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Activities and Engagements for People with Advanced Dementia

31 December 2023

Behavioral interventions in the routine care of people with Alzheimer’s disease and advanced dementia can promote the quality of life of both the patients, their families, and their caregivers, and occasionally prevent unpleasant incidents such as wandering or forgetfulness in situations that may put the person and their environment at risk. It is essential to maintain their dignity and treat them with respect at any stage. From a practical standpoint, there are several measures that can be taken to improve the patients’ quality of life, including:

Wandering: Individuals with dementia have a natural inclination for aimless movement, and it is vital to permit and oversee their wandering under supervision and companionship. Occasionally, they may wander aimlessly and get lost. It is advisable to take preventive steps and explore their walking routes so you can easily detect them. One can provide alternatives to aimless wandering, such as engaging in mutual strolls in nature.

Communication: Individuals with dementia experience a decreased ability to recognize those around them. It is important not to confront them with this forgetfulness and to show them love in various ways, including non-verbal gestures such as holding their hand or giving them a hug.

Functioning: Engaging in shared routine activities can aid individuals with dementia in maintaining basic cognitive functions. Examples of activities include sorting and rinsing vegetables and fruits, baking cookies, drying, and organizing cutlery, folding laundry, and similar tasks. It is important to be with them and to ensure their safety.

Enjoyment: It is advisable to establish a connection to the patient’s cultural background and personal preferences. You can offer them enjoyable activities that can be done together, for instance, engaging in garden care or tending to plants in pots, listening to music, watching television, taking care of pets (even if they did not have pets previously), and engaging in arts and crafts.

Older adults can live with dementia and Alzheimer’s disease for many years. Dementia typically starts with mild symptoms and progresses over time, resulting in a gradual decline in cognitive functions, memory loss, and time and spatial disorientation. As the disease progresses, there is a noticeable deterioration in the capacity to carry out everyday tasks, accompanied by unfamiliar behaviors. Additionally, the ability to communicate effectively with the environment diminishes. Occasionally, individuals with dementia struggle with daily activities such as eating, dressing, and maintaining fecal continence.

Modifications in behavior are affected by the progression of the disease as well as by the environment’s reaction to the patients. Acquiring tools to cope with the modifications, including behavioral interventions in the treatment routine, can help promote the quality of life for both your patient, yourself, and their caregiver.

At any stage of dementia, two fundamental principles underlie life and the treatment of individuals:
  1. Maintaining their safety
  2. Maintaining their dignity

Communicating with patients with advanced stage dementia

As the disease progresses, people with dementia experience a decreased ability to recognize those around them. As family members and caregivers, It is important not to confront them with this forgetfulness.

Experiencing difficulty accepting and coping with the situation is a natural and understandable response, and it is important to seek support. However, when it comes to your relationship with family members or patients with dementia, it is of the utmost importance to express love and exhibit respect, even if they may not recognize you or remember who you are. They can still sense the love and respect from those who are with them, knowing that their best interests are being considered.

Physical gestures like holding hands, caressing, and offering hugs serve as a form of communication, and it is essential to learn how to provide them in a way that is suitable for both the person with dementia and you.

Maintaining a pleasant tone is crucial, even if the individuals you care for may not comprehend your words. In these instances, the tone of voice carries the utmost significance.

It is crucial to avoid shouting or using abrupt and commanding language that may sound like orders, such as "get up," "sit down," "eat," and so on. This type of communication style can create stress and occasionally lead to resistance. It is preferable to replace it with a soft and pleasant tone of voice, for example, “now we shall try to get up”, “here is the chair”, you better sit down”, and so on.

Going outdoors with people with dementia

People who suffer from different types of dementia have a natural inclination for movement, and it is vital to allow them to walk and wander in a secure environment or under the supervision and companionship of family members or caregivers.

Occasionally, people with dementia choose to wander on regular routes and in familiar surroundings. It is advisable to take preventive steps and explore their walking routes so you can easily detect them. This can be achieved by accompanying them to the places they frequently visit and joining them on their walking routes. While walking together, you can point at landmarks that will facilitate orientation, including trees, stores, and benches, and even write down their location in a notebook.

Activities that can substitute the need for wandering

Outdoor walks, taking into consideration weather conditions

When the weather permits, it is advisable to go out on walks, to visit favorite places, and more. It is important to adjust the duration of the stroll to the physical abilities and endurance of the patient.

A stroll along a route with a variety of stimulus

Such as eating, drinking coffee, and so on. For instance, going out and making stops at a coffee shop, purchasing a popsicle, falafel, and so on.

An outdoor trip with experiences that stimulate the sense of taste

Like eating, drinking coffee and more. For example, a trip outside and a stop at the neighborhood cafe, buying a popsicle, falafel and more.

Shared activities with individuals in advanced stages of dementia

Dementia evolves and modifies over the years, and so do the communication channels with the patient: verbal information may lose its meaning quickly, but at the same time, information that reaches the dementia patient through their senses (sight, hearing, and touch), may leave a mark for a longer period.

Regular shared activities can help dementia patients in maintaining simple cognitive abilities, including categorization and adaptation.

It is important to ensure that the activities are conducted in a pleasant manner, without causing stress or frustration among the patients. Furthermore, it is advisable to avoid making critical statements or statements that may trigger feelings of failure or helplessness in the patient.

Some activities for example:

  • A simple activity combining sensory stimulation and practice of cognitive abilities. To improve it, you can also say the names of the vegetables and fruits and talk about them. For example, which is the patient’s favourite, what can they eat with them, what texture do they have, and so on.
  • For safety reasons, it is preferable to soak the vegetables and fruits in a water pail, rather than rinse them in tap water.
  • It is advisable to perform the activity while sitting down.

  • Baking is an activity that stimulates multiple senses, including touch, smell, and taste, and has the potential to evoke pleasant memories. To maintain long-term memory, you can take advantage of this mutual activity to reminisce (for instance, a cake that is passed down from generation to generation in the family), to mention who loves this cake in particular, and so on
  • Baking cakes is an activity which is not recommended for patients who struggle with swallowing, as individuals in advanced stages of dementia may tend to put objects in their mouth.

  • An activity which helps preserve cognitive abilities and fosters a sense of participation in household tasks, allowing individuals to maintain a sense of control over their environment
  • It is important to oversee the activity and adapt the choice of cutlery according to the patient's behavior. If necessary, ensure that knives and forks that could potentially pose a risk to the patient and their surroundings are kept at a safe distance.

  • An activity requiring cognitive ability, which combines stimulation of the touch and smell senses, activates the upper limbs, and widens their movement range
  • This activity does not pose any danger to the patient, as long as it is performed while sitting down
  • You can consider combining simple mathematics exercises, according to the patient’s abilities (for example, “how many shirts do you have?”, how many shirts were folded”? and “how many shirts are left to fold?”).

Enjoyable activities for people with advanced stage dementia

It is important to find enjoyable activities that align with the cultural background and past experiences of individuals in the advanced stage of dementia and integrate these activities into their daily routine.

For example:

Engaging in garden care or tending to plants in pots: an activity which combines sensory stimulation, and provides pleasant activities such as watering the plants and removing dry leaves, growing herbs in a planter, and so on

A relaxing activity in conditions of anger and a stimulating in conditions of detachment and apathy. It is important to adapt music to the person and their culture

Some people with dementia lose interest in verbal and entertainment programs. However, they might have an interest in documentaries about nature, sports broadcasts, music channels, as well as verbal programs delivered in their native language, among other things. It is important to select channels and programs that create a pleasant experience for individuals with dementia

A meaningful and recommended experience for both people who had pets in the past and those who have not. They can engage in activities such as petting and feeding them from the palm of their hand, among other interactions. It is important to do so with close supervision and carefully observe the reactions and sensations that this activity elicits

Pasting large stickers onto pages, sculpting with plasticine or fimo, collecting and gathering flowers for drying purposes, and so on.

You can arrange the objects you want to arrange on a table (organize work tools within a specifically designed box, put flowers in vases, arrange electrical wires that need to be separated) and then let the patient touch them. It is essential to always supervise the patient closely and ensure that they do not touch sharp objects or prickly flowers.

If you have any hesitation, or a query regarding any issues that arise while caring for a patient with dementia, it is recommended to seek guidance from geriatric teams available at the community clinics, including occupational therapists.

Important to note

Important to note

The Joint-ESHEL (Hebrew) Organization has established a new website that provides a comprehensive list of activities suitable for engaging family members and individuals with dementia at all stages.

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