Use of Activities to Maximize Quality of Life in Residents with Mental Illness

1. Use of Activities to Maximize Quality of Life in Residents with Mental Illness Brenda K. Keller, MD Assistant Professor Division of Geriatrics and Gerontology UNMC

2. Recreation's purpose is not to kill time, but to make life, not to keep a person occupied, but to keep them refreshed; not to offer an escape from life, but to provide a discovery of life. Author Unknown

3. Why Activities? • In a survey of caregivers, over 90% expressed that their biggest challenge was finding recreation activities that kept cognitively impaired individuals engaged in meaningful pursuits. • Buettner&Langris, 1999 • In our pre-series survey, Activities for Dementia Residents received the highest interest rating for many respondents. • In long term care facilities 60-80% of resident’s time when awake is unstructured.

4. Focus of this Talk • What is Therapeutic Recreation? • What is required of facilities? • How can activities make a difference? • How to choose activities for your residents? • Sample activities?

5. What is Therapeutic Recreation? • 2000 National Therapeutic Recreation Society (NTRS): • Therapeutic recreation uses treatment, education and recreation services to help people with illnesses, disabilities and other conditions to develop and use their leisure in ways that enhance their health, functional abilities, independence and quality of life. • Approved by the NTRS Board of DirectorsOctober 14, 2000

6. Who is responsible? • “All relevant departments should collaborate to develop and implement an individualized activities program for each resident.” • State Operating Manual

7. “But I’m not the activities director!” • Activities can (and should) occur at any time and are not limited to formal activities staff. • Occupation and activity is highly correlated with reduced levels of agitation • Reflect on your own activities at home—how many are formal and planned? • Strongly encourage all staff to engage in unscheduled activities

8. How can activities make a difference? • Residents participating in a sensorimotor therapy program have been found to have increased flexibility, strength and less agitation. • Walking programs in NH found to be just as effective as medications in slowing cognitive decline. • Facilities which incorporated family and friends in activities reported less agitation. • Giving family members an activity to engage in with the resident lowered their own frustration and burden

9. Individualizing Activities Based on Physical limitations • Vision

10. Individualizing Activities Based on Physical limitations • Hearing

11. Individualizing Activities Based on Physical limitations • Hand dexterity

12. Individualizing Activities Based on Social limitations • Preference to remain in room

13. Individualizing Activities Based on Cognitive limitations • Task segmentation • Break up the action or activity into many small discrete steps • Tasks using retained LTM • Reminiscence group • Length of activities based on attention span • Like meals, smaller and more often may be best strategy • Smaller groups and one on one activities • Increased ability to attend to task with less stimulus

14. Individualizing Activities Based on Behavioral limitations • In General- activities should be used to prevent behaviors, rather that treat behaviors. • Again, most research finds lessened levels of disruptive behaviors, psychiatric symptoms • Once behaviors escalate, activities may be less effective or actually worsen the behavior. • Forcing one to attend will lead to worsened concentration and more frustration

15. Individualizing Activities Based on Behavioral limitations • Wandering • Provide plenty of space and physical exercise. • Encourage walking programs with volunteers • Have rest chairs along path. • Place interesting objects at eye level that the resident can manipulate • Use music and aromatherapy around the walking space

16. Individualizing Activities Based on Behavioral limitations • Aggression • Provide calm, non-rushed environment • Folding, sorting, and matching tasks • Repetitive activities tend to lessen anxiety in any age • Preferred music, walking, snacks, looking at familiar pictures • Physical exercise • Lessens anxiety

17. Individualizing Activities Based on Behavioral limitations • Verbal outbursts • Counter verbal measures can be helpful • Listening to music the resident historically enjoyed • Speakers, headphones • Sing-a-longs can be very helpful • Videos of family members • Discuss past events • May have photos of event or family member on screen while family narrates • Audiotapes or CDs • Nature sounds • Babbling brook • Ocean waves • Rain forest

18. Individualizing Activities Based on Behavioral limitations • Rummaging through others possessions • Activities which require unpacking or disassembling objects • Taking it all out, put it back, take it out… • Use a relatively safe simplistic device to disassemble • Sensory aprons • Pockets full of miscellaneous objects

19. Individualizing Activities Based on Behavioral limitations • Social withdrawal • One-to-one interactions • Hand massage, blanket stimulation • Reading to the resident • Limited participation in past hobbies • Sort out fabric pieces • Arrange items in a tackle box • Videos of past interests • Football games • Weddings • Slowly increase the size of the group

20. Individualizing Activities Based on Behavioral limitations • Lack of personal safety • Activities with soft objects which cannot be swallowed • Walks, scheduled exercise • Especially if the resident attempts to stand on their own and is unsteady alone • Microwave cooking or making Jell-O • Avoid burns with cooking activities • Large puzzles with few pieces • Towel folding

21. Specific Programs and Activities • Simple pleasures • Sensory aprons • Sensory stimulation box • Look inside the tacklebox • Message magnets • Tether ball/balloons • Time slips

22. Simple Pleasures • Volunteer produced activities for use by residents, families, staff. Activity cart left on unit for use during “down” times. • Specific instructions on construction and use provided. Discussion points for each activity are also provided. • http://www.health.state.ny.us/diseases/conditions/dementia/edge/interventions/simple/docs/activity_apron.pdf

23. Sensory Aprons

24. Sensory Stimulation Box

25. Look inside Tacklebox

26. Message Magnets

27. Most Popular Item

28. TimeSlips • Storytelling activity that involves residents of all abilities focus is on imagination, not memory • Need photograph with non-specific content • Group members are encouraged to write a title and build from there. • All input validated and recorded while activity occurring. • Finished products can be included in bound volumes for families, staff.

30. Dog Talk or Two Dogs Making Friends Two dogs are saying “how are you?” and “how’s the family?”  The dog on the right has a red and white handkerchief on his neck.  That’s what color they usually are.  He’s saying, “I forgot to brush.”  They’re meeting at a stop and go light up in the air, someplace in the south, and they’re in an automobile. The more you look at this, the more comical it gets.  Pretty soon they’ll be shaking hands!  But they can’t reach each other. It’s a really nice day, but it’s cloudy.  You can see the clouds.  Maybe it’s not a very nice day. The dogs’ names are Tom and Fluff, or maybe their names are Pat and Mike.  Tom has more hair which I don’t have!  They are saying “come over and play with me.”  Either they’re not very smart, or they’re intelligent.  All dogs are smart.  One dog wants a big bone.  That sounds nice!  They’re going out of town and they will be in a parade at a fair.  They’re going to visit somebody.  They’ll sit there and have something to eat and go home.  Their heads are sticking out the windows because that’s what dogs do.  They want to get out.  They’re talking to each other and they’re just plain nosy!  I think they’re glad to see each other.  They had a good time—a ball at the mall.  They say, “We had a great time.  Maybe we’ll see one another again.”  Then they say, “Let’s call it a day!” April 9, 2008:  Written by Alice, Mary, Tom, Ellen, Sandy, Katie, Dorothy S., Dorothy Z., Florence, Ethel, Patsy Staff who assisted:  Lauri, Sally, Sherry, Pam Volunteers:  Susan, Jean Companion:  Ginny The storytellers are from Brewster Village, Appleton, WI. Posted by: Susan McFadden on April 10, 2008 http://www.timeslips.org/

31. Special Events • Walkathon fundraiser- set goals for number of steps/feet resident will walk in the week and seek sponsors to donate per step rate. Residents to choose charity to benefit from the walk-a-thon. • Senior Prom • Pie Contest-each unit makes a pie and then all residents vote on their favorite.