Carefully designed activities can have a positive effect on depression, confusion, and challenging behaviors. Activities should provide a positive experience, be meaningful, and be challenging.
Telenius et al., 2022
Whatever the stage of the dementia, everyone appreciates meaningful activities. We like helping one another, teaching someone a new skill, and contributing to the success of an activity. Caregivers often make the mistake of doing everything for the person they are caring for, stripping them of any meaningful way to contribute, to help, to learn, and to grow as a person. Everyone yearns for meaning in their lives and a good activities program can help accomplish that goal.
Activity programs start with a detailed interview about the person’s interests and skills. The nursing and therapy staff complete a thorough cognitive, language, and motor skills assessment. As a person’s dementia advances, activities are reassessed and simplified.
Activities programs can positively influence a person’s quality of life. Adult daycare facilities typically provide include strength and balance training, flexibility exercises, and cardiovascular activities. Other common activities are recreation and games, arts and crafts, musical activity, and rest.
The Montessori-based Activities for Person with Dementia has had some notable successes in the design of activity programs for people with dementia. This approach emphasizes matching a person’s abilities with the activity. It uses personalized interventions to maximize the abilities of each individual (Chan et al., 2021).
Montessori programming highlights task breakdown, guided repetition, progression in task difficulty from simple to complex or concrete to abstract, the careful matching of individual past interests and occupations, and self-correcting. The activities are designed with an individual’s past experiences and interests in mind. This approach is consistent with the person-centered care approach recommended for dementia care (Chan et al., 2021).
This program engages participants in meaningful activities that promote learning through procedural* or implicit** memory with the support of a prepared environment and external cues. The acronym “CREATE” represents the principles of type of activity design.
Program designers create a prepared environment and remove unnecessary distractions. They design an error free process in which all materials are familiar to the participants. Templates are provided according to individual needs and ability, and the environment is home-like. (Chan et al., 2021).
*Procedural memory: a form of long-term memory associated with motor skills, habits, and tasks.
**Implicit memory: unconscious or automatic memory.
6.1 Individual Activities
Successful individual activities for individuals with dementia are based on a person’s likes, dislikes, and interests. This means a caregiver must learn a person’s history and understand their capabilities and preferences. Understanding a person’s lifestyle, whether they can still read, write, or use a computer and determining what a person is physically capable of doing is the basis for the design of individual activities. Individual activities that stimulate the senses, such as cooking, singing, exercise, going for a drive, gardening, and aromatherapy, are encouraged at all stages of dementia.
Some organizations that serve older adults, such as the Eden Alternative, encourage pets in their facilities. Pets provide companionship, promote relationships, and provide meaningful activity and exercise. Taking care of an animal gives a sense of purpose and companionship and is a key component of person-centered care.
Adults often have a fear of failure (especially those aware of their cognitive decline) and may refuse to participate in activities because of this fear. Be on the lookout for signs of frustration and agitation and address these behaviors immediately.
Individual Activities at Different Stages of Dementia | |||
|---|---|---|---|
Activity | Mild | Moderate | Severe |
Word games | Word searches, crossword puzzles Card/computer games | Simple word searches, simple crossword puzzles Simple computer games | Discuss a simple topic Listen to others |
Letter writing | Write a letter Send email, use Facebook, social media | Dictate a letter or email Use Facebook with help | Listen to a letter or email being read |
Art/Music | Take photos Create a photo album Draw, play an instrument | Take photos Maintain a photo album Draw, sing along with others | View photos Listen to music Sing along to familiar songs |
Woodworking | Use tools Plan and complete projects with assistance | Use simple tools with supervision Assist with projects | Use activity board with bolts, screws Watch projects |
Sewing | Use sewing machine with help Plan and complete projects with help | Use simple tools with supervision Assist with projects | Use sewing cards, activity blankets or aprons with buttons, snaps, ties, Velcro, and zippers, watch projects |
Gardening | Garden in raised beds Help plan the garden and harvest | Perform specific tasks with supervision Eat food grown in garden | Sit in garden, eat food grown in garden Participate as able |
Crafts | Knitting or crochet using large needles | Choose colors, roll balls of yarn | Choose colors, use the items that are created |
At home activities | Help with laundry, put clothes away, assist with housekeeping | Sort and fold laundry | Fold laundry—may want to fold the same items repeatedly |
Shopping | Go along to store, help with purchasing decisions Help put groceries away | Go along to store, help as able with shopping decisions Help put food away | Go along to store, sit in car with supervision or shop with wheelchair or electric cart |
6.2 Group Activities
Cognitive impairment isolates us from other people, and can lead to anxiety, depression, societal withdrawal, and decreased self-confidence. Meaningful social interactions help a person with dementia regain a sense of self-worth.
As dementia progresses, group activities may become more challenging and individual activities may be preferred. Small groups of 5 to 6 people allow more activity and personal attention, although well-planned large-group activities can also be successful.
Group Activities at Different Stages of Dementia | |||
|---|---|---|---|
Activity | Mild | Moderate | Severe |
Karaoke | Sing while reading words | Sing familiar songs | Listen and sing along |
Cooking | Bake cookies, prepare a snack plate for others, clean up after cooking | Participate in making cookies, assist with cleaning up | Help decorate cookies that are already baked, eat the cookies |
Nature | Nature walks, outings to nature areas, fruit picking | Shorter walks Picnicking outdoors | Escorted walk or wheelchair outside the facility, attend picnic |
Crafts | Make ornaments Decorate room or facility for holidays | Participate in making ornaments Assist with decorating for the holidays | Participate in crafts Participate in decorating parties |
Outings | Shopping, eat out Theater and music events, museum visits, library visits, attend sporting events | Same as mild with some adaptation and more supervision. | Set up a store where the resident can purchase items Watch movies, outings with direct supervision |
6.3 Virtual Reality
Recently, a great deal of research has been done on the use of virtual reality programs for older adults with and without dementia. The programs are designed to reduce loneliness, improve physical activity, and engage older adults in activities such as virtual travel.
Mynd Immersive, in collaboration with several large companies, has created the “Great American Elderverse”, which allows older adult to socialize with friend and family, learn about the world, and engage in pursuits and passions. Elderverse programs focus on exercise and rehabilitation, recreation, reminiscence, and distraction. For older adults with dementia, the programs have been shown to reduce challenging behaviors, improve mood, and stimulate cognition.