Activities for Persons with Alzheimer’s Disease (updated)

March 19, 2007

Guest Presenter:  Connie Lucas, Alzheimer’s Association

 

It is important that people with Alzheimer’s disease be able to engage in meaningful activities.  These could be general household tasks.  Remember, just because a person might not be able to do the whole task, doesn’t mean they can’t do part of the task. Think about what part of the job your loved one could do to help you.

 

Often, “going home” means going where the person feels safe and secure and has some control over their life.  A way to give the person back some control is to have them participate in their care and to have a choice of activities.

 

Refer to the handout on Assessment of Dementia – Global Deterioration Scale.  Identify the stage that your loved one is presently at, or where the preponderance of their activities presently is.  How long a person stays in each stage is unknown as there are many factors that could cause rapid deterioration.  Look backward from Stage 7 and rule out stages until you come to the state that represents the preponderance of symptoms and behaviors. 

 

Grief and Guilt come together for caregivers, and caregivers experience anticipatory grief.  Generally a person with Alzheimer’s diseases loses their skills in the reverse spiral of how memories and skills were initially formed.  It is important to remember that a person with Alzheimer’s disease is “always right.”  That is, there is no point in arguing with them or trying to correct them. They are not capable of learning the correction because of how the disease has damaged their brain.

 

Handout:  Assessment of Dementia – Global Deterioration Scale Adapted for families

1.                  No cognitive decline

·        The person seems normal to everyone

·        There are no complaints of memory loss from the person

·        Their functional abilities have not lessened

 

2.                  Very mild cognitive decline (age associated memory impairment)

·        Changes in short term memory

·        Depression - may refuse treatment

·        Conflict with others (marital conflict)

·        Increasing frustration, increased anger

·        Symptoms seen as willful or purposeful

·        Problems with employers

·        Refuses treatment for depression

 

3.                  Mild cognitive decline (mild cognitive impairment)

·        Losses or changes in the ability to:

ü      Manage employment

ü      Manage money

ü      Drive safely (gets lost, makes mistakes, fender benders)

ü      Shop and make change

ü      Plan vacations and trips

ü      Comprehend complex written materials

ü      Understand phone scams, ordering from catalogues, or subscribing to appropriate magazines may become a problem

ü      Perform chores. Those with power implements (snow blowers, saws, gas tanks) become unsafe

ü      Social participation may change

 

4.                  Moderate cognitive decline (mild dementia)

·        Cleaning

·        Cooking

·        Thermostat

·        Withdrawal from complex tasks

·        Loss of sense of  “risk”

·        Withdrawal from high stimulus activities and social activities

·        Increased irritability and self-absorption

·        Difficulty with planning

·        High degree of awareness, yet may be denial

·        Anger with lost activities

·        Loss of sense of humor

 

5.                  Moderately severe cognitive decline (moderate dementia)

·        Bathing – starts with resistance

·        Catastrophic behaviors become more regular

·        Grooming

·        Selecting clothing

ü      Wears same clothing all the time

ü      Changes clothing frequently

ü      Odd combinations

·        Non-recognition of TV, mirrors, pictures, objects

·        Personal withdrawal from activities and people

·        Decreasing awareness

·        Increased visual-perceptual deficits and recognition, complaints that glasses need changed

·        Sensitivity to noise, avoidance of groups

·        Clings to caregiver

·        Repetitive behaviors

·        Decline in language ability

·        Resistance to intimacy

·        Child-like affect

·        Pacing, wandering

·        Day/night patterns disturbed

6.                  Severe cognitive decline (moderately severe dementia)

·        Toileting

·        Toddler-like affect

·        Eating with fingers

·        Occasional problems with recognition of spouse

·        Ambulation (walking)

ü      Getting “glued” to floor

ü      Falling

ü      Shuffling

ü      Coasting from object to object

ü      Difficulty rising from chair

 

7.                  Very Severe cognitive decline (severe dementia)

·        Loss of ability to move about purposefully, i.e. pushing a wheelchair

·        Brain no longer seems to be able to tell the body what to do

·        Loss of regular verbal communication

·        Dependence in all activities of daily living

·        Loss of recognition of family members except during moments of clarity

·        Spontaneous behaviors, such as yelling

·        Generalized rigidity

·        Seizures, additional neurological problems

·        Needs to be fed

·        Complications of immobility and medical complications

ü      Weight loss

ü      Skin breakdown

ü      Repeated infections

ü      Aspiration

ü      Falls from bed (rollouts or climb-outs)

 

 

Activities for persons in Stage 7:

  • The cognitive capability / skill functioning level of a person at Stage 7 is approximately equivalent to an infant age 1 to 20 months. 
  • They are very sensory system oriented…see, hear, feel. 
  • They can experience pain, but are generally not able to explain or express their pain.  The family caregiver needs to pay close attention to this person’s non-verbal communication.
  • Important to talk to them and touch them.
  • Try to interact with them a minimum of 30 minutes at a time if they are awake.
  • Sing to them and with them, especially old songs from their youth such as church hymns or children’s songs, or old popular music.
  • Put things into their hands such as blankets, baseball gloves, dolls, but without looking childish.  Find a meaningful way of doing this such as asking for help dressing the doll for your child or grandchild.
  • Commercially available “Fuzzy Mittens” are especially good for sensory opportunity
  • Behavior is the key to communication.

 

Activities for persons in Stage 6:

  • The cognitive capability / skill functioning level of a person at Stage 6 is approximately equivalent to a child age 2 to 5 years.
  • Most problems occur with acting out or combative behaviors
  • “no” and “mine” are often used words
  • The language area of the brain is affected.
  • Easy to help the person get calmed and settled by singing
  • Can use distractions to redirect behaviors
  • Helpful. If you want the person to do something, show them the object you want them to use, and demonstrate the use.  They need help getting started.
  • Sometimes comments are rude. Swearing often occurs
  • Frontal lobe is affected.  The social filter/screen is broken.

 

Activities for persons in Stage 5:

  • The cognitive capability / skill functioning level of a person at Stage 5 is approximately equivalent to a child of 5 to 7 years of age.
  • They use creative cover-ups to hide their memory loss
  • Helpful if asked to do something, but instructions need to be simple and single commands.  Will have difficulty performing directions if given multiple step directions
  • Should not be left alone unattended
  • See list of suggestions at end of notes.

 

Activities for persons in Stage 4:

  • The cognitive capability / skill functioning level of a person at Stage 5 is approximately equivalent to a child of 7 to 10 years of age.
  • Should not be left alone.

 

General Notes:

  • Clutter is very disorienting for people with dementia.  Attempt to keep belongings and surroundings orderly.  Put clutter out of sight.
  • People in Stage 4 on have trouble initiating activities. They need help with starting the task.  Once started, old habits will take over and help complete the task.
  • Overall, people with dementia have trouble remembering things, especially newer or more recent events.  Memories and skills are generally lost in the reverse order of how they were acquired.
  • There is a new drug in Phase 3 Clinical Trials, Flurizan, which appears to be working to flush out some of the plaques in the brain. It is still approximately 2-5 years away from being generally available.  Check with your physician about inclusion in the clinical trial if you are interested.
  • Other interesting news regarding medication, Namenda is now in trial to treat autism.

 

Neat things to use to prompt thinking / brain activities for persons with dementia:

  • Memory journal (good up to Stage 5) “To the Best of My Recollections.”  Encourages brain work.  Available from www.mymemoryjournals.com.
  • Story Corps “Memory Loss Initiative.”  Uses wisdom-type questions and encourages person to think about how different experiences have affected them.  Available at www.storycorps.net/about/outreach/memory_loss_initiative
  • Book: “Birth of the Chocolate Chip Cookie” stories to read aloud.
  • Story starting pictures available at www.TimeSlips.com.
  • Make a Life Story Book

ü      Helps person remember

ü      Helps caregiving staff learn about the patient

ü      Serves as good discussion starters

·        Talking photo albums.  Allows you to record a brief 7 second message with each photo.

·        Book: “A Curious Kind of Widow”

·        Remember to help people maintain their brains

ü      Books of Brain Games

ü      Nintendo games

ü      Thinking Cards available at www.attainmentcompany.com

ü      Puzzleminds available at www.puzzledminds.com

ü      Puzzle books

ü      Jigsaw puzzle books and jigsaw puzzles of smaller number of pieces.

·        Toys / things for the hands.  A good source is The Alzheimer’s Store

ü      Jacob’s ladder

ü      Clicks

ü      Cush ball

ü      Extra big calendars and calculators

ü      A roll of masking tape or painters tape

·        When you go visit, go with something in a little bag or small box to let them play with and fondle.

·        “Melissa & Doug’s” bag of wooden toys

·        Pictures and holograms

·        Plastic canvas and vinyl lace for needle point pictures

·        Talking video

·        Sorting activities (sorting for a purpose)

·        Ask opinions.

 

VISITING ACTIVITIES:

  • Sorting or matching projects
  • Category projects (Montessori)
  • Exercises the two of you can do – stretch bands, ball toss, ankle circles
  • Old bed sheets to tear into strips for rag rugs
  • Dance
  • Bring in something they can help you “fix”
  • Old photo books, cookbooks, school yearbooks
  • Bring a small tub to soak feet in and give a foot massage
  • Small candy bars to share with their favorite caregivers and friends
  • Chewing gum can help with agitation
  • Recite old proverbs and leave out the last word
  • Pray old familiar prayers
  • Cut out coupons
  • Bring a sack of newspapers to have them help you tie them up for recycling
  • Shoes and polish for polishing
  • Cut flowers and a vase to make arrangement
  • Polish your silver
  • Ask them to rub or scratch your back
  • Wind up things that make you laugh, like a set of walking false teeth
  • Bring the same special box or bag with a surprise in it
  • Celebrate daily victories
  • Plant something in small pots (parsley to share with the kitchen)
  • Recipe file box with different colored file cards to sort (bring a few recipes from home and start to organize your own recipes with them
  • Tell them how glad you are that they have been in your life
  • Life Story Book
  • Something to drink in a thermos and 2 pretty glasses or cups (homemade lemonade, hot chocolate, favorite soups)
  • Newsletters from church or clubs to read out loud
  • Letters from other family members to read. Put on a bulletin board for staff to read to them again later.
  • Take a large colored paper clip or other item and talk about what you might do with it. Write down the answers and you give some also.
  • Bring a large picture of a person doing something (not someone you know) and write a story together about the picture. Ask questions such as “what should we call this picture, what do you think they are doing, what might be their names?” Write down their answers.
  • Write a love letter and read it every time you visit. One gentleman rewrote his wedding vows and read them before he left each day.
  • Establish a tradition of something you do each time you come. Sing a certain song, go for a walk outside, have ice cream, play cards.
  • Play the “name game” and together think of and write down as many things as you can that are in the garden, are green, at the hardware store, in a bank, etc. Any answer is fine.
  • Is there a job you can do together for the facility when you visit
  • Send cards and write letters
  • Invite a friend or family member to go with you. They might have been “thinking” about a visit and were not quite comfortable going alone.
  • Bring something from home they might identify just to have something NORMAL in their hands (old baseball glove, tools, spools of colored thread, billfolds, old jewelry box, etc.) Stage 7 might like design ice cube trays
  • Yarn to roll into balls that you can wind and they can hold the skein.