dementia persons may be fighting to keep up a façade of control.

May respond negatively to games that seem “childish” or “too easy.”

Facilitator needs to use a sensitive, playful approach

Humor and Play

Middle and Later Stage dementia persons are letting go of past/future and living in the “here and now.” Often lose their inhibitions“Blossom” through playWhen play is presented in a spirit of fun, love

and respect, people don’t feel demeaned.

Play

Support “Play” Behavior: Play doh, fingerpaints, silly string,

puppets, stuffed animals,

mud pile Creative Dramatics, Make-Believe,

Charades: Make a collection of silly hats, clown

noses, Groucho glasses Funny Board or Basket:

Laminate cartoons, amusing pictures and funny sayings for a bulletin board or laugh basket

Humor Everyday

Funny ClothesWear amusing buttons, vests, jewelry

Kids and Animals Share funny children’s books:

Alexander and the Terrible, Horrible, No Good, Very Bad Day- Viorst; Wilfrid Gordon McDonald Partridge- Mem Fox

Bring in baby animals, pets

Activities for Smiles and Laughs

Funny Videos from Years Ago I Love Lucy, Milton Berle, Red Skelton

Funny Videos for Children Beethoven, Chitty Chitty Bang Bang, Baby

Einstein- Animals in Your Yard, Animals in Nature, Discovering Water, etc.

Therapeutic clowns

BurmaShave Signs

Henry the EighthSure Had

TroubleShort-Term

WivesLong-Term

Stubble

Said Farmer Brown

Who’s Bald on Top

“Wish I CouldRotate the Crop”

Older Than DirtHead light dimmer switches on the floor?Using hand signals for cars without turn signals?Blackjack chewing gumWax coke-shaped bottles with sugar waterCandy cigarettesTelephone numbers with a word prefixMetal ice trays with a leverMimeograph paperBlue flash bulbsRoller skate keysWash tub wringersNewsreels before the movie

How Not to Get Hit

Triggers for dementia behavior are the key

Prevention ( or reduction) of behavior works best

Environmental Triggers

RelocationArchitectural mazeUncomfortable environment: (too hot/ cold,

uncomfortable seating)Noise HubbubSensory stimulation: over or underInadequate lighting cuesReflective surfacesVaried flooring surfaces

Physical/ Psychosocial Triggers

PainIllness: UTI, MI, CVA, Dental problems, etc.MedicationsDisruption of circadian rhythmsDepressionBoredomPre-morbid personalityInteraction with peersDepressed caregiver

Caregiver Interactions

Lack of knowledge about dementiaYou need to know what type of dementia the person

hasRemember—it’s the disease, not the person, that is

in controlLack of knowledge about the person

Really know the person and what interests themWe all need to “do” things

Having meaningful daysLessens anxietyHelps keep emotions in balanceIncreases feelings of comfort & belongingReduces behaviors

Caregiver Interactions

Carried-over emotions from personal lifeHow’s Your day going?

HurryThe Tortoise ALWAYS wins

Communication failures

Final Thoughts

Persons with dementia are just the same as You & Me

EXCEPT their brains are devastated by a disease that destroys brain cells & connections and causes their behavior

They need (and deserve) our empathy & love

The End of the Story…