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Dementia care is notorious for testing the limits of caregiver patience. Many caregivers feel they are at their 'wit's end' trying to find ways to keep their care recipients' occupied and active.
In response to an online chat, ALZwell member Anthony Flach - a caregiver working in a residential facility for the elderly - shared some tips for those looking after elderly people with dementia. Anthony's suggestions are based on his experiences with those in the later-stages of dementia. Although you may not be caring for someone in these stages, Anthony feels that "my ideas can still be useful even if the person you're caring for is in earlier stages - you can just complicate these ideas a little more if you need to, to suit that person."
In general, Anthony thinks rote tasks are an effective way to keep your care recipient busy and active. He points out that brain cells involved in rote activities are some of the last to die off from diseases like Alzheimer's.
"Doing things over and over again when we are young imprints that task on the brain; if the activity is something we do habitually throughout our lives, it becomes so strongly imprinted that we can do this task automatically without thinking about it as we do it."
By rote tasks, Anthony means chores like sweeping. He explains, "sweeping works well because the person recognizes the broom - from rote activity over 70 - 90 years of living - and will most likely start sweeping automatically. In their mind, nothing may be happening but the person, by rote, is doing something - and, in the 'gratification center' of the brain, messages come that cause the person to feel useful and satisfied, rather than useless, bored and frustrated. Simple tasks that don't need the person to think about 'how to do it' work well with dementia patients."
Anthony describes other tasks that work well:
Try putting some beads of a few different shapes or colors in a bowl. Have your care recipient sort them into different sets of colors/shapes (e.g., all the red beads in this red bowl or all the square beads in this bowl). You can use anything that can be easily sorted and that is not harmful to your care recipient. Another example would be sorting a pile a paper you don't need. Ask your care recipient, "Can you please sort these out for me?" and let them sort the papers in their own way, even if it makes no sense to you. Who cares if the papers don't get sorted into a sensible order - the task will keep your care recipient busy and allow them to feel useful rather than useless - which can lead to wandering or other undesirable behaviors. Old photos, junk/old mail or anything that can be compiled into one large stack/pile for sorting will work well.
One of my favorites - this task works terrifically well with many patients especially when they want to leave or roam and you don't have time to watch them right then. Give your care recipient a tall stack of unfolded napkins. Stand beside them and demonstrate how to fold one in half. Watch them fold a couple and have them put the folded ones into a new stack. When they have finished the first stack give them another. They will likely forget that they've done the first pile but, if they don't, wait a few minutes and start with the new pile.
Give your care recipient a couple of sheets of blank paper and tell them to make a list. The list should be something that seems needed, not something your care recipient knows you don't need. Try to choose a list that suits their life; for example, if your care recipient never went shopping, don't ask for a shopping list. Ask for a list of tools you 'need' or maybe a list of clothes they need instead. A woman could write a grocery list or a list of things they needed for sewing - whatever they used to do/is familiar to them will work well. The list may consist of nothing but scribbles but if you comment every so often, "How's that [grocery] list coming along?", you serve as a cue to remind them of what they're doing.
I have patients help me fold clothes all the time. They like to feel useful and when they work with me they seem to feel even more useful than if I leave them alone with the task. They will lose interest in a task after a few minutes when left alone. Also, my presence helps to remind them that they are helping me with something - togetherness works wonders. We're all human and we need closeness with others.
Your care recipient may not fold the clothes the right way. Is this a big deal? Other people I've worked with have made comments like, "Why are you doing that - you know pants don't get folded like this!" or "Why are you folding those like that? You're just making a big mess!" Criticism defeats the purpose - instead of feeling useful, your care recipient will feel bad.
Your care recipient may not understand what they're doing, or they may understand but be unable to explain it (or they may be able to do both or neither) but they will always feel bad if you criticize the way they do something.
People with dementia are very sensitive, much like small children - and if you criticize a small child harshly, what happens? Crying, right? Why? Because the child knows they didn't do something right and you are displeased.
Criticism never works on someone with dementia, all they know is that for some reason you are unhappy with them and, as a result, they feel bad and you don't want that to happen.
If your care recipient folds all the clothes wrong, so what? When you've finished folding the clothes together, say, "Wow, thank you! Working together we got this done a lot faster, didn't we!" Smile and go off to put the clothes away. You can always re-fold them yourself as you're putting them away (and they're not watching).
Hugs and Smiles Work Wonders
People who are now in their 70s - 90s were fairly huggy, kissy and touchy-feely people back when they were young - especially women. If your care recipient is a man who doesn't like all that "touchy stuff", friendly pats on the back or quick rubs on the back as you walk by, saying, "Hey, how are you?" work well. Give lots of extra greetings, even if you feel like you're repeating yourself. Remember, to the person with dementia, every moment is new and past moments are forgotten - you can use this to your advantage to work with the person, rather than against them.
- Activities and Crafts for People With Dementia by Jan Allen
- 101 Things to Do With a Person With Alzheimer's Disease from the Columbia, Missouri Chapter of the Alzheimer's Association
- Things to Try, Things to Do from the New York State Office on Aging