Keeping persons with dementia peaceful and improving their quality of life: practical tips from a nurse

Sheila is a registered nurse who has worked in Aged Care assisted living facilities (long-term stay homes for elders). She is currently working in an acute hospital where caring for patients with dementia is an everyday occurrence. She has interacted extensively with several dementia patients as part of her professional work. In this interview, she uses her professional experiences to share tips that can be used by family caregivers looking after persons with dementia in a home setting. [note]

As someone who has been working with patients with dementia, you must have often encountered upset and agitated patients. Can you describe a couple of such experiences and how you and your colleagues resolved them?

In my experience, when persons with dementia are admitted to a hospital for an acute medical condition, it is not uncommon for them to occasionally become agitated. This also happens in “aged care” facilities, where patients have moved in for long-term assisted living care. Sometimes this agitation is related to simple things like the patient not being able to find the toilet. Sometimes they know that they are not at their usual place, and hence have a desire to leave.

..a woman with dementia may be living with her husband, but her mind is back in another time/in another house/ with her mum and dad. Persons with dementia don’t have the ability to reason that they are not children any more, and they do not know the difference between past and present, because the area in the brain that handles higher functioning has been damaged and lost

Also, such agitation can happen even to patients living at home, and such a desire to “go home” (even though they are already at home) may be related to their mind being in a different chronological time in their history. For example, a woman with dementia may be living with her husband, but her mind is back in another time/in another house/ with her mum and dad. Persons with dementia don’t have the ability to reason that they are not children any more, and they do not know the difference between past and present, because the area in the brain that handles higher functioning has been damaged and lost.

In hospitals, patients often have to share a room with other patients, and they may not like the people they share the room with, or others may come and invade their space or touch their things etc. There are many challenges of managing patients with dementia in a group setting. There is a lot of activity because of people coming and going, and conversations happening around them, which their mind is trying to make sense of and often interweaving into their own thoughts. In “aged care facilities”, where we strive to create a home away from home, persons with dementia may share a room with one other person for company or have a room on their own, which is a lot nicer for the patient.

In both “aged care” facilities and hospitals, we try to keep the environment quieter and calmer to reduce episodes of agitation. We are better at creating a calm environment at “aged care” facilities, than we are in hospital where there is always a lot happening because the medical problems being treated require constant attention and action.

It really would be ideal to try and resolve health issues of patients in their own familiar surroundings with their own doctor who has a relationship with them. Home care, therefore, is preferable if the family can handle it. This is not always possible, and if patients do need admission to a hospital for some medical problem, then it is often best if the family members can spend a lot of time visiting, and during the visit, take their loved one away from the room to a quieter area for a spell.

When a patient gets agitated, the nurses try to assess the cause of the agitation. Do the patients need to go to the toilet? Do they need to have a drink or a snack? Has someone annoyed them? Is there too much activity or noise that is causing it the patient’s agitation? Is it related to memories, for example, they feel they have to get to work, or go do the shopping, or go home? Are they in pain– a simple headache may lead to agitated behavior.

Once the cause is established and the patient’s basic comfort needs have been met, then if the agitation persists, we try to use distraction techniques.

We try general soothing conversation using a calm tone, low pitch and slower pace. We point out pictures in a mag or in photo albums and elicit conversation. We may ask simple questions requiring simple answers like ‘yes’ or ‘no’. We can elaborate and suggest a response, just to keep the conversation going, and we also take the stress out of them struggling to find an appropriate answer. We might make them a cup of tea and sit with them for a chat. We might get them singing or play some olden-days cheerful but gentle songs. We play simple children’s games with them, give them something to cuddle or just hold their hand stroking it gently. We might get their loved ones on the telephone to speak with them — this often helps to calm them down– the promise of a visit ‘later’. We might take them for a gentle slow paced walk away from their area.

If simple measures don’t work, we may use medication.

If patients are aggressive, we might just leave them alone in a safe environment and observe them from a distance. With time sometimes, the aggression may resolve. We may get another staff member to approach them, as sometimes for a while you become the ‘bad guy’ or the cause of their frustration.

Note that, to be effective while helping a patient, we need to know enough about them. Persons with dementia might not be able to tell us what their age is or what their profession used to be, or what their family members’ names are. To be able to care for them in an “aged care” or hospital setting, it helps enormously to have some background information when interacting with patients with dementia. This helps us manage their agitation better. Fortunately for home caregivers, they typically know enough about the patient.

Each case is different and the challenges faced by the carers depend on what area of the brain is affected and what ability is lost.

One important thing I’d like to emphasize is that we have to separate the person from the disease, so that we don’t lose sight of them as individuals. Each case is different and the challenges faced by the carers depend on what area of the brain is affected and what ability is lost.

Can you share some tips about possible triggers?

Some triggers for agitation may be needing to go to the toilet, can’t find the toilet, needing a drink or food, too much noise, pain/headache, something on T.V. if that is playing in the background, the tone of our voice, reacting to our impatience, feeling cold/or hot,.

The time of the day can be a trigger, often at sunset (this is called ‘sundowners syndrome’) probably because in the past they had to get things ready for the family coming home, or had to get home by a certain time. Sundowning is managed best by medication, as they remain agitated till it gets dark.

Sometimes agitation is just related to memories that come up– ‘got to go to the bank’, ‘got to go to the shops’, ‘got to get the car fixed’, ‘got to get the crop harvested’ etc.

Another trigger may be related to pain, or being constipated, or if the symptoms have worsened over a few days it may be related to a urine infection or other health problems.

Sometimes, patients get into a sort of “loop” where they keep repeating a demand or remain stuck into an emotional pattern even when the “trigger” is resolved. What do you suggest?

If the behavior is repetitive questions, first establish that they don’t need to go out to the toilet or need a drink or are free from pain. If it still persists, then you don’t have to become frustrated by feeling that you have to answer every time; it is just a behavior, develop a bit of a deaf ear. Involve them in some meaningful activity.

They may be acting repetitive because they are bored. If you are getting a meal ready, then give them a simple chore like peeling vegetables or shelling peas or setting the table(unbreakable dishes are a good idea, like thalis).

As a last resort, medication might be an option.

Can you give some examples of changes we can make in our homes to reduce the chances of patients getting agitated, or wandering out, or harming themselves?

Keep the temperature comfortable.

A dark mat (black or dark brown) at the front door often works to turn them back, because they can’t make out if it is a hole on the floor, or how to cross it.

Reduce the auditory and sensory stimulation. For example, don’t have the T.V. blaring loudly in the background, or have them in a room where children are running around fighting or playing noisily. Keep the environment calm, with adequate but not glaring lighting. The T.V. news is often distressing as it usually contains unpleasant, anxiety-producing negative content about wars or thieves etc. Nature shows or travel documentaries or children’s shows are often good distraction for a short while.

A dark mat (black or dark brown) at the front door often works to turn them back, because they can’t make out if it is a hole on the floor, or how to cross it.

A simple picture of a male/female and a toilet on the door of the toilet helps them locate the toilet if that is a problem.

You can also make some changes in the home to make it an uncluttered, safe environment, such as remove loose rugs/mats that they might trip or slip on.

Can you suggest ways to keep patients engaged and active when we are busy with household chores and not able to sit down with patients for games or other activities? Are there any activities that do not require continuous supervision, and would not frustrate them if they are alone?

You generally can’t leave them alone for long unless they were accustomed to spending large amounts of time on their own listening to music or reading.

One good and simple idea is to have a rummage box, a bit like your grandmother’s sewing box, full of interesting bits of fabric, spools of thread, buttons, lace, and add other interesting things like colorful balls, small bells, costume jewellery etc. For men, you can have a box of nuts and bolts, small spanners, bits of wood, scraps of fabric etc.

Start them off picking up items and putting them on a table in front of them. Suggest they sort out the box or tidy up. Once they empty it out, they will often pack it up again— a few minutes of time is bought.

Instead of using a rummage box, we sometimes make a ‘fiddle mat’, which is easier to handle, and takes less space to play with. A fiddle mat is a small fabric place-mat to which we attach objects of the sort we may have kept in a rummage box. For example, we stitch on things like zippers, ribbon tied in a bow (which they can undo and fiddle with), colorful buttons, bells, pieces of fabric, things from their past that hold memories like bobbins( thread reels), bits of knitting or crochet etc. Patients often spend hours trying to get the objects off the mat or trying to ‘fix’ it. Such a mat would be simple to make at home, too.

fiddle mats for dementia patients
Photograph of some fiddle mats. Courtesy: Sheila

Some people with dementia often rummage through drawers. They will pull out all their clothes and pack them away in bags as if getting ready to leave. You can have drawers they can rummage through without upsetting you, and just put everything back when they’ve lost interest later. Try not to scold them, or it will backfire on you and just make them agitated. I’d suggest you keep their everyday clothes in another area, and just let them have items in their drawers that won’t upset you if they mess it all up.

In the “aged care” or hospital setting, nurses will often take the patients with them when they are doing routine tasks like restocking cupboards etc. While the nurses are tackling the tasks, they give the patients something simple to hold or ask them for help with tasks like folding cloths.

You can do things like that at home, too. If you are doing laundry, have them sitting nearby (like you would have done with your kids or grandkids) and give them pegs to fiddle with or some folding of simple items. Again, don’t expect a task to be completed as they often lose their train of thought and can’t concentrate for long periods. Remember that you are giving them something to do to keep them occupied and happy while you are doing your own work; you are not giving them the task in order to get it completed perfectly.

If they are strong on their feet they can help you carry items and walk along with you.

Everyone wants to be useful. It would be pretty scary especially in the early stages of dementia to be aware that you were losing your mind and not being able to recognize everyday items and people.

Caregivers would love to spend quality time with the patients, but don’t always know how to. What sort of joint games/ activities have you found patients enjoying with their caregivers?

Some activities you could try:

Armchair exercises: Stand/sit in front of your loved one and ask them to mimic your exercises. Raise your arms over your head, then lower them out to the side. Raise your arms above your head, then touch your shoulders with your fingertips. Bend your head from one side to the other, up and down, side to side etc. raise your legs out in front, then back down. Rotate your ankles, and so on– you get the picture. Make up your own routine and keep it simple.

If they liked to paint when they were young, get some poster paints/crayons or colored pencils and a scrap book or children’s’ coloring in books. Even if they were never too interested in painting, they will often participate and produce meaningful pictures.

Look through photo albums, talking about the people and places.

Make scrapbooks of comforting pictures. Patients can help cut out pictures and glue them down. When made up, these scrapbooks are good to look at and chat about. Fill the scrapbooks with large pictures of flowers, or scenery or animals and birds, or even household items or festivals. You can glue pieces of fabric down– choose colorful patterns or fabrics with texture that they can touch and feel.

In our “aged care” setting and in hospitals, our patients often like walking around the corridors looking at the pictures on the walls, pictures of sceneries and birds, or framed embroidery or tapestry. We always stop and reflect on the picture and have a gentle conversation about it.

If you take them for a drive, go somewhere not too stimulating. Avoid noisy shops, etc. A peaceful park would be a good option. Large family gatherings can be overwhelming after the first few hugs.

Watching happy old movies may be okay. They might fall asleep during it or walk away. Just be guided by what mood they are in.

If you take them for a drive, go somewhere not too stimulating. Avoid noisy shops, etc. A peaceful park would be a good option. Large family gatherings can be overwhelming after the first few hugs.

A soft toy or baby doll might be of comfort, especially to the ladies.

Stroking pets (if they are fond of pets) is comforting. You can always get friends to bring a calm pet over.

Asking family or friends to telephone or visit one at a time, also breaks up the day.

How can we know which activity to try out, and when? How much activity is good, and when does it become over-stimulation?

Do activities when they are at their best/ most alert.

Think of how you would entertain a toddler at home. Similarly, the attention span of persons with dementia is limited and their ability is often limited, so keep games simple. Matching cards/pictures. playing snakes and ladders, try any children’s’ games and see what they are able to do. You will know they’ve had enough if they become restless or fall asleep.

Intersperse activities with walks. Walking in the garden is good. Point out flowers and trees on the way. Keep an easy social chitchat going even if they don’t reply. Ask simple questions on and off, and answer your own question if they’re having trouble answering.

It is better to have a daily routine. Get up around the same time, eat around the same time, and so on. Just swap the activities around every now and then.

Are there any other observations you would like to share?

I would suggest family carers try and get some time out for themselves every day just to go for a walk, or have coffee with a friend, or just do the shopping.

Friends are often willing to sit with your loved ones and read to them or talk with them, if they know what to do and what to say. If you are feeling stressed (just like you did when looking after your children when they were young), ask friends for help or time out. It is not dissimilar to minding a young child– just make sure they get to know your friend before you leave them alone with them.

It is not selfish to have time for yourself or admit you are feeling frustrated and stressed. You will feel a lot more loving if you can have some ‘me time’.

Your roles have swapped completely, and instead of having that parent you looked up to for advice, you now have a little child in an adult’s body. Some family members describe it as “living with a stranger”. If you are caring for your spouse, your husband or wife no longer recognizes you. It is recognized that carers go through a grieving process as the person they knew disappears for ever.

Go easy on yourselves. You are doing a wonderful service. Take time out so you can last the distance and feel good about yourself.

Thank you for this very informative set of tips, Sheila!

[This is part of the expert interviews on this site. View the list of all interviews of health care professionals and volunteers]
Note: This is an interview of an expert/ volunteer. The views expressed and the suggestions given are those of the interviewed person, and not a recommendation being made by Dementia Care Notes. Suitability and applicability of the suggestions remain the responsibility of the reader. For professional advice suitable for your situation, please consult an appropriate professional.

Taking dementia patients for outings: a volunteer shares his experience

Satish Srinivasan volunteers two days a week at a dementia day care centre in Bangalore. As part of this, he coordinates activities for the persons with dementia and also takes them for outings. [note]

Could you give us an idea of the locations you have visited along with the patient, and how the patients responded?

We have been to 13 places so far. Aquarium, Science Museum, Planetarium, Elders Enrichment Centre Malleswaram, Bimba Art Hut, Lal Bagh Flower Show, Ramakrishna Ashram, HAL Aerospace Museum, Bangalore Dairy, Lal Bagh, NCAA, Ragi Gudda Anjaneyana Temple, Durga Puja Pandal

In all cases, patients responded well and were enthusiastic. Some examples of their responses:

  • When we went to the aquarium, one patient,who was normally  not communicative, said she had an aquarium at home with similar fish!!
  • There was a particular patient who used to ask me every time I came in as to where we were going today!!
  • One client thanked me profusely after each visit
  • One client wanted his picture (hard copy) which I gave him. Next time he gave me a 50 rupee note and said thanks (I had to politely return it to him)
  • They loved the Lal Bagh flower show.
  • They liked playing badminton and cricket and knew the basics.

What is the state of dementia of the patients you take for the outings? Are they able to walk without support? Are any of them on wheelchairs?

The patients are either in the early stage or middle stage of dementia. Some walk without support and some with support. Only one client needs a wheel chair.

What about the toilets at the destinations? How dementia-friendly did you find the locations you visited?

Toilets are available in all places we visited. Generally, all these places visited are dementia friendly with lifts, wheel chairs etc. available,

Could you give us an idea of the planning that each outing requires? For example, how do you decide on a destination? How do you check its suitability for the outing? How do you prepare the patients? How do you take them and bring them back?

A fair amount of planning is required such as:

  • Suitability of the weather (should not be too hot)
  • The place is to be open on the day of the visit. This is to be checked out earlier. Many places are closed on Mondays. Some places are open 365 days of the year
  • The timings of the visit are also important. Many temples close at 12 noon and open only in the evening
  • The place of visit should be close to the day care centre so that patients can return to the day care centre in time for lunch. Also, in an emergency, the group should be able to return to the day care centre quickly
  • Patients should use the toilets before leaving. Those with incontinence use diapers
  • Water and biscuits are carried
  • The transport should be road worthy and diesel/petrol to be filled in advance
  • Camera to be carried to capture happy moments

The destination should be interesting and not very crowded.

The suitabilty for outing is verified out earlier by physically checking out the place.

The group travels in a van.

How long is each outing? How do you handle it if a patient gets tired midway?

Each outing is between one to two and a half hours. We normally leave by 1030 am and are back by 1 pm.If a patient gets tired midway, we make him/her sit for a while and give him/her water and biscuit

You mentioned once that you find the outings a stress-buster even for the social workers and caregivers of the day care centre. Could you elaborate on this?

The social workers and care givers are very excited about these outings. These outings break their day to day routine which is stressful. Some of the care givers have asked me to organise a visit to Taj Mahal at Agra

Based on your experience, what tips do you have for family caregivers if they want to arrange such outings? For example, tips on planning, on the types of locations that can be visited, or that should not be visited, etc.

The tips to family care givers would be to do the detailed planning as outlined above. The data base of places to be visited, days open, timings, entry fees, facilities available can be shared with all.

You conduct activities for patients in the day care centre. Could you tell us some more about these activities, such as, which activities do the patients like more, and how they respond?

Antakshari, carrom, cards, blocks, snakes and ladders, separating seeds, knitting, colouring, painting are some of the common activities

Could you describe any one popular activity in some detail?

Antakshari is a very popular activity and patients take part singing songs in their own language etc.

Do you have any tips for family caregivers for conducting home-based activities for their patients?

I suggest one visits the day care centre to see the range of activities available. Only those activities that interest patients should be pursued.

The family should try and get extended family, volunteers, neighbours  to help in home-based activities rather than try and do it all alone.

Thank you, Satish!

Note: The day care centre described above is the Nightingales Dementia Day Care Centre at Bangalore. Check our Bangalore resource page for contact information.

[This is part of the expert interviews on this site. View the list of all interviews of health care professionals and volunteers]
Note: This is an interview of an expert/ volunteer. The views expressed and the suggestions given are those of the interviewed person, and not a recommendation being made by Dementia Care Notes. Suitability and applicability of the suggestions remain the responsibility of the reader. For professional advice suitable for your situation, please consult an appropriate professional.

Improve the quality of life of persons with dementia

Persons with dementia enjoy some types of activities. They also like to do useful things.

What caregivers can do: Add fun-filled and creative activities to the person’s daily routine. Help them think of pleasant memories from the past. Add activities they consider useful (meaningful activities) to the day. Encourage them to enjoy what they can still do. Share relaxed and happy moments together.

If persons with dementia get suitable surroundings, they can lead productive and satisfying lives for many years after the diagnosis. They are happier and less likely to get angry or show worrying behavior. The caregivers are also less stressed and can enjoy the company of the person.

  • Help the person with dementia feel safe and comfortable.
  • Provide a relaxed environment and emotional support.
  • Add meaningful activities.
  • Add fun-filled activities.
  • Spend time relaxing with them and talking to them.
  • Do’s and Don’ts for more effective activities.
  • See Also….

Read the full post here : Improve the quality of life of persons with dementia

Persons with dementia enjoy some types of activities. They also like to do useful things.

 

What caregivers can do: Add fun-filled and creative activities to the daily routine of someone with dementia. Help them think of pleasant memories from the past. Add activities they consider useful (meaningful activities) to the day. Encourage them to enjoy what they can still do. Share relaxed and happy moments together.

If persons with dementia get suitable surroundings, they can lead productive and satisfying lives for many years after the diagnosis. They are happier and less likely to get angry or show worrying behavior. The caregivers are also less stressed and can enjoy the company of the person.

Sections on this page:

Tips for the COVID situation: Choose activities that are safe and are enjoyable even while taking all precautions to keep person safe from COVID infection. Connect with family and friends and also for group activities and exercises using digital ways.

Help the person with dementia feel safe and comfortable

Adapt the home and adjust the daily routine of the person with dementia so that the person is comfortable and safe. Change how you interact with the person to reduce the frustration the person feels because of the growing dementia problems.

Try to reduce any confusion the dementia person has about the time and space. This can be done using various reality orientation techniques. Help the person have a suitable daily routine that is predictable; most persons with dementia find a day with routines easier to handle than a day full of surprises. Use suitable ways to talk to the persons so that you understand them and they understand you. When helping them, give just the right amount of help so that they feel capable and independent to the extent possible, remain safe, and don’t get frustrated.

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Provide a relaxed environment and emotional support

dementia patients may benefit from aromatherapy

Different persons find different things relaxing, depending on their personality, likes, and dislikes. Here are some things to consider:

  • Lighting incenses / aromatherapy
  • Instrumental music
  • Bhajans
  • A small altar for worship

Dementia persons who are fond of pets may respond well to pet therapy. This is also called animal-assisted therapy. Some experts say that this can help because the unconditional love a pet gives can be very soothing and fulfilling for a person with dementia. But pets are not as common in India as it is in other countries, and many Indians have never owned pets. So the suitability of pets would depend on the person.

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Add meaningful activities

Persons with dementia have led useful, active lives before their dementia. Their reducing abilities may make them feel useless and worthless.

Find activities that such persons can help in. Look for activities that make them feel useful and good about themselves. Choose activities depending on the state of their dementia. For example:

  • spreading clothes to dry, or picking them up and folding them
  • removing stones from daal/ rice
  • shelling peas, destringing beans
  • making rangoli
  • helping in the garden
  • placing flowers in the vases
  • rolling out dough for gujjiyas
  • sharpening pencils, stacking newspapers
  • filing newspaper cuttings
  • helping children with their craft projects
  • dusting
  • explain a recipe to a grandchild
  • walking a pet
  • giving clothes to the dhobi/ taking them back
  • filling filter water in bottles
  • re-arranging photos in photo albums

While choosing a meaningful activity make sure it is something the person will feel good about doing. Someone who used to like cooking and was proud of doing housework will be happy if asked to shell peas or roll out dough for gujjiyas. But someone who disliked cooking and considered it an unpleasant duty would not. Persons who always used servants for housework may even feel insulted if asked to do things like fold clothes or remove stones from daal.

Remember that the persons with dementia will make mistakes. Or they may lose interest midway of a task, or be very slow. Do not push them to complete the task. Do not expect them to do it faster and correctly. The purpose of these activities is to make the person with dementia feels useful and a part of normal life.

Select activities depending on the abilities and problems of the person with dementia. In some forms of dementia, persons remain mentally active and capable. Their problems may be in other areas like movement, decision-making and socially correct behavior, emotional apathy, problems with words, etc. Activities suitable for such persons may be very different from what may work for persons with memory and concentration problems.

Do include activities that involve exercise, such as walking or yoga. These activities have health benefits, and they also reduce frustration and aggression because they provide a sense of well-being.

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Add fun-filled activities

dementia patients can enjoy some activities like these
Activity room at Nightingales Centre for Ageing and Alzheimer’s, Bangalore

Persons with dementia can definitely have fun! They can enjoy creative activities, social outings, and games if these are chosen carefully and planned well. While choosing an activity, make sure it is something the person can do and which the person likes.

Persons with dementia often enjoy playing games and painting and other such activities, especially in the company of grandchildren or other family members. Don’t put any pressure on them to be perfect. They may make mistakes and forget rules. Don’t try to “correct” the persons, and don’t insist that they follow a complex set of rules. The idea is to have fun.

One caution. Please don’t insist the person takes part in activities if the person is uninterested or tired. Caregoivers may not realize how, for someone with dementia, the simple everyday tasks can be difficult and stressful and tire the person. Also, interests of the person may have changed. Activities should be done only if the person is interested and enjoying them.

Here are some activities to consider:

  • Painting
  • Using crayons
  • Playing board games like Ludo and Snakes and Ladders
  • Simple games like stacking colored rings
  • Antakshari

Outings can be enjoyable if planned well. Some persons with dementia may enjoy meeting other people and talking to them, or seeing new places. Be careful not to overdo this, as too much newness is usually stressful. Find a suitable balance. Choose times and places that would be interesting for the persons but which do not make them feel any pressure. Some persons may no longer want to eat in a restaurant. They may not be able to handle cutlery. They are more likely to get tired easily, and they may get confused, so keep outings short. Be ready for the dementia person suddenly wanting to return home.

Visitors at home can be a welcome change for someone with dementia, but only if the visitors understand the person’s condition and know how to interact. In India, because dementia awareness is low, unaware visitors often start lecturing persons with dementia and telling them to use “will power.” They say things like “you must do crosswords to improve your memory” or “you should not take so much help from your daughter-in-law; you should do your own work.” Such visits stress the person with dementia instead of providing company and fulfillment.

Many people assume that anyone with dementia cannot think clearly. But the decline in abilities depends on which part of the brain is affected. This varies from person to person. Some retain their ability to do crosswords and sudoku and can spend hours in solitary pleasure with them. Some even enjoy trying out new gadgets, like the latest mobile’s features. For example, Sir Terry Pratchett continued writing fantasy novels and doing new things for many years in spite of his dementia. Keep this in mind when selecting activities.

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Spend time relaxing with them and talking to them

Caregivers often forget to spend relaxed time with loved ones who have dementia. Yet, if you can set aside the need for being correct, you can spend time in a relaxed way with the person, just talking or maybe sharing memories. Dementia persons have gaps in their memories, but in a relaxed setting, they are often able to remember many things of the past. They usually enjoy such sessions.

Appropriate use of music can be particularly powerful for many persons with dementia. Pleasant memories of the past may be easier to trigger by using music popular in the older days, childhood jingles and poems, bhajans, lullabies, and stories that often told to children. Often, persons with dementia may even start singing along, even though they seemed uninterested and uncommunicative earlier. Select music depending on what the person seems to enjoy. Often persons with dementia like the music of their teens or early youth, but this may vary. Film songs are often easy to remember. Many Indians enjoy bhajans and classical music. Consider playing music to a schedule rather than all the time. Softer, slower melodies may be better in the evenings as they can be relaxing and don’t make people want to sing along. Also, music can soothe pain and reduce agitation. Cheerful music can be used to make people feel active. Selection and use of suitable music in suitable company is key to effective use. Some explanations and practical suggestions for effective use of music for dementia are also available in an article listed in the references below.

Smells of spices or the aroma of favorite foods can also help. Discuss with other family members about what can trigger pleasant memories for the person with dementia.

Some ways the family can spend time together:

  • Listen to old music and talking about favorite songs
  • Watch old movies together
  • See family albums, or re-arranging photos in them
  • Share anecdotes from the past

The idea again is to relax together, not to be accurate and complete in the memories. If the person with dementia starts talking of things that did not happen, don’t try to correct them. Just listen and try to appreciate their reality, while also remembering that they may say something totally different tomorrow.

photo album for reminiscence therapy for dementia

Reminiscence therapy has been used successfully with persons with dementia. A project of Pam Schweitzer has shown that the long-term memories of people with dementia are sometimes better than their relatives think. The project used weekly meetings with groups of people with dementia and their family carers (from 12 – 18 weeks) to revisit their shared past experience. This was explored using creative ways such as music, drama, art, objects, multi-sensory stimulus and non-verbal communication.

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Do’s and Don’ts for more effective activities

The above discussion covers several types of activities that can be considered to improve the quality of life of people with dementia. In practice, some families are able to use activities successfully, while others are not. This is often because families have very high expectations about what they can achieve with activities. These expectations interfere with the basic objective of activities: improving the quality of life of the persons with dementia. Here are some general do’s and don’ts to keep in mind when introducing activities.


    Do…

  • Do use the time together for interesting/ relaxing activities and to increase a sense of participation and togetherness
  • Do adjust the activity to make sure it balances the sense of achievement and a need for challenge for the persons with dementia. It should not seem condescendingly simple. It should not be so complex as to be frustrating.
  • Do let persons with dementia do the activities at their own pace and interest level
  • Do select something that the person finds meaningful

    Don’t…

  • Don’t force the persom to do an avtivity if the person is tired or just not interested.
  • Don’t monitor the activity or supervise it like a task the person has to do “correctly”
  • Don’t hurry dementia persons or force them to do the activity/ complete what they started.
  • Don’t assume the activities will “improve” skills or memory, or expect that the “dementia will reduce” the underlying disease (this is a faulty understanding of dementia)
  • Don’t use activities where mistakes can hurt the person or cause loss or irritation
  • Don’t get tense or bossy
  • Don’t point out mistakes or grab control of what the person with dementia is doing. Support them, but don’t rush them
  • Don’t laugh at their mistakes or feel amused.
  • Don’t suggest activities that are obviously trivial or may be seen as condescending by the person with dementia.

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See also….

Resources/ references from Dementia Care Notes and related sites

Pages with caregiving discussions related to above

Some relevant interviews on this site:

The full list of interviews is here: Voices: Interviews with dementia caregivers and Tips and advice from health care professionals and volunteers.

Caregiver resources in India and Other dementia/ caregiving resources: Many of these sites contain suggestions on quality of life for persons with dementia.

External links related to above page on topics like music, art, and reminiscence therapy

Discussions on use of music for persons with dementia

Most books on dementia care discuss the usefulness of “activities” that can be fulfilling for persons with dementia and their carers. You can see our list of suggested books at: Books on dementia and care or surf Amazon.com or Amazon.in for your specific needs.

Two books have been specifically recommended by some persons to look for ways to have interesting and fulfilling activities and create joy in the life of the person with dementia and the caregivers. The books have also received good reviews but have not been evaluated by us. These are listed below for you to evaluate and check suitability; you can read the book descriptions, reviews, and samples on a site like Amazon to decide whether they would be helpful.

cover of ctivities to Do with Your Parent Who Has Alzheimer's Dementia
Activities to Do with Your Parent Who Has Alzheimer’s Dementia (Judith A. Levy) Provides a selection of user-friendly activities intended to help maintain the parent’s self-care skills, mobility, and socialization. The book includes an Assessment Form. While not all of the book’s over fifty activity ideas may help a caregiver, some ideas may be usable. Available on Amazon.in as paperback Opens in new window and as Kindle Opens in new window .


cover of Creating Moments of Joy
Creating Moments of Joy Along the Alzheimer’s Journey: A Guide for Families and Caregivers, Fifth Edition, Revised and Expanded (Jolene Brackey). This well-rated book contains practical advice on how to focus energies on creating moments of joy for persons with dementia. Reviewers have found it easy to read and with enough usable ideas and full of hope and enthusiasm. Available on Amazon.in as paperback Opens in new window and as Kindle Opens in new window .


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