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 a person’s dementia, everyone wants activities to be meaningful. 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.

4.1 Individual Activities

My 89-year-old mother Jane often expressed longing for a dog, but she knew she would be unable to walk and care for one. She was adamant that she stay in her own home but eventually it was no longer possible. It turned out her care facility had a golden retriever dog that lived in the unit. Mother was very pleased to see him, and it helped her adjust to living in a care facility.

Jane’s daughter, Kansas City

Successful individual activity programs for people living with dementia are based on a person’s likes, dislikes, and interests. This means learning about a person’s history and understanding their capabilities and preferences.

Determine whether they can still read, write, or use a computer and what they are physically capable of doing. Individual activities that stimulate the senses—including 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. Celebrating the holidays is both an individual and group activity, which is interesting and stimulating.

Some people may refuse to participate in activities. Be on the lookout for signs of frustration and agitation and address these behaviors immediately.

4.2 Group Activities

Cognitive impairment isolates us from other people, causing anxiety, depression, withdrawal, and decreased self-confidence. Meaningful group activities help all of us maintain a sense of self-worth.

Small groups of 5 to 6 people allow more personal attention, although well-planned large-group activities can also be successful. Keep in mind that, as a person’s dementia progresses, group activities can become more challenging and individual activities may be preferred.

Group exercise programs such as walking, resistance training, and seated exercises that focus on improving aerobic endurance, strength, balance, and flexibility are beneficial.

An innovative group exercise program developed at the University of California at San Francisco integrates principles from several well-established traditions including Feldenkrais Method, Rosen Method, Tai Chi, and yoga, with elements from occupational therapy, physical therapy, and dance movement therapy (Chao et al., 2021).

The program, Preventing Loss of Independence through Exercise (PLIÉ), was specifically designed to address the needs of people living with cognitive impairment using seven guiding principles (Chao et al., 2021):

1. Repetition with variation (to promote procedural learning while maintaining engagement).
2. Progressive, functional movement (to support basic functional movements such as standing safely from a seated position).
3. Slow pace and step-by-step instruction (to enable participants to participate fully, experience feelings of success, and minimize cognitive demands).
4. Participant-centered goal orientation (a goals assessment is performed at the beginning of the program, and instructors tailor content to address the personal interests and goals of participants).
5. Body awareness, mindfulness, and breathing (to bring nonjudgmental awareness to the body in the present moment).
6. Social interaction (participants sit in a circle, and many movements involve reaching across the circle to touch hands or elbows or standing in a circle holding hands and moving together to facilitate social connection).
7. Positive emotions (participants are encouraged to move in ways that feel good, personally meaningful music is incorporated, and all classes end with sharing of appreciations and things that bring joy).

4.3 Virtual Reality

There has been a great deal of research done in recent years on the use of virtual reality (VR) programs for older adults (with and without dementia). VR programs are designed to reduce loneliness, improve physical activity, and engage older adults in activities such as virtual travel.

Virtual reality offers a multisensory experience that can be attractive for people living with dementia because it stimulates multiple senses. VR may be helpful in improving memory, dual tasking,* and visual attention. For some people living with dementia, it can reduce anxiety, improve feelings of well-being, and increase use of coping strategies (Stasolla et al., 2024).

*Dual tasking: doing two things at once, such as walking and talking or cooking dinner while watching television.

Although the use of virtual reality is often user-friendly and well-accepted by older clients, side effects can occur. The most common reported side effects associated with virtual reality use include cybersickness (nausea, dizziness, disorientation, postural instability, and fatigue). Some people have reported delusions, strong negative emotional responses, upsetting memories. Adverse effects can also include vestibular-related side effects, physical experiences, and psychological impacts (Woo and Lee, 2023).

Some older virtual reality study participants reported issues with the head-mounted device, including that it was too heavy; caused general discomfort, disorientation and imbalance; and caused feelings of being trapped, confined, afraid, or anxious (Healy et al., 2022).

For a person living with Lewy body dementia, cognition can fluctuate from day to day. A person’s response to the use of a virtual reality device can be good one day and cause confusion, hallucinations, and panic the next day. To prevent cognitive overload* and hallucinations—especially in clients with Lewy body dementia—the virtual reality experience needs to be tailored to the user’s own capabilities. Keeping the programs simple and providing close monitoring can reduce or prevent these adverse reactions.

*Cognitive overload: when the brain tries to process too much information all at once.