How to Have Fun and Not Get Hit- - Successful Activities for Persons with Dementia

1. How to Have Fun and Not Get Hit--Successful Activities for Persons with Dementia Kim P Petersen MD Spring Green, WI kim@dementiaeducation.com

2. Is This How You Feel Working with Dementia Residents?

3. How to Have Fun Activities with Persons with Dementia

4. FIRST--Start with Understanding the Person with Dementia

5. Personhood • A feeling, human being who is is not limited to memory, problem solving, or ability to perform activities of daily living • A person with a disability, not a terminal illness • A person who is valued and respected for who they have been and who they are at this moment • A person whom we must learn to understand and know.

6. Personhood Denied • Consequences of denying personhood: • Cognitive and Functional Decline • Disability • Victimization (AD victim) • Dehumanization • Isolation and Alienation

7. Personhood Denied • Terror • Depression • Non-support • Shattered life

8. Personhood Denied USTHEM Sound of Mind Damaged Contributing Deficient Whole Without Value Cognizant No Contribution

9. Treachery & deception Disempowerment Infantilization Intimidation Labeling Stigmatization Outpacing Invalidation Banishment Objectification Ignoring Imposition Withholding Accusation Disruption Mockery Disparagement Toxic Interactions

10. Personhood Identity Attachment LOVE Occupation Comfort Inclusion Tom Kitwood, Dementia Reconsidered: The Person Comes First

11. SECOND—Understand Their Pre-Dementia Intelligences

12. Intelligence • Howard Gardner’s Definition: • Verbal • Mathematical/ Logical • Visual-Spatial • Musical • Motor • Naturalist • Spiritual/Existential • Interpersonal Emotional • Intrapersonal Intelligence (Daniel Goleman)

13. You May Need to Get This Background Information from the Family

14. Verbal Intelligence • Likes to read, write, do crosswords • Enjoys conversation, public speaking • Enjoys puns, jokes, wordplay • Loves to tell stories • Enjoyed English, social studies, history, foreign language, speech, drama, forensics in school

15. Mathematical/ Logical Intelligence • Good with numbers • Enjoys playing cards • Likes sports statistics • Follows the stock market • Likes to find patterns, logical sequences • Enjoyed math, science, law classes

16. Visual-Spatial Intelligence • Is artistic • Likes to draw or paint • Enjoys sewing, knitting, woodworking • Good at home decorating and repair- is “handy” • Likes color and design • Likes to take photos • Enjoyed art, home ecc, mechanical arts classes

17. Motor Intelligence • Enjoys playing sports • Likes to dance • Is graceful and coordinated • Enjoys physical exercise • Likes working with hands • Is mechanical • Enjoyed phys ed, home ec, mechanical arts classes

18. Musical Intelligence • Likes to sing or play a musical instrument • Enjoys listening to music • Knows a lot about a musical era • Enjoyed band, chorus, orchestra, dances

19. Naturalist Intelligence • Loves the natural world: animals, plants, nature • Would rather be out of doors • Cares for pets, birds, the environment • Likes to garden • Enjoyed science, botany, biology, ecology, geology classes

20. Spiritual/ Existential Intelligence • Is religious or spiritual • Practices meditation • Contemplates “the big questions” • Enjoyed philosophy and religion classes

21. EmotionalIntelligence • Is self-reflective and insightful • Good at interpreting personal needs and those of others • Is a “people person” • Good listener, empathetic • Fun to be around/ good sense of humor • Enjoyed psychology classes, drama, social events

22. Emotional Intelligence- Humor • Loves jokes, wordplay • Isn’t afraid of looking silly • Enjoys comedies, funny books • Sees life’s silliness and “fabulous realities” • Uses humor in difficult situations, laughs in the face of adversity • Sought out by other people for sunny outlook on life

23. Aging Underwear

24. Assessing Cognitive Strengths of Persons with Mild-Moderate Dementia • What type of jobs have you had? • What skills have you developed for your job? • Tell me about your schooling. • Did you have a favorite class or classes? • Did you have any subjects that you didn’t like at all? • What are your hobbies? • What keeps you busy now? • What have you always wanted to learn or do? • When do you feel happiest, most satisfied, creative?

25. Improve YOUR Communication Skills

26. General Communication Principles • Set the Stage • Quiet environment • Even bright lighting • Avoid strong backlights • Reduce clutter and distraction • Turn off the television! • Disasters portrayed on tv may seem real and immediate

27. General Communication Principles • Earn attention • Make eye contact • Use touch, if appropriate • Sit if the person is sitting • Be at the same level • Smile genuinely • Greet the person • Use the person’s preferred name • Introduce yourself • Be willing to come back, if this isn’t a good time

28. General Communication Principles • Vocal Quality • Lower pitch • Calm • Slow down • Don’t use Elderspeak • Sing-songy voice, childish intonation and language, “Imperial we” • If a person is hard of hearing, consider using a pocket talker or other assistive device • A loud voice may be perceived as angry or cross

29. General Communication Principles • Non-Verbal Cues • “Center” and collect yourself, so your body language will be calm, positive, open • Smile with the eyes, as well as the mouth- mean it! • Open, non-threatening stance, hands relaxed, visible • Be aware of each person’s personal space comfort zone

30. Keep Language Simple Slow down! • One step at a time • Add descriptors and gestures: • Please sit down in this chair right here • This blue chair • This blue rocking chair • Don’t argue or confront • NEVER SAY NO!

31. Let’s explore the garden. I’m sorry, I must have bumped the table and spilled your juice. Let’s us early-birds have some coffee. Let’s go freshen up. Don’t go out to the street! Oops, you spilled your juice all over! You can’t get up now- it’s 4 a.m. I need to clean you up, you had an accident. Positive Language Negative Language

32. The Art of Questions • Who is this? • Open-ended question • Is this a picture of John Wayne? • Question that gives the answer • Gee, John Wayne looks serious here, don’t you think? • Make a commentary • How do you feel when you see this picture of John Wayne? • Creative question, with no right or wrong answer

33. Responding • “Give me the ……..the…..you know…” • It must be really frustrating when you can’t find the word you’re looking for. • “I was in the Navy on an aircraft carrier…” • What an interesting story– I love to hear you talk about being in the navy! • “I want to go home…I want to go home..” • I wish I could take you home

34. Responding • “Please don’t leave me, stay here…” • I hate to leave, but I’ll look forward to seeing you tomorrow. • “Nobody loves me or wants me…” • I cherish your friendship, love. • “I don’t want to go back in…let’s stay outside.” • I had so much fun watching the squirrels play in the yard. Thank you for sharing this time with me.

35. THIRD—Use Tested Activities for Persons with Dementia

36. Reminiscence and “Life Review” • Process, not product • “Just do it!” -- Don’t worry about grammar, spelling, mechanics • “Life Story Books” • TR- Bios (Therapeutic/ Restorative Biographies- Gene Cohen) • “Making Memories Together” game- GENCO GAMES

37. TimeSlips- Creative Storytelling Project Developed by Anne Basting, PhD, the TimeSlips project has generated hundreds of stories and plays. The creative processes promotes communication, connection and joy in elders who are living with dementing illnesses. www.TimeSlips.org

38. Music Therapy in DementiaMeta-analysis of Study Results • Persons with dementia can continue participating in structured music activities into late stage • Instrument playing and dance/ movement are most preferred live music activities • Singing participation declines in late stage dementia • Modeling of expected responses helps to maintain participation

39. Music Therapy in DementiaMeta-analysis of Study Results • Individual or small groups (3 - 5) are optimum • Social and emotional skills and communication are enhanced • Music can enhance cognitive skills such as memory • Information presented in a song context enhances recall and recognition • Effective alternative to medication for behavior management

40. Music Therapy Resources • Alicia Clair, Therapeutic Uses of Music with Older Adults • David Aldridge, ed. Music Therapy in Dementia Care • Oliver Sacks, Musicophilia: Tales of Music and the Brain

41. Here’s A Neat Idea !!

42. Adding a “Spark of Life” to Your Programs • Jane Verity- Dementia Care Australia • www.DementiaCareAustralia.com • Goals for Participants: • To have their self-esteem boosted • To be creative • To be the leader • To express themselves in their own unique way • Program called “The Sunshine Club”

43. Adding a “Spark of Life” to Your Programs • Rules of the Sunshine Club program : • One room • Two facilitators • Three club levels • Everything is right • Nothing is wrong

44. Sunshine Club Format • Minimum of 1.5 hours • Inviting Ritual: • Hello. I’m so pleased to invite you to come to our Sunshine Club meeting! • Walk with person to club room • Greeting and welcoming ritual • Hi George, I’m so glad you’re here. • Beginning ritual • May be a song “You Are My Sunshine,” motor activity, snack

45. Middle Theme – May be seasonal Potential Themes, written on the back of a game: Affirmations Life wisdoms Proverbs Jokes “Did you know?” Information, not quizzes Nursery rhymes, when appropriate Use black writing on a white background Upper and lower case letters with serifs Large print: minimum 26 Bold Sunshine Club Format

46. Sunshine Club Format • Ending Ritual • Recap special moments from the day • Sing a song- “Good night ladies” • Thank each person for coming • Promise to meet again on the next scheduled day • “We’ll meet again on Thursday.”

47. Club Levels • Club 1- Those needing highly focusing activities 4 – 6 members • Stimulation through use of large, colorful moving objects • May use giant balloons, dice, parachutes, flags • Later stage dementia persons • Communicate primarily non-verbally • Can concentrate for a few minutes when attention is focused on someone else • Can contribute to the group with smiles, caring for others, expressive movement or sounds, touch, eye contact

48. Club Levels • Club 2- Those needing focusing activities: 6 – 8 members • Uses stimulation through a mix of verbal communication and large, colorful moving objects. • Middle stage dementia persons: • Can respond to and initiate conversation • Can express themselves verbally when given time • Can concentrate for up to 15 minutes

49. Club Levels • Club 3- Those needing least focusing activities: 8 members • Stimulation through use of objects and verbal communication • Sharing thoughts, feelings, life experiences and wisdom • Choices often made by members themselves • Early stage dementia persons • Initiates spontaneous verbal conversation • Can concentrate for 15 minutes of longer • Can verbally validate and support one another

50. Sample Club 3 Activity • Bring in a bunch of old kitchen and workshop tools • Ask each participant to choose one • Ask: “What do you think of when you see this old bit and brace/ meat grinder/ rug beater?” • Encourage everyone to share their ideas. • Allow the conversation to drift– you don’t have a “plan” you need to follow