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Meaningful activities for a person with dementia

Dr. Karen Harrison Dening, Head of Research and Publications at Dementia UK, introduces this blog post pointing to why meaningful activities are so important for someone with dementia.

Maintaining meaningful activities add value and quality to a person’s life, whether they have a diagnosis of dementia or not. If a person is diagnosed with dementia their strengths and abilities will vary a great deal depending on what stage of dementia they are at. By thinking of activities which give the person with dementia meaning and engagement as much as possible, we can make sure these needs continue to be met, not only when their dementia progresses but also in the pandemic we’re facing which has  meant that many people are now staying indoors.

Meaningful activities can include a range of things from the usual tasks of daily life, such as, cooking, cleaning, gardening, self-care, through to activities which engage like a call or a zoom session with a relative or friends.

Dementia can cause people to withdraw from activities and enjoyable interaction with family so it’s important to try and maintain those interests and relationships to support people living with dementia to lead a better and more enjoyable quality of life. People who live with dementia may show signs of apathy and seem to withdraw, such as, falling asleep at inappropriate times or becoming easily distracted. This can make engaging with the person living with dementia difficult at times.

Meaningful activities should be linked to hobbies or interests the person enjoyed before the diagnosis of dementia. Where ever possible the person with dementia should be encouraged to take an active role in choosing and defining activities that are meaningful to them. This will help to ensure that activity is meaningful and that relationships are developed and maintained.

Adapting activities as the dementia progresses

Adaptation and adjustments to activities may be necessary and will be dependent on things such as, what stage of dementia the person is at, a person’s physical abilities, the range of support available to them, such as whether they’re living on their own or have any family carers. As far as possible, people with dementia should be included in family activities. There is nothing to say that that this cannot happen following the pandemic with more families now spending time indoors, if the right meaningful activities are followed.

Overall meaningful activity provides the person living with dementia:

  • A sense of purpose and routine.
  • Acknowledges and uses the skills and life experiences of the person with dementia
  • Emotionally nurturing experiences which increase self-esteem and help the person to feel valued.
  • Opportunity for more social time with family
  • Maintain skills and independence, and in some cases improve the person’s ability to perform certain daily activities.
  • Opportunity to make decisions and have choice

A women gardening

Physical exercise

The old mantra of what is good for the heart is good for the brain rings true for people with dementia as much as it does for people who haven’t been diagnosed. Studies have in fact shown that people who engage in physical activity can bolster their mental health as well as their ability to think. Exercise seems to help your brain not only by keeping the blood flowing but also by increasing certain chemicals that protect the brain and tends to counter some of the natural reduction in brain connections that occurs with ageing. It also reduces the risk of heart disease and diabetes, strengthens bones and muscles and reduces stress.

As we mentioned earlier, exercise can be so meaningful to a person with dementia so it’s important to look at how these activities can help them specifically. Exercise can improve self-sufficiency, self-confidence and cognition and can also help to build or maintain muscle strength and balance, helping people living with dementia maintain their independence for longer.  There is also a lot of evidence to show that certain exercises can also be protective against frailty in older age which is often experienced by people living with dementia.

However exercise may be difficult to take part in now with all the confinement measures which have been put in place. There are still ways though in which you can improve your health even in the comfort of your own home and garden, if you have one.

Consider physical ability

First of all, it’s important to consider what a person with dementia is still able to do. Whether a person with dementia can take part in physical exercise depends on a number of factors. This can include pre-existing conditions such as arthritis, breathing problems, heart problems, high blood pressure, dizziness or fainting, balance problems or falls. If you don’t know already, you could check with your doctor if they are offering telephone or online appointments so you can establish if any pre-existing conditions might prevent some exercise activities. It is after all important to adapt the activity according to the person’s abilities.

Here’s a list of physical activity suggestions which a person with dementia may like to do around the home:

  • Gardening is a great way to exercise; it can be a light activity or something more strenuous depending on the person’s dementia. More importantly, it provides an opportunity to get outdoors which can help with stimulation and improve mood. However, you can also garden indoors through potting seeds, for example.  Standing at a worktop to do this can help strengthen balance muscles for the family carer and the person with dementia
  • Indoor bowls or skittles can again be an activity undertaken outside in your garden or indoors, and can be adapted to a person’s abilities, whether it’s carried out from either a standing or a seated position.  It can maintain and develop other skills related to hand eye coordination too.
  • Dance can be a very structured exercise. It can be an activity done within the home on a one to one basis.  It does not have to be masterful and of Strictly Come Dancing level to of benefit or enjoyable!  Both the person living with dementia and a family carer dancing to a favourite song using an outdoor coat as the partner can be both invigorating and fun! Dancing to a favourite song can also allow families to reminisce about a wedding or birthday dance providing a powerful moment of reconnection
  • Household chores can be great exercise, like folding laundry, dusting, light vacuuming, or washing the car.
  • A person living with dementia can also exercise from their chair, sofa or bed. It is often better if the family carer can perform it alongside the person with dementia so any activities can be mirrored.  It can also help engagement and flow of the movements if you play accompanying music from a playlist with all their favourite songs for example.

Some examples of seated exercises include:

  • Whilst holding a ball or a cushion rotate at the waist moving the ball from left to right.
  • Stepping in rhythm to music in a marching like fashion.
  • With heels on the floor alternatively tap each set of toes to music.
  • Lift arms out in front and then slowly raise to the ceiling and waggle hands and fingers.
  • Raise arms to the song ‘head, shoulders, knees & toes’ (build up the stages and include toes when able).
  • Holding hands on the arms of a chair, move bottom to the seat edge and slowly raise to a standing position.
  • Stretch while lying in bed and move various body parts and stretch stiff muscles, this can be done with assistance (passive exercise with the support of a carer) or independently.

You can work together to create more types of exercises at a sitting position to music and there are lots of videos that can guide you through some basic exercises.

  • These activities can also be done from a standing position but may be more strenuous. Start slow and build up the numbers of movements in a cycle as the person becomes used to the movement and pace.

Beyond the home….

  • See if you can exercise together somewhere close to your home, such as a walk along country lanes or around your street.

A pair of glasses sits atop a pile of books

The arts, creativity and dementia

The impact of the arts on people with dementia is becoming increasingly significant. It can be a powerful way for people with dementia to not only express themselves but also stimulate their mind which can improve thinking ability.

Creative activities like painting and listening to musi can stimulate the brain. It can help people living with dementia to create a dialogue and provide them with an additional means to express themselves.

Painting

Painting has been found to be particularly valuable in helping people living with dementia to communicate in a non-verbal way, when verbal communication is more difficult, or lost. Similarly, painting and drawing can allow us to use their power of imagination which can make people living with dementia to feel more connected to the world and people around them.

Adult colouring books are popular for stress relief and can be found in craft shops or on online stores such as Amazon.

Music

Research suggests that listening to music or singing songs can provide emotional and behavioural benefits for people living with dementia. Musical memories are often preserved in dementia, when other types of memories are lost, because of the areas in the brain that are affected. Music has the power in all of us to relieve stress and reduce anxiety and depression, but also to be uplifting and joyous. In people living with dementia it can also have the effect of reducing agitation. You can work together to develop playlists, whether that be to help relaxation prior to bedtime, provide distraction when a person seems agitated, or to motivate them if they seem apathetic or listless. There are several things to consider when developing a personal playlist:

  • What kind of music does the person with dementia enjoy?
  • What music evokes memories of happy times in his or her life, or even the life you share together? It may be memories of music of when they went to dances, hymns at their wedding, a particular group/singer or band. This is an activity you can involve the wider family and friends in by asking them to suggest songs or to help you to make the playlists.
  • Music can also benefit family carers by reducing their own anxiety and distress levels, lighten your own mood as well as providing a way to connect especially when communication has become difficult.

Films

Watching films with a person with dementia can be another good way to stimulate a person with dementia and increase feelings of connectivity with the wider family. Whilst no experience of dementia is the same and families are best placed to know what kind of films would be most suitable for their relative with dementia, there are certain styles which can be broadly appealing. This can include films which do not have complex story lines, as well as films where there is a strong action, comedic or musical element.

Reading

Whether fiction or non-fiction, reading can be a great way to increase understanding as well as providing a useful activity with people with dementia to help stimulate and maintain connections.

For the last few years Dementia UK has been supporting the work of the Reading Agency who have initiated a number of useful projects about the importance and value of reading.

‘Reading Well; Books on Prescription’ provides a useful list of recommended books for both people with dementia and family carers, which aim to provide information and support. These books can be brought directly or you could even loan them in an e-book format.

For a person with dementia who is struggling to read, you can try reading to them. This can be a nice activity for children to do with their parent or grandparent. If there are any challenges in concentration, try short stories, poems or picture books. These can evoke memories and help start conversations, which can bring great pleasure and help the person reminisce.

For the carer, try and make sure you find time to relax and enjoy reading, if this is something you used to do. Making time for yourself is important as it will help sustain you and keep you going

Reminiscence

Even though a person living with dementia may find their memory becoming worse, they may still benefit from activities that require their long-term memories to be accessed, rather than relying on recent memories.

Reminiscence therapy involves discussing events and experiences from the past and aims to evoke memories, stimulate mental activity and improve a person’s well-being. Reminiscence can often be supported by props such as videos, music, pictures and objects that may have particular meaning for an individual. Reminiscence can take place with wider family members and friends or with just one other person in the family.  Reminiscence can also be of great value when a person living with dementia is supported to develop their own life-story book.

Research has shown that reminiscence therapy can help older people with depression by focusing on positive and rewarding aspects of their past to support more positive thoughts. It may be suitable for people living with dementia both because depression is common in dementia and because people living with dementia typically have a better memory for the distant past than for recent events.

Begin with conversations about the past, you can introduce a topic or an item to look at or handle if this is easier. Engaging in conversation is a good start and helps the person feel that they are important and valued by you, also helping with their sense of being loved and belonging.

Other possible reminiscence topics

  • Childhood and earlier holidays
  • Favourite playground games/board games
  • Foods, smells, likes, dislikes (most people will have a Brussels sprout story!)
  • Pets and animals
  • Family and relationships
  • School days
  • Photographs, family albums
  • Music, playlists, album covers
  • Tactile activities like painting, pottery, or other crafts.
  • Topics such as sports, cars, beauty products
  • The list is endless! 

Reminiscence dementia activities, including life story work or memory boxes can also have many benefits, such as, improving a person’s mood and wellbeing as well as providing meaningful activity.

  • Memory boxes containing personal objects from the person with dementia’s past can be used in a variety of ways, such as; triggering certain positive memories, support wider family members and friends to stay connected by providing conversation prompts, provide insights into a person’s life story. They can often be used within life story work.
  • Life story work is important for carers as well as loved ones to show a genuine interest in what the person with dementia is saying and to show that you value their story. You can decorate this book with photos or vibrant colours to help keep the person with dementia stimulated

If you have any questions or concerns around dementia, you can call our free Dementia Helpline on 0800 888 6678 to speak to a dementia specialist Admiral Nurse.

Scrabble letters spelling out LIVE WELL in an upside down T shape

Keeping the mind fit during periods of isolation

People living with dementia and their family carers are often advised that ‘mental exercise’ may be helpful in slowing down the decline in memory and thinking experienced by many with a diagnosis of dementia. One form of mental exercise is called ‘cognitive stimulation therapy’.

What is cognitive stimulation?

Cognitive stimulation therapy involves a wide range of activities that aim to stimulate thinking and memory generally; activities may include discussion of past and present events and topics of interest, word games, puzzles, music and practical activities such as baking or gardening. Typically cognitive stimulation therapy is delivered with groups of four or five people living with dementia and carried out by trained staff, such as psychologists or occupational therapists. Groups will last for around 45 minutes at least twice a week.

However these are unusual times so it’s important to remember that family carers can also been trained to provide cognitive stimulation to the person they care for on a one‐to‐one basis in and around the home.

There is evidence to show that people living with dementia who undertake word or number puzzles frequently show better performance across all cognitive areas (memory, thinking, reasoning, attention, organising, planning, etc.) compared to those who never use them. Research shows that cognitive improvement is similar for either type of puzzle, whether that be word or number based, so it is participating in a brain engaging activity on a regular basis that is the important thing.

How does cognitive stimulation compare with other treatments?

Improvements following cognitive stimulation were compared with those seen without treatment and with standard treatments, such as, medicine, day care or visits from community mental health workers. People living with dementia who received cognitive stimulation showed greater benefits in memory and mental tests than did those who had received standard treatments and the benefits lasted for longer after the cognitive stimulation stopped.

As with any meaningful activity used in dementia care there is also evidence to show that people living with dementia who undertake puzzle activities on a regular basis report an improved quality of life. Family carers found the person they care for communicated and interacted better than they did before they received cognitive stimulation activities. Importantly, family carers that facilitated and delivered cognitive stimulation did not find it stressful or a burden to their everyday caring activities.

Such cognitive stimulation exercises seem to be of more benefit to people living in the mild to moderate stages of dementia.  There are other, more focused activities that are of more use for people living with dementia in the more advanced stages, such as Namaste.

As with any research, we need more to examine how long the effects of cognitive stimulation last and for how long to continue for.