(Alzheimer’s Society) As a person’s dementia develops, it is likely to have an impact on their ability to carry out certain activities. This factsheet looks at why it is important to remain active, including maintaining everyday skills. It gives tips to carers on how the person with dementia can continue to take part in everyday tasks, and suggests pastimes that might be suitable at different stages of dementia.
Meaningful activities should be enjoyable, and may be linked to hobbies or interests that the person enjoyed before the diagnosis of dementia. Activities such as taking a walk, cooking or painting can help preserve dignity and self-esteem. Some of the most beneficial activities can be simple, everyday tasks such as setting the table for a meal or folding clothes. They can help a person with dementia feel connected to normal life and can maximise choice and control. Some activities offer an emotional connection with others.
Benefits of Keeping Active and Maintaining Everyday Skills
Keeping occupied and stimulated can improve quality of life for the person with dementia, as well as for those around them. Activities can act as an opportunity for fun and playfulness. They can also encourage independence, social inclusion, communication or expression of feelings.
Benefits to the person with dementia
- Activities can bring enjoyment and pleasure.
- By remaining involved and active, a person with dementia can maintain their skills and independence for longer.
- Activities can help people to express how they are feeling and relieve the symptoms of anxiety and depression.
- Activities can increase social interaction and reduce isolation.
- Sharing an activity with others may promote shared interests, increased interactions and understanding.
- An activity may help a person feel important and valued because it relates to past roles and experiences, such as raising children or helping around the home.
- Shared activity can promote a sense of belonging.
- Leading a physically active lifestyle can have a significant impact on wellbeing. Exercise is beneficial for physical and mental health and can improve the quality of life for people at all stages of dementia.
Benefits to carers, family and friends
- Taking part in activities with a person with dementia can help maintain a good relationship.
- Activities can offer a break from the everyday caring routine.
- Shared activities can provide mutual enjoyment and companionship, which can support the relationship between the person with dementia and their carer.
- Activities can encourage closeness between a person with dementia and people around them and improve feelings of comfort and security.
- Engaging a person with dementia in meaningful activities may improve behaviour that challenges.
Tips: Finding Suitable Activities
It is helpful to talk to the person with dementia about what they enjoy. Take clues from them and try to find creative ways to adapt activities, focusing on what can be done. Try not to worry about getting things wrong first time; this can lead to finding the right activity. The focus of the activity should be on whether someone is enjoying it and that it has meaning for them, not the ‘result’ of the activity itself. The following suggestions may be helpful.
Conversation is a good example of a simple activity that is meaningful and beneficial for a person with dementia. It can take place in any setting, and with most people. It can be a good way for younger family members to engage with the person with dementia. This type of activity can have a positive impact on the wellbeing of the person with dementia. Even if the person with is having difficulties with verbal communication, non-verbal communication (eye contact, gestures and touching) can be just as meaningful. The important thing is to have a connection through the social interaction.
It is important to involve the person with dementia in the conversation, not cutting them off or talking to others as if the person is not there. Do not assume that someone cannot contribute to a conversation just because they have dementia. Time and support can help the person with dementia make themselves understood and remain involved in the conversation. Some ideas for aiding conversation can include using different prompts for conversation such as a past job or a favourite sports team, reading a newspaper or magazine together, or using technology such as online videos of old TV shows or events.
Exercise could include gardening, walking or swimming. Exercising together will be beneficial to the person with dementia and anyone accompanying them. Some exercises are appropriate for people with limited mobility, for example chair aerobics or a seated game of bowls.
Exercise can still be beneficial in the later stages of dementia. Exercises at this stage could include changing position from sitting to standing, walking a short distance or moving to a different chair. For more information see factsheet 529, Exercise and physical activity for people with dementia.
Creative pastimes can be enjoyable and relaxing for the person with dementia and those supporting them. These could include knitting, woodwork, and painting or drawing. If these pastimes start to become difficult for the person with dementia, it may be possible to adapt them, for example using an easier knitting pattern. If the person with dementia previously did an activity to a high standard, they may be frustrated at not being able to maintain this standard. It may be better to introduce a similar, but completely new, activity. For example, if someone used to enjoy cooking, they may now enjoy growing herbs.
Puzzles and games
People with dementia may enjoy activities that keep their mind active such as crosswords, jigsaw puzzles, cards, board games and electronic games. If the person with dementia struggles with these, it may be possible to simplify them, for example choosing easier card games. Some people also find electronic versions of some puzzles easier to manage.
Activities at home
Activities around the home and garden are very important to people with dementia. They help people feel involved, provide a sense of normality and can help a person’s self-esteem because it shows they can still manage useful tasks. These activities can be enjoyable and can be adapted to a person’s abilities. It may be that they can be continued with the help of a family member, or with reminders about what needs to be done. There are lots of tasks both indoors and outdoors that can provide opportunity for meaningful activity, such as washing up, dusting, or potting and watering plants. Reading aloud to a person with dementia who enjoys books and newspapers can also be a good joint activity.
People may enjoy activities that reflect past interests and hobbies, and they can be a good way of retaining skills. Examples include cooking a favourite meal or helping in the garden. The end result may not be perfect, but this is less important than the sense of achievement and involvement.
Even when other abilities are severely affected, many people still enjoy activities relating to music. Musical memory is often retained when other memories are lost. There are many ways to enjoy music, including listening, singing, following the rhythm and moving to the music. Evidence suggests that music can improve someone’s mood, behaviour and wellbeing. Physically responding to the music (through dance or movement to rhythm) can offer a chance for exercise and non-verbal communication. Favourite songs or pieces of music can also be powerful prompts for reminiscence.
Reminiscence (including life story work and memory boxes)
People with dementia can often remember the distant past more easily than recent events. Activities focusing on reminiscence can help improve mood and wellbeing, and promotes social inclusion and seeing the person as an individual with a unique life experience. It is a good way of helping relatives and friends stay connected as well. There are many ways to initiate conversation and participation in reminiscence, including using photos, creating a life story book or using technology, for example watching memorable events (such as the Olympics, a royal wedding or the moon landings) on a computer or handheld device. Reminiscence should focus on the individual and their experiences; a person’s memories will have helped shape their present identity. However, it should be noted that not everyone will enjoy reminiscing about the past. The following suggestions for reminiscence activities may be helpful:
- Involve the person with dementia. It is their life history and talking about it together will be beneficial.
- Tangible items are an effective way of triggering memories. These could be photos or objects with significance to the person such as a football or quilt.
- Make up a ‘memory box’, life story book or an attractive display board that captures important elements of the person’s life. Physically handling things may trigger memories more effectively than looking at pictures.
- A visit to a favourite place might also prompt happy memories and provide another opportunity to get out and about.
- Dementia damages the memory, and the thinking and reasoning parts of the brain, but emotions remain intact. It is not necessarily a bad thing if the person becomes emotional, although you may uncover painful memories as well as happy ones. Make sure you acknowledge someone’s feelings and allow them to express themselves.
- Avoid asking very specific questions that require factual responses and could put the person under pressure, for example, asking where and when a photo was taken. The main aim is to enjoy the memories rather than to make the person feel tested in any way.
- It is important to show a genuine interest in what the person is saying and value their story.
- Stimulating all a person’s senses is important, as is using verbal and non-verbal communication.
- Reminiscence may uncover other unknown activities or interests that the person has previously enjoyed.
Activities in the community
There can be many opportunities for activity and engagement in the local community for people with dementia, their families, friends and carers. These can include art galleries, places of worship, museums and pubs. If the person has links to a community group it can be helpful to maintain these, as it will increase social interaction and provide an opportunity for activity. It may help to discuss the dementia diagnosis so that people in the community are aware of how they can offer support. However, this should only be done with the permission of the person with dementia and if it is what they want.
There are many pastimes that can be undertaken in groups which may help to prevent social isolation or loneliness. They can also create a sense of togetherness and belonging, for example singing or reminiscence groups.
Birthdays and seasonal events can be a good focus for activity and inclusion. They can help to bring people together and reduce social isolation, while helping to focus on the individual. For more information, see factsheet 455, Supporting a person with dementia during visits, holidays and celebrations.
Interactions with others, especially family members and friends who can offer emotional and practical support, are very important for people with dementia. It can be helpful for people other than the main carer to spend time with the person to do something they both enjoy. There are benefits to engaging other people, such as giving the main carer a break and allowing them to recharge their batteries. It gives the person with dementia more varied interaction and more social opportunities, which can lead to improved wellbeing. Touchscreen technology (such as tablet computers) has real potential to enhance interactions with others. For example, a person with dementia and their carer could use YouTube to watch an old film or play music together. Applications for video calling (eg Skype) can help people stay in touch with family and friends who don’t live nearby. The technology can also act as a link between younger and older generations.
Meetings with other people with dementia, and their families, can be rewarding for people with dementia and their carers. They give people the chance to share how they are feeling, offer support and a chance to meet with people in a similar situation.
Activities During the Later Stages of Dementia
As a person’s dementia progresses, they will still be able to carry out some tasks that are very familiar to them, but will probably be more interested in the process of doing the activity than in the end result. Activities can be simplified so they are still manageable.
Tips for finding an activity
- Look for activities that are stimulating but that don’t involve too many challenges or choices.
- Dementia often affects people’s concentration so they may not be able to focus on what they are doing for very long. It may be a good idea to do activities in short bursts.
- Dementia can affect a person’s motivation. You may have to help them get started, but try not to be disheartened if they seem uninterested in the activity. It may be worth coming back to the activity later or trying a different activity.
- Break instructions down and try to make sure each step of the task is simple.
- Try to think of activities that involve an easy, repetitive action and simple steps, such as sweeping, dusting or watering plants.
- People with dementia can sometimes crave a sense of structure, so folding or sorting things can be simple but rewarding tasks.
- Focusing on ‘normal’ everyday life, such as helping to dust or tidy up the garden, is important in giving people a sense of feeling useful and valued.
Sensory stimulation is important for people with dementia, and can improve wellbeing and quality of life. During the later stages of dementia, people often develop increased difficulties with reasoning and language, meaning that they may be unable to process information or communicate through words. They will still have some or all of their senses. There are various things you can do to stimulate these senses:
- Encourage the person to touch or stroke pieces of fabric, dolls or cuddly toys.
- Try giving the person a hand massage. This can be very soothing for those who enjoy touch. Some people may enjoy using a scented oil such as lavender, although not everyone will like the feel of the oil.
- Continue to take the time to sit and talk to the person or to read out loud. Being with somebody sends out a powerful message that they are valued.
- Help the person to position themselves so that they can see a fish tank, or a window with a nice view. This may have a calming effect.
- Make sure the person has a regular change of scenery and the stimulation of fresh air and the outdoor environment.
- If you are visiting a person living in a care home, you can help the person to feel included and active. You might like to take a short walk with them, even if it is just down the corridor, or to bring in something of interest from outside the care home such as flowers or a seashell.
Tips for helping a person with dementia with a task or activity
If you spend time with someone with dementia, you can support and encourage them to do whatever they can for themselves, by only offering as much help as they need. This is not always easy – it can be frustrating watching something being done slowly when you could do it quicker and easier yourself. But even if the person is struggling with a task, try to avoid the temptation to take over. If you do, they may lose confidence and withdraw from engaging in activities.
- If you do need to offer help, try to do things with, rather than for, the person. This will help them feel more involved and show that you are not taking over or questioning their abilities.
- Focus on what the person can do rather than what they can’t.
- Adjust activities as necessary based on a person’s interests and abilities.
- Their concentration may be affected and they may find it difficult to follow instructions. Try to be patient and allow plenty of time for tasks. Take breaks if necessary.
- Offer praise, reassurance and encouragement.
- It is the sense of belonging and involvement that is important, not necessarily the activity itself.
- Try breaking tasks down into sections. For example, the person may find it easier to continue dressing themselves if you put the clothes out for them in the order that they need to put them on. Or you could pass the next garment to the person, holding it out ready for them to grasp at the right place. You could also encourage them to put their vest on over their head before you straighten it down for them.
- Even if the person can’t complete a full task, carrying out one or two steps of it – particularly the final step – can give them a sense of achievement.
- Make sure that any reminders or instructions are simple. Use short sentences, with gestures and body language to add meaning.
- Be tactful. Try to imagine that you are the person receiving help and speak in a way that you would find helpful if you were in their position.
- Try doing things together, such as going for a walk, folding clothes or drying dishes.
- Try to make doing things together a part of your daily routine.
- Non-verbal communication is very important. Try gesturing, demonstrating, or guiding an action. For example, the person may be able to brush their own hair if you hand them the brush and start by gently guiding their hand.
Tips for People with Dementia and a Sensory Impairment
- Make the most of the person’s sight – make things such as a calendar or clock bigger, bolder (use contrasting backgrounds) and brighter (use good lighting).
- If the person with dementia needs glasses, make sure they are the correct ones and that they are clean. It may help to label them.
- Reduce physical and visual clutter and obstacles.
- Good communication is important – describe what is happening, for example that you have just come into the room, or what they are eating.
- Use other senses such as scent, sound, touch and movement. This could include massage, cookery and music.
Think about using versions of daily living items that have been adapted to make them more accessible such as:
- audio versions of some newspapers, magazines and books
- tactile and large-print games
- audio guides (you can create your own) if going out and about
- kitchen utensils and equipment.
- If the person with dementia needs a hearing aid, check that it works and encourage them to use it.
- Communication is important. Make sure that the person can see your face clearly, get the person’s attention before you start to speak and speak slightly more slowly than usual but try to keep the natural rhythms of your speech.
- Non-verbal communication is important. Use eye contact and use objects or pictures rather than just describing items.
- In the physical environment, try to reduce any background noise and ensure that the area is well lit.
The following suggestions may help:
- Think about where people are sitting.
- Keep noise levels down.
- Provide visual information – think about using both words and pictures.
- As with sight loss use the other senses that the person still has.
Help the person to relax
There are plenty of things you can do to help the person feel calm and secure.
- Ensure that the person is as close as possible to the people and things that give them pleasure.
- A relaxing atmosphere could help the person feel calm and secure. This could be through music, people or familiar belongings.
- Try to ensure familiar surroundings and a regular routine, as this may be reassuring.
- Physical stimulation such as a cuddle or hand-holding can help the person with dementia feel valued and reassured.
- Try to avoid too many conflicting sounds or large numbers of people, as this can add to a person’s confusion. If the person needs to concentrate on something in particular, take them to a quiet place.
- If the person becomes upset or embarrassed by their declining abilities, give them plenty of reassurance. If things do go wrong, be tactful and encouraging. Keeping a sense of humour and having a laugh together can often help.
Memory aids and other reminders can help the person to remain active and use their skills. These may be of most help in the early to moderate stages of dementia when the person is better able to understand the aid and to act upon it.
- labelling cupboards and drawers, using pictures and words – for example, a photo of a cup and jar of coffee
- a large calendar showing the day, month and year
- a noticeboard for messages
- notes stuck by the front door
- a book containing named pictures of significant people such as home carers, or listing important contacts such as the day centre.
There are assistive technology aids designed to help people with memory problems. For more information, see factsheet 437, Assistive technology – devices to help with everyday living.
Consider seeking professional advice
Help may be available if the person with dementia finds it particularly hard to cope with certain activities, either because of the dementia or because of other conditions or disabilities. An occupational therapist (OT) can assess the difficulties and can make recommendations that will aid the person’s independence, safety and confidence when doing certain activities. This may be by adapting the task, by doing things using a different approach or by using assistive technology. You can contact an occupational therapist through:
- social services
- your GP
- your local memory service (ask your local hospital for details)
- the College of Occupational Therapists
If the occupational therapist recommends any changes, try to make them as soon as possible, to give the person the best chance of taking in the new information. The earlier you contact an occupational therapist, the more effective their solutions will be.
All content © 2015 Alzheimer’s Society.