Activities and Interaction as Daily Dementia and Alzheimer's Care

Activities and Interaction as Daily Dementia and Alzheimer's Care

The condition and level of care required by a Person with Dementia (PWD) will differ from one individual to another. Differences in need relate not only to physical capability, but also to variations in cognitive function (thinking ability), memory, and the behaviours that emerge as a result of brain dysfunction.

Whatever the individual differences and uniqueness of each person, one universal principle in caring for a PWD is the value of routine, social interaction, and meaningful daily activity — to slow the rate of decline and pursue the best possible quality of life given their current condition.

The Benefits of Routine

Performing things routinely helps to reduce stress and pressure for a PWD by limiting the need to constantly make new decisions or adapt to new situations.

With a consistent daily schedule — from wake-up time, bathing, breakfast, and onwards through to bedtime — life for a PWD becomes more structured and predictable. When a person can follow an established pattern, they can feel more comfortable and secure because they are better able to understand what is happening around them.

Beyond a regular schedule, standardising the sequence of various daily living activities brings the same benefit. For example, the sequence of activities from the moment of waking can be set — first making the bed, then going to the bathroom, having breakfast, watering the plants, and so on.

Certain processes can also be standardised to reduce confusion — such as where the toothpaste, toothbrush, and rinsing cup are kept, and the sequence of opening the tube, applying toothpaste to the brush, filling the rinsing cup, brushing, rinsing the brush, and returning everything to its place.

Although these steps may seem trivially simple, for a PWD a situation in which they cannot find their toothbrush or do not know when it is time to eat can become a significant problem that causes genuine distress.

The Benefits of Activity in Dementia and Alzheimer's Care

The purpose of engaging a PWD in more substantive or meaningful activity is not only to optimise their basic capabilities (such as reading, speaking, singing, painting, and so on). Engaging in activity also aims to build their sense of confidence and pride through being able to do something productive and meaningful.

One important thing to always remember: because of their condition, a PWD will almost never initiate an activity on their own. They will therefore always need to be guided into an activity — with the intensity of guidance adjusted according to the symptoms present, such as difficulty concentrating and short-term (working) memory limitations.

Meaningful activity can take virtually any form — the key lies in how we guide the PWD so that the activity can be completed to the best of their ability and delivers the satisfaction that is hoped for. Examples include:

• Arts and crafts: painting, various handicrafts, composing poetry, etc.
• Performing arts: dancing, singing, reciting poetry, etc.
• Communication: discussion, sharing opinions, storytelling, etc.
• Physical activity: various ball games (e.g. throwing and catching, kicking, basketball shooting), gentle exercise, etc.
• Games: various tabletop games (e.g. cards, Scrabble, draughts, Uno), riddles, puzzles, etc.
• Household tasks: sweeping, folding laundry, washing dishes, cooking, watering plants, feeding fish, etc.

Several studies have confirmed that engaging in a variety of activities provides measurable benefits in maintaining thinking ability and daily life satisfaction — with benefits that exceed those of medication alone. Improvements in quality of life and communication ability have also been observed.

Challenges in Implementing Activities in Dementia and Alzheimer's Care

Although activity is clearly beneficial for a PWD, they may sometimes hesitate or refuse to participate. This can occur for several reasons, including:

• feeling self-conscious that their capabilities have declined;
• worrying that they no longer know how to do something;
• fearing they will do it incorrectly or imperfectly;
• difficulty understanding what is happening around them; or
• simply feeling physically drowsy or tired at that moment.

A passive lifestyle, however, leads to boredom — and boredom is frequently the root cause of the negative behaviours that can emerge in a PWD.

The following are practical tips to bear in mind when implementing activities in dementia care:

• Timing of activities — Try to time the activity and match its type to the person's physical rhythm. Is the activity too energetic for late afternoon when they are already tired? Activities requiring concentration are better suited to the morning when they are still fresh.
• Environment — A supportive environment will help the PWD be more cooperative. Is the surroundings noisy? Aim for a quiet, tidy space to support their ability to focus.
• Personality — Is the person more comfortable in a one-on-one setting or do they enjoy being with a group? Matching the activity context to their personality supports a higher likelihood of success.
• How to initiate the activity — Avoid inviting them in the form of a question, such as "What do you want to do?" or "Do you want to paint?" Instead, frame it as an invitation: "Come, let's try painting a flower." If resistance may arise due to self-consciousness or feeling incapable, try: "I would like to paint a flower — could I ask for your help mixing the colours?" This way, their participation can be gained gradually while building confidence until they may be willing to join in the painting itself.
• Provide step-by-step guidance — Instructions and guidance must be given one step at a time so they can follow each stage easily, in line with their capability. Depending on the complexity of the activity and the person's ability, each activity can be broken down into five levels:
  • Preparation — materials are set out in advance. For example, for a flower-potting activity, the pot, seedling, trowel, and other items are arranged beforehand.
  • Supervision — observe the existing capabilities of the PWD as they engage in the activity. If their independence is relatively high, supervision and minimal assistance is sufficient.
  • Prompting — providing cues for each next step. For example, after placing the seedling into the pot, what is the next step?
  • Verbal guidance — instruction in words, such as: "Now you can add soil to the pot until it's full."
  • Physical assistance — PWDs often need physical guidance, such as demonstrating a movement first, or gently holding and guiding their hand.
• Don't be too rigid — The core principle in doing activities with a PWD is a perspective focused on what they can do, not what they cannot. Everything must start from whatever ability currently exists in the person. If their capability is only to paint a single line or make a dot with a paintbrush, accept that as an initial success — then work toward improvement as far as they are able. It is we, as their companions, who must remain enthusiastic and not give up or avoid an activity because we feel the PWD cannot do it "properly." The benefit comes not from the outcome of the activity, but from doing the activity itself.
• Always encourage — Related to the point above, every activity achievement by the PWD should be appreciated, to build their confidence and increase their willingness to continue participating.

Accompanying a PWD in activities requires patience and wholehearted sincerity. We must maintain sensitivity and a high capacity for empathy in order to ensure that our efforts to engage them in activity are truly aimed at enhancing their own comfort and satisfaction.

The best living environment for a PWD and those around them is one where the PWD's daily life is planned proactively — with an adequate level of social interaction and activity — so that they consistently feel safe, comfortable, and productive.

About RUKUN Dementia Support Solution

RUKUN Senior Living offers a range of residential facilities and specialised services for seniors with dementia as a solution for senior families.

www.rukunseniorliving.com/dementia-support
Email: info@rukunseniorliving.com
Phone: 021 8795 1525