Each person is worth of dignity, taking care of the weak and sick is therefore very important. People with dementia need caring support and help, but gradually. Dementia is a condition, that develops over a longer period of time. The researches show it takes from 8 to 10 years or more. With different levels of dementia progression, we need different stages of help and support.
Work, profession, hobbies, free time activities, care of others, everyday chores, personal care, care for home and other important activities are preserving person's identity, competence, self-worth, security and sense of ability. When a person gradually notices that some of the functions are fading and things are not as easy as they used to be, they are in distress and need emotional and physical support of others.
Every activity or chore that a person is still able to do on their own, is comforting and is keeping the feeling of competence, worth and satisfaction. That is why the planned and gradually offered help of the relatives is extremely important. The procedure is the same when we are dealing with the children and if we do things for them they will not learn anything on their own. The same goes for the person with dementia. The only difference is that we allow a person with dementia to do things on its own because we don’t want him/her to learn new things, but to preserve the left functions and vitality. Each activity is strengthening or preserving the vitality of the mind process, sensory and motoric functions. Preventive action is therefore crucial. The research shows that different free time activities, that are obtaining or strengthening the brain plasticity can slow the progression of dementia.
It is reasonable to regularly check what a person can do and where he/she needs support. In the beginning of dementia people might need a little bit of support (notes, where they put certain things, help with finances, escort to the city, store, etc.). Later, the abilities to do house chores are going to fade gradually (cooking, working in the kitchen), therefore the exercises for motoric functions can be subtly included in other chores. For examples they can cut, peel, etc. We can also organize some free time activities, that would stimulate those functions and abilities. For example, the person does not recall what he/she had for the last meal, because the short-term memory is weakened, but he/she remembers some stories from life while looking at the old photos. This kind of activities can relax and also obtain the feeling of self-worth, self-consciousness, pleasure and connection with others.
People with dementia need different and unique approach, that requests a lot of flexibility and adjustments in communication and cooperation. It is very hard when we spend a lot of time with a person with dementia and we dedicate our free time for them, do our best to make them feel good (cook for them, take them for a walk, play with them, etc.) but the person doesn’t even remember anything, or they don’t even recognize us. It is very painful for the family to realize that and it takes a lot of emotional adjustments and understanding.
We are listing which activities are suitable for people with dementia and what are the things you should bring special attention to while executing the activity or training.
Adjust the surroundings
Remove any unnecessary labels or items from the material for the activities and from the table. Adjust the noise level and make sure there are no other distractions (noises from other rooms, loud speech, loud music, loud neighbours). All of these things can be distracting for a dementia patient and they won’t be able to concentrate solely on the activity.
Talk less, show more
At the moderate stage of dementia, you always have to show, how to do an activity- if it’s necessary, you have to adjust or simplify the activity. While doing this, you should give as little verbal instructions as possible and concentrate more on showing the activity. It will be easier for the dementia patients to follow the activity if they can see what is happening, rather than to only hear the instructions. The processing of verbal instructions are fading quicker than the ability to process gestures and visual signs.
Choose an activity with a significant meaning
One of the keys of success to help patients with dementia complete an activity successfully is to use the items or objects that are close to that person. We have to know their past interests or hobbies. Therefore, we have to offer or provide known things as a didactic material.
As an example; a person who was a carpenter, knows tools very well. If we show him the tools he knows, it might bring back some explicit memories. We have to know that more similar the objects are to the real items, more likely is that a person will remember something. This kind of activity guarantees quality time for family, because it will surely bring back some memories or stories from the past. For people with severe stage of dementia there is specially designed and adjusted activity Tool Shed.
Offer a choice whenever that is possible
When we decide to do an activity for strengthening an implicit-procedural memory with a person with a moderate or severe stage of dementia, we have to avoid questions such as: “What do you see in the picture?”, “When did you work as a mailman”, “What do you want to drink?”, “What do you want to do today?”. These kind of questions only confuse the person, because they are too wide.
The point of the brain training/ strengthening memory is, that we make a person with dementia feel good and successful. If they feel stressed or embarrassed, they normally shut down and do not want to cooperate anymore. That is why, we always have to offer them two options so they can choose their answer. Examples: “Do you see a Slovenian or English flag in the picture?”, “Do you want to drink milk or apple juice?”, “Do you want to assemble puzzles with a motive of a cat or a train?”- we can provide both options in visual form as well so the person can decide. We offer them an answer as there is, and there is an automatic connection with implicit and explicit memory.
Another important thing to keep in mind is to invite a person to join for an activity rather to order them to. Example: “Would you like to help me assemble the puzzle?”, “Would you like to help me clean the dishes?”
Repetition is the key to success
Repetition is always the key to success. That is why, we have to practice activities and routine chores, that are still well preserved in the memory (they are a part of implicit memory, that stays in our brain the longest). The more we train with the patient, the more successful he/she will be (the term for this is repetition priming). The satisfaction with the small victories are good for the self-image and well-being. The person might not remember how the activity went from start to finish, but the memory will keep the process execution. The repetition is essential with the patients with severe stage of dementia, because we will keep the brain occupied without the stress of learning something completely new. The results of several researches show, that repetition of a known activity has a much bigger success than trying to teach something new.
The activity can be done with everyday objects such as toothbrush, combs, silverware, etc. All these items can be put in a box with an open top and a person can reach in the box and try to guess which object they are holding in their hand, solely using the touch (no looking). If they recognize the object, they can pull it out of the box/bag. Similar product can be find in our webstore.
Divide the process into more steps, simplify as much as possible
Because the routines and processes are staying in the memory for the longest, they have to be repeated and nurtured. Even though the memories of the activities are damaged, we can restore some of the memories with appropriate presentation and repetitive actions. The simple procedures can be taught and the knowledge can be restored (they can easily forget they were already taught the procedure maybe a day ago or an hour ago, but the process will be remembered).
The part of the implicit memory is also classical conditioning, which is based on internalized patterns of behaviour. It is representing an activity when a stimulus automatically triggers the next impulse. For example: if we throw a ball to a person, their reaction would be to catch that ball. In the similar way our body reacts when we hear a song that we know or when we recognize a saying. These automatic reactions are very useful for the communication or motoric function practise with a person with dementia.
Another good example is following: If we suggest the person with dementia to vacuum the apartment and if we show them the vacuum cleaner, their reaction will be automatic. They would grab the handle and start vacuuming. The process of vacuuming is a routine therefore it is imprinted in the implicit memory. The same thing goes for board games. If we take ludo for example, it is our reflex to throw the dice. If a person with dementia ever assembled puzzles earlier in life, they would know what to do with the pieces. Of course not in the same pace as before, but still would know the process. The puzzles have to be adjusted to the level of dementia.
If the person helps us make tea, we have to make them find the tea pot, have them fill it with water, heat up the stove, wait until the water boils, pick the tea, take the tea bag, put the tea bag in the water for the exact amount of time and put some sugar in the tea. To make this easier for the person, we can take the picture of the tea pot and put the picture on the place where they can find the tea pot. Sometimes in later stages of dementia people don't remember where they put known objects, that is why the picture where it is, is always helpful. We have to slowly lead to the next step and we should never rush the person. We have to adjust the steps or make them more simple.
In the same way a person with dementia can help us set up the table (put the plates and silverware)- if they did this in the past, the memories should be stored in implicit memory. The person should be able to find the plates and silverware in the kitchen, if we help them by putting pictures of the items on the kitchen cupboard. With patients with severe stage of dementia we can take the number of the plates and put them on the table and the person can set the table without the stress of miscounting the plates and other items. If the person has problems with setting the table, we can make everything for them and only let them to put the plates on the places we have prepared.
Person can also help us wipe the dishes. If we hand them the wet silverware and they have a dishcloth in the hands already, they will automatically start drying the things in the hands, because of the implicit-procedural memory. If they are suffering from a severe stage of dementia and cannot recall this action, we have to show them (not tell) how to do it so they can repeat our action. The same goes for folding laundry, towels, ...
From simple to complex activities
We should always adjust the level of difficulty of an activity to the stage of dementia. Instead of immediately focusing on the activity (playing cards or dominos), we allow a person to sort the cards or dominos. Then we start playing the simple version of the game. After a few repetitions we can adjust the game to a complex version.
Patients with dementia also like to paint or draw. We have to stick to the simple-complex rule. People with the mild stage of dementia can be offered a bit complexed colouring books or complexed shapes. With the moderate stage or severe stage we have to start with easier paint products. Very simple paint products can be found here.
No pressure- there is no wrong or right
Always focus on the progress and less on the accuracy of the process. The person does not have to do everything right (do not correct them or insist on something if the person is having fun doing it), nor does a person need to finish the activity. The important part is the participation and enjoying the time doing the activity.
Adjust the speed and intensity of communication
The basic principle of communication should be, that you speak as much the person speaks (adjust the level of the speech). In the conversation never correct the person, speak calmly, slowly, articulate words and use a kind voice. Even if a conversation does not make sense, it comforts the person with dementia and it gives a lot of positive benefits to a person. Speaking to a person with dementia gives them a sense of respect.
Meaning of the music
Cognitive impairment effects different parts of the brain separately. The right hemisphere, which gives us ability to hear (recognition of sounds, music) is usually damaged later than the left hemisphere. Patients with dementia can remember some song lyrics or melodies when they do not remember other important things. Sometimes it happens that people do not speak anymore, but some known music can make them remember certain lyrics. If we sing with the person, or play some instrument, or even listen to music together, we can re-connect with them, create a certain bond between us and stimulate the brain. The implicit memory is responsible for song recognition therefore the chance of remembering the lyrics or a melody is big. This kind of communication is priceless for a person with dementia.
Auditory, sensory and visual perception are a shortcut to our personal memories
With the purpose of stimulating the visual perception, we can use photographs or pictures. They should be familiar to the person, they should be from everyday life, from the past, their occupation. To bring back explicit memories, the pictures should be very similar to the real life/original situations. The more original the picture is, the more likely is, that the person will recall some memories from it. Within our memory activities, you can find a lot of helpful material to recall memories and encourage the conversation.
We can also stimulate smell or taste. If the person smells known scent, it activates long-term episodic memory (where the smells, tastes are stored). If they recognize and can name the smell, it will trigger long-term explicit semantic memory. With our sensory products, you can stimulate multiple senses.
Try multiple activities
Try new and versatile activities. It is the only way to find the right activity where a person with dementia will enjoy. With all of our products, you can stimulate communication that creates a very intense bond between you and the patient. The person with dementia will appreciate your effort, and it will make them feel accepted and safe.