Monday, November 9, 2015

Things to Know About Dementia, Part 3

For Part 1, click here.
For Part 2, click here.
For Part 4, click here.

18.  Activities for Dementia Patients

What activities can you do with dementia patients?  Guess what - this is not an easy question to answer, either!  If you're looking for a bullet-point list of activities to try, that's not the place to start.  Like everything else with dementia, you're going to have to work harder than finding a list of suggestions.

Why?  Well, like many things about dementia, this is a question whose answer depends heavily on the individual patient.  Variables include the stage and type of dementia being exhibited by the patient, their overall disposition and competencies before their diagnosis, other physical limitations they may have, and however robust their attention span is.

Indeed, a dementia patient's attention span plays a critical role in how and what they can accomplish.  An attention span relies almost exclusively on memory, and what's the hallmark of dementia?  An ever-declining capacity for memory, right?

Why is attention span so important?  There are many residents at Autumn Leaves who can only remember simple instructions for simple tasks for literally a second or two.  I'm not kidding.  So, if they can't remember what they're doing, or why they're doing it, the best activity in the world will be fruitless.  You'll be spending so much time reminding the dementia patient of basic procedures and reasons, it won't be a positive experience for you, and your aggravation likely will be negatively sensed and processed by the dementia patient.

Sometimes, for example, staff members have to repeatedly remind residents of a task like "sit down."  One lady who can't walk will try to stand up out of her wheelchair, and the staff will say gently, "sit down, please;" and she'll obediently say "okay," and sit down. But as soon as her bottom touches the seat of her wheelchair, the resident will begin her process of trying to stand up again.  The staffer will say gently, "sit down, please," and she'll say "okay" in the same obedient, monotone voice, and sit down.  Yet this process can go on numerous times until a staff member wheels the resident to another room.  Is the resident being intentionally belligerent?  No, she simply cannot remember the request for more than a second or two.  Meanwhile, the staff has discovered that placing her in a new environment - even just another room - usually is enough to "redirect" her attention span to something else, instead of wanting to get up out of her wheelchair.

So when it comes to activities for dementia patients, you will need to factor in the length of time a dementia patient can literally remember what they're supposed to be doing.

Plus, their ability to remember what they're supposed to be doing correlates with their ability to remember how to do it.

During the early years of his retirement, my father used to paint with acrylics and watercolor, work crossword puzzles, draw, read, mow the lawn, and listen to classical music.  It wasn't long after his diagnosis of dementia that Mom and I noticed him painting less and less.  Finally, he'd become so frustrated in his growing inability to paint what he wanted to paint that he completely stopped what had, for a long time, been his favorite hobby.

Crossword puzzles lasted a little bit longer, but I noticed they became more and more incomplete.  Drawing stopped.  Dad continued to read his Bible up until the time we finally had to place him in Autumn Leaves - but by then, it seemed as though he spent more time staring at his open Bible than actually reading it - and who knows how much of what he read he could comprehend.

He mowed the lawn up until the spring of 2014, even though the quality of his mowing had already gotten pretty bad.  He'd leave gaps of tall grass across the yard, a sloppiness due at least as much to his forgetting to wear his glasses as much as his overall mental decline.

And classical music?  Over the years, Dad had amassed a collection of dozens of CDs, cassette tapes, and over 100 old LPs, but about two years ago, we noticed that he never listened to them, or to the all-classical radio station in Dallas.  Occasionally, he'd ask me to find WQXR on his Bose radio, but that was one of New York City's classical stations, and he didn't understand that Dallas' station was all his radio could get here in Texas.

So how did Dad spend his days?  Well, he spent a lot of time staring at his Bible, dozing, asking Mom and me the same questions over and over, and rummaging through the drawers of the desk in his home office, rearranging all of the pens, pencils, 3x5 cards, nick-knacks, small hand tools, paper clips, and other whatnots countless times.  In fact, rearranging his desk drawers, his office closet, his bookcase, and his collection of music CDs soon became his primary activity.

At Autumn Leaves, the staff will give high-functioning residents some repetitive tasks so that the residents will be occupied but also get a sort of sense of purpose and accomplishment.  Things like folding letters, stuffing envelopes, folding towels, sorting M&M's by color.  They're things "healthy" folks consider monotonous; yet monotony is a valuable, soothing, and healthy thing for dementia patients.

One of the most engaging activities they hold at Autumn Leaves involves a big balloon that a staff member, in a room full of residents, will toss at somebody, and then encourage them to bounce towards somebody else.  Even weak and lethargic residents can at least tap the balloon, or let it hit an arm or leg, and thereby make the balloon move.  And with a balloon - softer than the softest sports ball - nobody gets hurt.  Balloons also move through the air at a slower speed than any other ball, so dementia patients can more easily watch it and visually track its movement, giving their brain and muscles time to coordinate and react to however the balloon is moving.

Some residents could paint quite artistically, and a professional artist with training in coaching dementia patients through crafts was brought in monthly to host a painting workshop.  They took Dad in to paint in one of those workshops, however.  The artist had cut up bits of scrap wood and drawn a bird on each one that the residents could then paint however they wanted.  Dad had scrawled a weak line of yellow paint across his bird, and could do no more.  Mom and I almost cried when we saw it, and what it represented:  the complete absence of his former proficiency in painting.

So, in what ways can you creatively engage your dementia patient?  Be realistic about what you want to accomplish.  Even at Autumn Leaves, the number of residents who participate in daily exercises, sing-alongs, "this day in history" activities, and cooking activities represents a small portion of the facility's overall population.  Some of the higher-functioning residents get taken on short excursions out to eat or even to the zoo, but those require a high degree of planning and execution so everybody is kept safe and accounted for.

We let Dad do at home whatever he wanted to do, and that was predicated on what he'd wanted to do back before dementia.  But your loved one's interests and abilities will decline, and there's little you can do about it except adapt to each new low.  Dad used to enjoy fixing his own lunch, for example, but when we caught him trying to microwave something wrapped in aluminum foil, we had to start warming things up for him ourselves.  He used to go down the steep embankment to the creek behind our house to feed the turtles, but when we realized his balance was getting bad, Mom simply stopped giving him bread to take down there.  And he forgot to ask.

Fortunately for us, Dad was often content to merely sit under the massive magnolia tree in our backyard and watch jet airplanes circle about overhead in the afternoons.  But again, his balance was so bad, I'd often go out with him, just to make sure he didn't fall when setting up or closing up his camp chair on the grass.

I'd also sit with him out there so that when he'd ask me whose backyard we were in, I could reassure him that it was his.

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