How to Have Fun and Not Get Hit-Successful Activities for Persons with Dementia
Kim P Petersen MD
Spring Green, WI
[email protected]
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 Denied
Consequences of denying personhood:
Cognitive and Functional Decline
Disability
Victimization (AD victim)
Dehumanization
Isolation and Alienation
Personhood Denied
Terror
Depression
Non-support
Shattered life
Personhood Denied
US
Sound of Mind
Contributing
Whole
Cognizant
THEM
Damaged
Deficient
Without Value
No Contribution
 Treachery &
deception
 Disempowerment
 Infantilization
 Intimidation
 Labeling
 Stigmatization
 Outpacing
 Invalidation
 Banishment
 Objectification
 Ignoring
 Imposition
 Withholding
 Accusation
 Disruption
 Mockery
 Disparagement
Personhood
Identity
Attachment
LOVE
Occupation
Comfort
Inclusion
Tom Kitwood, Dementia Reconsidered: The Person Comes First
SECOND—Understand Their
Pre-Dementia Intelligences
Intelligence
Howard Gardner’s Definition:
Verbal
Mathematical/ Logical
Visual-Spatial
Musical
Motor
Naturalist
Spiritual/Existential
Interpersonal
Emotional
Intrapersonal
Intelligence
(Daniel Goleman)
You May Need to Get This Background
Information from the Family
Verbal Intelligence
Likes to read, write, do crosswords
Enjoys conversation, public speaking
Enjoys puns, jokes, wordplay
Loves to tell stories
Enjoyed English, social studies,
history, foreign language, speech,
drama, forensics in school
Mathematical/ Logical Intelligence
Good with numbers
Enjoys playing cards
Likes sports statistics
Follows the stock market
Likes to find patterns, logical sequences
Enjoyed math, science, law classes
Visual-Spatial Intelligence
Is artistic
Likes to draw or paint
Enjoys sewing, knitting, woodworking
Good at home decorating and repair- is
“handy”
Likes color and design
Likes to take photos
Enjoyed art, home ecc,
mechanical arts classes
Motor Intelligence
 Enjoys playing sports
 Likes to dance
 Is graceful and coordinated
 Enjoys physical exercise
 Likes working with hands
 Is mechanical
 Enjoyed 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, nature
Would rather be out of doors
Cares for pets, birds, the environment
Likes to garden
Enjoyed science, botany,
biology, ecology,
geology classes
Spiritual/ Existential Intelligence
Is religious or spiritual
Practices meditation
Contemplates “the big questions”
Enjoyed philosophy and religion classes
Emotional
Intelligence
 Is self-reflective and insightful
 Good at interpreting personal needs and those of
others
 Is a “people person”
 Good listener, empathetic
 Fun to be around/ good sense of humor
 Enjoyed psychology classes, drama, social
events
Emotional Intelligence- Humor
Loves jokes, wordplay
Isn’t afraid of looking silly
Enjoys comedies, funny books
Sees life’s silliness and “fabulous realities”
Uses humor in difficult situations, laughs in
the face of adversity
Sought 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 Stage
Quiet environment
Even bright lighting
Avoid strong backlights
Reduce clutter and distraction
Turn off the television!
Disasters portrayed on tv may seem real and
immediate
General Communication Principles
 Earn attention
Make eye contact
Use touch, if appropriate
Sit if the person is sitting
 Be at the same level
Smile 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 Quality
Lower pitch
Calm
Slow down
Don’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 device
A 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, open
Smile with the eyes, as well as the mouthmean it!
Open, non-threatening stance, hands relaxed,
visible
Be aware of each person’s personal space
comfort zone
Keep Language Simple
One step at a time
Add descriptors and gestures:
Please sit down in this chair right here
This blue chair
This blue rocking chair
Don’t argue or confront
NEVER SAY NO!
Positive 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.
Negative Language
 Don’t go out to the
street!
 Oops, you spilled
your juice all over!
 You can’t get up nowit’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
answer
3. 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 Dementia
Meta-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 Dementia
Meta-analysis of Study Results
 Individual or small groups (3 - 5) are optimum
 Social and emotional skills and communication
are enhanced
 Music can enhance cognitive skills such as
memory
Information presented in a song context enhances recall
and recognition
 Effective 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 Australia
www.DementiaCareAustralia.com
Goals for Participants:
To have their self-esteem boosted
To be creative
To be the leader
To express themselves in their own
unique way
Program called “The Sunshine Club”
Adding a “Spark of Life” to Your Programs
Rules of the Sunshine Club program :
One room
Two facilitators
Three club levels
Everything is right
Nothing is wrong
Sunshine Club Format
Minimum of 1.5 hours
Inviting Ritual:
Hello. I’m so pleased to invite you to come to
our Sunshine Club meeting!
Walk with person to club room
Greeting 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 seasonal
Potential Themes, written on the back of a
game:
Affirmations
Life wisdoms
Proverbs
Jokes
“Did you know?” Information, not quizzes
Nursery rhymes, when appropriate
Use black writing on a white background
Upper and lower case letters with serifs
Large print: minimum 26 Bold
Sunshine Club Format
Ending Ritual
Recap special moments from the
day
Sing a song- “Good night ladies”
Thank each person for coming
Promise to meet again on the next
scheduled day
“We’ll meet again on Thursday.”
Club Levels
Club 1- Those needing highly focusing
activities 4 – 6 members
Stimulation through use of large, colorful moving
objects
May use giant balloons, dice, parachutes, flags
Later stage dementia persons
Communicate primarily non-verbally
Can concentrate for a few minutes when attention is
focused on someone else
Can contribute to the group with smiles, caring for others,
expressive movement or sounds, touch, eye contact
Club Levels
Club 2- Those needing focusing
activities: 6 – 8 members
Uses stimulation through a mix of verbal
communication and large, colorful moving
objects.
Middle stage dementia persons:
Can respond to and initiate conversation
Can express themselves verbally when given
time
Can concentrate for up to 15 minutes
Club Levels
Club 3- Those needing least focusing
activities: 8 members
 Stimulation through use of objects and verbal
communication
 Sharing thoughts, feelings, life experiences and
wisdom
 Choices often made by members themselves
 Early stage dementia persons
Initiates spontaneous verbal conversation
Can concentrate for 15 minutes of longer
Can verbally validate and support one another
Sample Club 3 Activity
Bring in a bunch of old kitchen and
workshop tools
Ask each participant to choose one
Ask: “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: Collaboration
Tree of life game
Draw a large tree trunk on a poster
Make brightly colored autumn leaves out of
cardboard
Put a number 1 – 6 on the front of each leaf
In 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 toys
Quilts/ fabric
Bubble pipe
Scarves
Balloons
Fountains, envirascapes
Favorite perfumes/ aftershave
Musical Instruments to play
Sample Club 1 Activities
Greeting or ending ritual with large balloon
Theme: 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 LateStage Dementia Residents
Activities to maintain or regain tactile
sensation, auditory, temperature and scent
discrimination
Match 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 journey
e.g. the motions for knitting, sanding a wooden piece
 Break task into small component parts
e.g. sorting fabric by color for quilt pieces
 Remember: process, not product
 Adaptations 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 list
Hankies/ scarves to fold
Peppermints
Jewelry to sort
Hand lotion
Bandana
Stuffed animal
Collaboration- Working Together
Job Box
Toys to sand
Fabric for bandages
Candlestick to polish
Old milking machine
Ledger books/ grade books/ restaurant order pads
Cross stitch hoops
Large knitting needles, crochet hooks
Old post cards to sort
Fishing bobbers to sort
Soda bottle with birdseed/ objects to find.
Multi-Sensory Stimulation
Create a Spa:
Decorate the room like a resort with palm trees,
umbrellas, beach posters, etc.
Facials, make-up, manicures and pedicures
Hair care
Massage and aromatherapy
Soothing music or environmental sounds
Juice bar
Do “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 sleeves
File folders make durable pages for
pictures
Use copies of precious pictures
May also make a Life Story box with 3-
Spirituality
Beloved religious items: Bible, rosary,
Koran, Menorah
Magazines from faith organizations
Sacred music
Designated 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 play
When 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 Clothes
Wear 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 Eighth
Said Farmer
Brown
Sure Had
Trouble
Who’s Bald on
Top
Short-Term
Wives
“Wish I Could
Long-Term
Rotate the Crop”
Stubble
Older Than Dirt
 Head light dimmer switches on the floor?
 Using hand signals for cars without turn signals?
 Blackjack chewing gum
 Wax coke-shaped bottles with sugar water
 Candy cigarettes
 Telephone numbers with a word prefix
 Metal ice trays with a lever
 Mimeograph paper
 Blue flash bulbs
 Roller skate keys
 Wash tub wringers
 Newsreels before the movie
How Not to Get Hit
Triggers for dementia behavior are the key
Prevention ( or reduction) of behavior
works best
Environmental Triggers
 Relocation
 Architectural maze
 Uncomfortable environment: (too hot/ cold,
uncomfortable seating)
 Noise
 Hubbub
 Sensory stimulation: over or under
 Inadequate lighting cues
 Reflective surfaces
 Varied flooring surfaces
Physical/ Psychosocial Triggers
 Pain
 Illness: UTI, MI, CVA, Dental problems, etc.
 Medications
 Disruption of circadian rhythms
 Depression
 Boredom
 Pre-morbid personality
 Interaction with peers
 Depressed caregiver
Caregiver Interactions
 Lack of knowledge about dementia
You need to know what type of dementia the person
has
Remember—it’s the disease, not the person, that is
in control
 Lack of knowledge about the person
Really know the person and what interests them
 We all need to “do” things
Having meaningful days
 Lessens anxiety
 Helps keep emotions in balance
 Increases feelings of comfort & belonging
 Reduces behaviors
Caregiver Interactions
Carried-over emotions from personal life
How’s Your day going?
Hurry
The 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…
Download

How to Have Fun and Not Get Hit--Successful