Please share your best ideas to create meaningful engagement with dementia sufferers.

[BentFork]

I'm newly working in a care setting and my job is to do meaningful activities with dementia residents. What I mainly observe is:

• a flat 'no' (with raised flat of hand) when encouraged/offered activity.
• People who can converse a little bit in a very fractured way, but who are only interested in getting out/going home.
• People who are bedridden & non-verbal.

I have had lots of training to understand the dementia experience but almost nothing in how to deliver meaningful enriching activities. Music, games, art & craft & exercise are 99.5% ignored. My day is 8hrs. It's a very long time to be pushing against a closed door. Any ideas?

It can't just be talking either. I'm to engage them in activity.

Suggestions:

In general people with dementia respond to activities that engage at a non-cognitive level.

So music that has a significance for them. So not just random music. Look at how old they are and try to work out what was popular when they were in their teens/early twenties. Then play a whole selection and see if anything gets a response.

Sensory - so fiddle muffs are often suggested but having pets and animals visit is also popular. Does the setting have a dog? Some do.

Simple jigsaws perhaps? Just get one out and start doing it while talking to them, see if they follow your lead.

Wordsearches too.

Obviously if they're really far gone neither of those suggestions will work, but I know of people who were able to engage with these activites while having dementia.

I am of an age where I have/had parents with various levels of mental deterioration. Neither in a home, both lived/living in their own home.

My deceased father, finally diagnosed with dementia due to a head injury 30 years previously. He liked gardening so planting seeds, watering, planting out, watering, cropping, composting would have suited him. He became very repetitive so an activity that was repetitive would have suited him. He also used to enjoy woodwork, so eg making planters for sale for benefitting the home might be an idea.

My mum, no diagnosis of dementia but clear memory loss. She is an intellectual snob, so she would enjoy an intellectual talk on arts, music etc. And a classical concert. Can you take the residents out? But the classic crafts - good god no.

When I have to do this type of thing, with some I don't really ask if the person (kids with SEN, ASC and PDA) wants to do it. I just start and then interested people tend to sidle up and either join in or ask if they can have a go. Even if they just watch me or others then that is ok.

I've very little knowledge of dementia but would therapy dogs also be appropriate?

It doesn’t sound as if you have much experience with a wide variety of dementia sufferers?

What I would say is ‘activities’ might be a very different thing to ‘meaningful activities’ - and the latter will be completely different for each individual.

If you met my nonagenarian relative they would mostly want to talk in great detail about specific events in their early childhood. And if you allowed them to do that you might report that they are lively and articulate and engaged. If you insisted they take part in some random craft they might be frustrated and angry.

Tbh I think if you need to ask on a public forum for ideas you probably need more training.

Realistic baby dolls ?

My friend is a volunteer with a therapy pets organisation so she's the owner and her lovely dog is a pet therapet. She takes her dog to a place for a hour or so once a week where a few of the residents absolutely light up when they get to interact with the dog. H&S means a staff member needs to chaperone as my friend doesn’t have the training to be alone with the residents obviously but it’s been very helpful particularly for a couple of the people who live there who must have been pet owners before their circumstances changed.

there are apparently lots of organisations across the country who do similar things.

try searching therapy pets or therapet etc.

It’s the “doing” that counts, not the completion! Anything that stimulates memory, senses, and sense of wellbeing, rather than being too task-orientated, tends to be easier ime!

I would bring in some kit (do you have a small budget for supplies?), set up, tell people what you’re doing, and invite them to have a go. Take items round to those who can’t come to you.

Music (playlist for life have some great resources) - we have a “musical memory bump” ages 10-17 so nearly everyone will remember some tunes from this time in their life. Get a playlist together from each person if you can, to share - ask family members for suggestions of songs if necessary, perhaps run a quiz for those who can, guest performers, having a go with percussion or instruments from other countries, have a day themed around a decade or a country…

reminiscense - there are some lovely books (Robert Opie?), the BBC archives website if you can get it up
on a laptop is fantastic to get a conversation going, local history websites too, bring in old photographs, old tv programmes , historical events, old newspaper cuttings etc, find out a bit about people’s life histories and which bits they enjoy sharing if possible.

sensory activities - scents, lights, textures - loads of ideas online - look at Alzheimer’s Society online shop, loads of lovely things. Clay modelling, Lego, magnets, (magformers), twiddlemuffs, fabric collage etc can all be really enjoyable for people with cognitive loss as it’s something you “do in the moment” which is generally easier than something that appears like a “task”.

Simple cookery (nearly everyone can enjoy the smell and touch of baking bread, for example, at any level of memory loss)

indoor gardening - flower arranging, simple seed planting, can be really joyful, enjoy the smells and textures…

Hand massage, relaxation exercises (can be really really simple like gentle music and a meditation or simple breathing exercise to music), very gentle exercise (I know of one place that does a “tea party tunes and toe tapping” afternoon)

simple games will work for some - tiddlywinks, snakes and ladders, hangman etc.

and yes sometimes just start doing it, rather than asking too much, don’t be afraid to be the person who looks a bit silly to put others at ease and enjoy!

At my mum’s care home, there are activities in the lounge that anyone who is there can either join in or watch. These often are music and singing. The care home has bought into Oomph which is a company which provides interactive internet activities, and they use karaoke microphones. They also do seated exercises, have outside entertainers come in, a vicar does a church service every week, they have birthday parties, celebrate national events and holidays. It’s quite normal for most of the room to observe more than they participate but that doesn’t mean they aren’t getting something out of it.

A visitor comes in once a week and does craft activities in the dining room. In a home of 60+ she maybe gets 8-10 participants. The yearly visit from alpacas (in the garden) tends to draw a crowd. The visiting hairdresser and manicurist are in demand.

There are visits out to a local cafe and shops and 5-6 residents participate in those.

I don’t know if you’ll have time to spend one-on-one with the residents who spend most of their time in their rooms, but recently mum has seemed to enjoy me reading her nursery rhymes and poems, singing ABBA songs together, and colouring in together (though she can’t sustain any activity for more than about 20 minutes).

Dominos.
Nail painting.
Snakes & ladders.

You need to build rapport and you need to see the person, not the job. Otherwise you'll get nowhere.

Children from the local school came into a local home and sang. The children got cake and orange after. Also there are organisations who bring animals in. We had a 1940's dressed singer in singing the songs from that decade and later. Also movement to music. People going round chatting to them, holding their hand if they like that. Painting nails. Eye contact. Engaging about the past. Food from their younger days. Help them decorate a simple photo frame with stickers and take their photo. Occasionally having tea, sandwiches cake, in their armchair rather than the dining table as maybe they did this at home.
Celebrate birthdays. On my mother's birthday I made a pass the parcel to music and they all received a gift from it. This lit them all up. Another year I paid a guitarist to sing. The staff were amazed that some got up to dance, mouthing the words to the songs when their speech had gone. With dementia they may not remember what they have done but the happy feelings stay with them.

Babies and animals always get a reaction. I took my baby daughter to see her greatgrandfather in his care home.
.Elderly ladies sat in a circle in the lounge not talking or doing anything. When they saw the baby they started craning forward for a better look . They chattered about her, about their own babies. They wanted to touch mine and one old lady who never spoke.or reacted to anything became agitated till I brought the baby over. I had tears in my eyes before I left.

There was a woman who brought her dog to visit someone. Same. reaction.Old hands petting and stroking.It was lovely.

Music from their era? On nice days having a walk even if in the grounds? Old fashioned film days with popcorn?

Tastes and smells may spark memories, lavender oil is a good one, aniseed balls and pear drops if they are not at risk of choking, Pears or cold tar soap, baby powder with an old fashioned powder puff

It can't just be talking either. I'm to engage them in activity.

Who’s telling you this? You have to tailor your expectations to the people you’re with. I’m a volunteer at a care home, and some of the people I visit, all of whom have cognitive issues to varying degrees, seem to get comfort from me just sitting and holding their hands and chatting, at whatever level they can manage. They need to be listened to, even if it doesn’t make a lot of sense all the time. I don’t think you can launch in to introducing activities without getting to know someone first. For example, it turns out one lady used to be a very keen knitter and is provided with wool and needles. She’ll knit lots of long ‘scarves’, which gives her pleasure. Another lady loves listening to Vera Lynn, so I play her clips on YouTube on my phone and we both sing along! Another likes me reading to her. These things I discovered during the course of conversations with them. With non-verbal residents maybe try playing music or reading aloud.

In all honesty, I would spend some time getting to know the residents you’re working with first of all, and establish a relationship with them. Other ideas will stem from that. I really think it’s very shortsighted of whoever has told you not to just talk. Many of the residents won’t get much opportunity to communicate with any of the other staff at anything but a superficial level, and appreciate someone taking an interest. I’d take a bit of time and get to know them. Hope it goes well.

You could try this book, created specially for people with dementia - the activity could be to read it together.

Blue Sky, White Clouds

There's a woman who posts videos online about interacting with dementia patients. I can't remember her name but she sometimes pops up on my Facebook shorts acting little scenarios to help dementia families understand and deal with their relatives. She talks about how direct demands will often get a no (even hostility) but if you pose something as e.g. doing you a favour, or quickly getting their opinion on something, or I'm trying to decide between x and y what do you think etc you get a better response. Having a doll and asking the patient to hold it for you for 5 mins while you 'pop to the toilet' might allow them to actually enjoy it for instance.

I usd to have a client who owned and operated care homes. He used to arrange hand massages and aromatherapy sessions for the people in his homes. He said scent was hugely evocative and that so many people are just touch starved. Hands are very sensitive but also a part of the body normally in view.

I’d also say therapy pets and music would be a good way of engaging in a sensory level. With music you can also opt for things that were people when the people involved were children/teens/twenties to help connect with memories.

A few more we did. Taking them outside to be wheeled or walked round the garden, smelling the lavender, honeysuckle, roses. And also taken down the road if safe, to see another environment. Ours were taken to the local shop.
Also the the ice cream man was asked to come into the car park and, appropriately to their diet etc, they could eat an ice cream outside.
We had a company come in with slippers, clothing. These things needed to be organised, some residents loved choosing, some families sorted clothing, some people had no-one to buy for them and the staff helped. The personal money amount was used, but this needed to be sorted properly first.
Our home had a gazebo up outside in the summer, some loved the feeling sitting in the shade of the sun or slight warm breeze for a time, notice how they are and not to long; well hydrated, sun hats etc.
The local church/chapel came in. The residents recalled the hymns/songs they had probably sang from school/going to church. The church members went round and chatted to the residents after, one on one time again, maybe holding a hand, many loved this touch and time for them.
We had small bean bags for them to throw into a net, or throw at skittles on the carpet. Also a large beachball or a large woollen ball to catch. For the ones not wishing to join in, sometimes just an activity happening is something they can get stimulation from.

In my DM’s dementia care home, they had a sort of musical bingo game - a tape or CD with snatches of very well known songs/hymns/carols/nursery rhymes, which they had to mark off on their (large) bingo cards.

Those who were able certainly seemed to enjoy it, but virtually all of them needed help. And those were just the ‘less bad’ ones.

TBH my DM hardly ever wanted to join in anything, even when she was still just about able. When she no longer was, I certainly didn’t want her chivvied into anything she didn’t want to do. And so I was pretty bloody annoyed, when staff told me apologetically that they’d had to take her to some activity she didn’t want to go to, and was no longer even capable of, because there was an Ofsted inspection, and they’d get a black mark for anyone ‘just sitting’. (Annoyed with Ofsted, not the staff!)

Another activity I saw that was evidently popular with some of the less advanced ones, was several of them sitting round a table having their nails done. I remarked to one of them what a pretty colour her nail polish was, and she said, ‘Yes, and do you know, it was only one and six!’ 😂. (Old money, 12.5p!)

Singalongs of old songs with various volunteers were evidently popular with quite a few of them, too.

Good luck, it can’t be easy!

Singing and music quizzes used to go down well in my mum's care home .

Seated exercise too.

And dancing - but you would need more than one carer available to support them .

They also used to have a lot of joint activities with both the dementia and assisted living sections mixing together which I think benefited those whose dementia was not so far advanced .

In terms of music you need to bear in mind the ages of the people within the home - sure they will all know the singalong music hall and WW2 stuff but that would have been their childhood or often before they were born . They sometimes had 70s music on (as background rather than singalong) in mum's home which surprised me to start with - but then realised that someone in their 20s or 30s in the 70s would be 70+ by now. So consider stuff from 50s, 60s etc which is well known and can sing to .

Regarding sensory - yes, my mum loved stroking soft toys.

Agree about age appropriate music. My mums care home used to always play WW2 wartime hits. Completely wrong for my mum, and to be honest hardly anyone is alive now for that to be “their music”
The staff also used to try and play bingo games etc which was a nice effort but hardly anyone knew what was going on.
Almost all the residents enjoyed seeing animals and children. Lots had baby dolls or teddies to look after.