Use of Activities to Maximize
Quality of Life in Residents with
Mental Illness
Brenda K. Keller, MD
Assistant Professor
Division of Geriatrics and Gerontology
UNMC
Recreation's purpose is
not to kill time,
but to make life,
not to keep a person
occupied,
but to keep them
refreshed;
not to offer an escape
from life,
but to provide a
discovery of life.
Author Unknown
Why Activities?
• In a survey of caregivers, over 90% expressed
that their biggest challenge was finding
recreation activities that kept cognitively
impaired individuals engaged in meaningful
pursuits.
•
Buettner&Langris, 1999
• In our pre-series survey, Activities for Dementia
Residents received the highest interest rating for
many respondents.
• In long term care facilities 60-80% of resident’s
time when awake is unstructured.
Focus of this Talk
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What is Therapeutic Recreation?
What is required of facilities?
How can activities make a difference?
How to choose activities for your
residents?
• Sample activities?
What is Therapeutic Recreation?
• 2000 National Therapeutic Recreation
Society (NTRS):
• Therapeutic recreation uses treatment,
education and recreation services to help people
with illnesses, disabilities and other conditions to
develop and use their leisure in ways that
enhance their health, functional abilities,
independence and quality of life.
• Approved by the NTRS Board of Directors
October 14, 2000
Who is responsible?
• “All relevant departments should
collaborate to develop and implement an
individualized activities program for each
resident.”
– State Operating Manual
“But I’m not the activities director!”
• Activities can (and should) occur at any
time and are not limited to formal activities
staff.
– Occupation and activity is highly correlated
with reduced levels of agitation
• Reflect on your own activities at home—
how many are formal and planned?
– Strongly encourage all staff to engage in
unscheduled activities
How can activities make a
difference?
• Residents participating in a sensorimotor
therapy program have been found to have
increased flexibility, strength and less agitation.
• Walking programs in NH found to be just as
effective as medications in slowing cognitive
decline.
• Facilities which incorporated family and friends
in activities reported less agitation.
– Giving family members an activity to engage in with
the resident lowered their own frustration and burden
Individualizing Activities Based on
Physical limitations
• Vision
Individualizing Activities Based on
Physical limitations
• Hearing
Individualizing Activities Based on
Physical limitations
• Hand dexterity
Individualizing Activities Based on
Social limitations
• Preference to remain in room
Individualizing Activities Based on
Cognitive limitations
• Task segmentation
– Break up the action or activity into many small
discrete steps
• Tasks using retained LTM
– Reminiscence group
• Length of activities based on attention span
– Like meals, smaller and more often may be best
strategy
• Smaller groups and one on one activities
– Increased ability to attend to task with less stimulus
Individualizing Activities Based on
Behavioral limitations
• In General- activities should be used to
prevent behaviors, rather that treat
behaviors.
– Again, most research finds lessened levels of
disruptive behaviors, psychiatric symptoms
• Once behaviors escalate, activities may be
less effective or actually worsen the
behavior.
– Forcing one to attend will lead to worsened
concentration and more frustration
Individualizing Activities Based on
Behavioral limitations
• Wandering
– Provide plenty of space and physical
exercise.
– Encourage walking programs with volunteers
– Have rest chairs along path.
– Place interesting objects at eye level that the
resident can manipulate
– Use music and aromatherapy around the
walking space
Individualizing Activities Based on
Behavioral limitations
• Aggression
– Provide calm, non-rushed environment
– Folding, sorting, and matching tasks
• Repetitive activities tend to lessen anxiety in any
age
– Preferred music, walking, snacks, looking at
familiar pictures
– Physical exercise
• Lessens anxiety
Individualizing Activities Based on
Behavioral limitations
• Verbal outbursts
– Counter verbal measures can be helpful
• Listening to music the resident historically enjoyed
– Speakers, headphones
• Sing-a-longs can be very helpful
• Videos of family members
– Discuss past events
– May have photos of event or family member on screen while
family narrates
• Audiotapes or CDs
– Nature sounds
» Babbling brook
» Ocean waves
» Rain forest
Individualizing Activities Based on
Behavioral limitations
• Rummaging through others possessions
– Activities which require unpacking or
disassembling objects
• Taking it all out, put it back, take it out…
• Use a relatively safe simplistic device to
disassemble
– Sensory aprons
• Pockets full of miscellaneous objects
Individualizing Activities Based on
Behavioral limitations
• Social withdrawal
– One-to-one interactions
• Hand massage, blanket stimulation
• Reading to the resident
– Limited participation in past hobbies
• Sort out fabric pieces
• Arrange items in a tackle box
– Videos of past interests
• Football games
• Weddings
– Slowly increase the size of the group
Individualizing Activities Based on
Behavioral limitations
• Lack of personal safety
– Activities with soft objects which cannot be
swallowed
– Walks, scheduled exercise
• Especially if the resident attempts to stand on their
own and is unsteady alone
– Microwave cooking or making Jell-O
• Avoid burns with cooking activities
– Large puzzles with few pieces
– Towel folding
Specific Programs and Activities
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Simple pleasures
Sensory aprons
Sensory stimulation box
Look inside the tacklebox
Message magnets
Tether ball/balloons
Time slips
Simple Pleasures
• Volunteer produced activities for use by
residents, families, staff. Activity cart left
on unit for use during “down” times.
• Specific instructions on construction and
use provided. Discussion points for each
activity are also provided.
• http://www.health.state.ny.us/diseases/con
ditions/dementia/edge/interventions/simple
/docs/activity_apron.pdf
Sensory Aprons
Sensory Stimulation Box
Look inside Tacklebox
Message Magnets
Most Popular Item
TimeSlips
• Storytelling activity that involves residents of all
abilities focus is on imagination, not memory
• Need photograph with non-specific content
• Group members are encouraged to write a title
and build from there.
• All input validated and recorded while activity
occurring.
• Finished products can be included in bound
volumes for families, staff.
Dog Talk or Two Dogs Making
Friends
Two dogs are saying “how are you?” and “how’s the family?” The dog on the right has a red and white handkerchief on his neck. That’s what color they
usually are. He’s saying, “I forgot to brush.” They’re meeting at a stop and go light up in the air, someplace in the south, and they’re in an automobile.
The more you look at this, the more comical it gets. Pretty soon they’ll be shaking hands! But they can’t reach each other.
It’s a really nice day, but it’s cloudy. You can see the clouds. Maybe it’s not a very nice day.
The dogs’ names are Tom and Fluff, or maybe their names are Pat and Mike. Tom has more hair which I don’t have! They are saying “come over and
play with me.” Either they’re not very smart, or they’re intelligent. All dogs are smart.
One dog wants a big bone. That sounds nice!
They’re going out of town and they will be in a parade at a fair. They’re going to visit somebody. They’ll sit there and have something to eat and go
home.
Their heads are sticking out the windows because that’s what dogs do. They want to get out. They’re talking to each other and they’re just plain nosy! I
think they’re glad to see each other.
They had a good time—a ball at the mall. They say, “We had a great time. Maybe we’ll see one another again.” Then they say, “Let’s call it a day!”
April 9, 2008: Written by Alice, Mary, Tom, Ellen, Sandy, Katie, Dorothy S., Dorothy Z., Florence, Ethel, Patsy
Staff who assisted: Lauri, Sally, Sherry, Pam
Volunteers: Susan, Jean
Companion: Ginny
The storytellers are from Brewster Village, Appleton, WI.
Posted by: Susan McFadden on April 10, 2008
http://www.timeslips.org/
Special Events
• Walkathon fundraiser- set goals for
number of steps/feet resident will walk in
the week and seek sponsors to donate per
step rate. Residents to choose charity to
benefit from the walk-a-thon.
• Senior Prom
• Pie Contest-each unit makes a pie and
then all residents vote on their favorite.