Guidelines for
Meaningful Activity Planning and Implementation
Excerpt from The
Actvity Planning Workbook by Dr. Teresa
Shanahan, PhD.
The following are guidelines to help start planning
and implementing activities for people with Dementia. Each guideline
is illustrated with one or more profiled examples. While there are many
cognitive impairment commonalities, each person with Dementia is unique
and has their own set of strengths and limitations.
One person may be interested in music, while
another finds it a source of agitation. One person may be able to
follow two-step directions, while another can only follow directions
given one short step at a time. One person may have lived a life
of a social butterfly, while another lived a life of a loner. We
must always consider the person first and the disease, Dementia,
second.
1. Meaning and Purpose.
The activity is purposeful. It promotes
feelings of usefulness and self-esteem. Demonstrate an active
interest on your part.
Scott might
have felt that folding and stuffing envelopes seemed purposeless,
but his care partner continually reinforces that he is helping a
non-profit organization.
2. Orient toward Process.
The activity is process-oriented toward
the step-by-step enjoyments rather than orienting toward goals or
outcomes.
To Edith, finishing
the task of placing family pictures in the photo album may not be
as important as reminiscing about past family events.
3. Respect.
The activity offers respect for the person’s age, current abilities
and who the person is. It promotes an acceptance of self.
Bob, who
has been an artist most of his life, is offered oil pastels and textured
paper. Crayons would not be an appropriate medium for Bob.
4. Promote Success.
The activity offers opportunities for success.
Pearl has
always been a social butterfly; therefore together you plan an afternoon
get-together for a few friends. The plan is initiated with lots of
time ahead for completing each task. One simple task is completed every
day or every other day. Due to the planning and breaking down of tasks
to manageable portions, the get-together is a success.
Stella attempts
to place a picture in the memory book you are working on for her
family. When she becomes frustrated, you quickly suggest another
option which results in success.
5. Limit Options. There
are minimal expectations, the activity is kept simple and is broken
down step by step. The environment is calm, yet stimulating, and
has few, if any, distractions.
Joe joins
in the task of putting together bean soup bags for gifts. The first
step is opening one bag of beans into a dish. The second is measuring
one-fourth cup into another dish.
George relaxes
in the environment of the kitchen. It is quiet, the radio or television
is not on. Low-volume, quiet calm music is playing in the background.
If there are other care partners joining the activity they are careful
not to interact loudly or talk around George.
6. Promote Physical and Cognitive Exercise.
The activity promotes physical activity and cognitive functions that
are strengths.
For Cecila, planting
vegetables in a garden uses fine and gross motor abilities. In addition,
completing each step of the planting process requires problem solving,
decision making and many other cognitive abilities.
7. De-emphasize Impaired Skills.
The activity should not place extreme demands on the physical and cognitive
areas that are impaired.
Cecila handles
gradually and singularly, and slowly, the soil, the plants and then
a trowel while she plants vegetables. If she is asked to sequence
and problem-solve her way through several items and many different
steps, it may demand cognitive skills beyond her ability. Approaching
an activity with a slowed and simplified pace helps to avoid agitation
or over-stimulation.
Lola has
problems with her gait. You may avoid expecting her to take part
in a simple dance step to avoid her becoming confused and frustrated
and no longer wanting to be involved in dance activities. You will
assist her in focusing on upper body movement.
8. Interact with Positive Humor.
Emphasize the opportunities for sharing positive interactions and humor.
Lydia takes
delight when you laugh together at your baking mistake. While making
cookies for the neighbors you realize you forgot the flour and the
cookies are the size of a large plate.
Howard’s spirit
brightens while reading “Laughter is the Best Medicine,” from
the Large Print Readers Digest. You keep the environment light and
fun, laughing as often as possible.
9. Lead with Direction and Break Down Manageable
Steps.
As the person bringing in the activity, you will need to initiate the
activity and offer direction.
Harry will
work with you to write short notes to people who live in Skilled
Nursing Facilities. You begin by bringing out the cards. As the first
step you set out one card. As a second step you ask if the card should
go to Maxine or Ruth? As a third step you ask Harry to dictate an
introductory sentence. Harry, who has Dementia, is unable to provide
a sentence so you suggest one and ask for his approval.
10. Adapt, Adapt, Adapt. Every activity is
adapted.
The person with Dementia cannot adapt to us or the activity. We must
adapt activities and ourselves to the person with Dementia.
Harry needs
the Activity Director to compose the card, but he can give opinions
and answers through the process.
Margaret needs
to have a board game’s rules relaxed and simplified in order
to enjoy the game.
David may
from day to day be able to read, or he may need his care partner
to read to him. David may be able to read parts of the poem or story
but not entire pages.
Bill needs
to have gestures incorporated into communication, and he needs the
Activity Director care partners to limit the number of words in the
directions given.
11. Utilize repetition and sorting activities.
Gloria takes pleasure in familiar, repetitive, personal tasks such
as folding laundry, dusting, wiping dishes, or pairing socks.
12. Challenge in the morning, Calm in the
afternoon.
For many, more success is found by focusing on tasks that require more
ability in the mornings. In the afternoons, which may be restless times,
focus on calming yet meaningful activity tasks such as music, slow-moving
familiar movies, or reading poetry.
Susan and
her care partner, in the morning, collect clothing to donate to the
Senior Center in town. In the afternoon Susan and her care partner
listen to classical music and read poetry by Langston Hughes.
13. The activity feels good!
For Everyone, seek pleasure,
fun and success!
The guidelines above have been kept simple.
You will learn through gentle experimentation which activity adaptations
work and which do not. Refer to these concise guidelines when you
encounter new challenges or limitations for the person with Dementia.
For further information, please contact your local Alzheimer’s
Association or visit the National Alzheimer’s Association website
at www.alz.org.
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