Family caregivers of persons with dementia are growing in numbers as the number of elders diagnosed with Alzheimer’s and other dementia’s increase.
Dementia diagnosis has often come later in the disease but more and more, of late, the diagnosis occurs in the early stage of dementia. There are benefits to an early diagnosis, though many believe waiting is preferable as there remain few treatments and no cure for Alzheimer’s.
There is a person diagnosed with Alzheimer’s disease every 69 seconds!
Family caregivers play a strong role in keeping their senior loved one connected and engaged throughout the stages of Alzheimer’s. Activities can keep persons with dementia engaged in their environment and improve their quality of life throughout all stages of the disease. Activities can also help reduce certain behaviors common to dementia including wandering, sundowning and agitation.
Stages of Alzheimer’s Disease
There are seven stages of Alzheimer’s disease, each holding challenges for the person with dementia and their family caregivers.
Stage 1 – no impairment, no identifiable memory loss
Stage 2 – very mild cognitive decline, highlighted by memory lapses and trouble finding words
Stage 3 – mild cognitive decline exhibited by difficulty coming up with words, difficulty remembering names of new people, trouble with new tasks, forgetting what was just read, losing objects, trouble planning and organizing
Stage 4 – moderate cognitive decline, shown by clear-cut symptoms such as inability to remember names, difficulty with challenging arithmetic such as bill paying, becoming moody or withdrawn, forgetfulness, difficulty with complex tasks
Stage 5 – moderately severe cognitive decline with gaps in memory, need help with day to day activities, inability to remember own name or address, confusion about day/time/place, need help choosing appropriate clothes, can still eat and toilet self.
Stage 6 – severe cognitive decline with memory loss and personality changes, help needed for daily activities, unaware of recent events or even surroundings, unable to remember spouse or family names, help needed with dressing, sleep disturbances, incontinent, personality changes include delusions, repetitive behavior and wandering
Stage 7 – very severe cognitive decline with inability to respond to their own environment and carry on conversation, require help with all activities, impaired swallow, inability to hold own body up and rigidity
Activities for Persons with Dementia
During Stages 1 and 2, most of your senior loved ones’ activities will continue unchanged. They will be able to participate in hobbies and complete activities that they have enjoyed, such as sports, reading, hobbies and travel.
As their disease progresses, it may be up to you – the family caregiver – to plan, schedule and organize the activities that will keep them involved, their mind engaged and allow them means to socialize. You will be the one to get the supplies ready, put them out and clean them up. Your senior may be able to perform the activity once the needed equipment is set up for them but unable to gather and put away the pieces of the activity but enjoy participating and feeling useful. As the stages progress, you may need to supervise and direct the steps in an activity.
As the disease progresses, your senior will begin to withdraw from the activities or hobbies that they have come to love. When you observe your loved one retreating from their favorite activities, you can discuss it with them. If you can determine where they feel unable to participate, you can often modify the activity to make it easier and less confusing for them to continue to enjoy. If, for example, your senior enjoyed woodworking then select some projects that are less complex and keep the tools organized so that they are stored in order of use such as measuring tape, saw, hammer and nails, and paint.
When sequencing is clearer, they will likely be able to complete the task without as much frustration.
Another strategy to keep your senior loved one engaged with others is to reduce the number of people in gatherings. Too much noise, activity and stimulation can be disturbing so keeping the groups smaller will make it easier for them to interact without over-stimulation.
Find a Schedule that Suits Them
When planning the day’s schedule, keep in mind the things your senior loved one is used to. If they always eat lunch at noon, then put that in the plan. If they prefer to bathe in the morning, schedule that then. If they always do laundry Monday afternoon, make time for that. If they take a nap every day from 1-2 pm, be sure to keep from scheduling activities during their rest time. When you over-schedule or upset their routine, this could lead to escalating behaviors.
As the stages progress, be aware of changes in physical abilities. Don’t plan activities that they are no longer able to perform such as hiking or playing monopoly if they have trouble walking, decreased stamina or trouble focusing for long periods.
Many people with dementia do better in the morning than the afternoon. They find it easier to focus and concentrate in the morning. The afternoon brings tiredness and distraction, not to mention sundowning. It is often a good idea to schedule activities and events in the morning when your senior is better able to participate and engage with others.
Find Activities Enjoyed in the Past
When planning activities, no matter what the stage of the disease, finds things that your senior enjoyed in the past. If they liked music and played an instrument, give them the opportunity to do it again. Or you may try to provide activities that relate to the career or job they had throughout their lifetime such as filing or organizing paperwork if they were office workers.
Involve them in the running of the household helping with daily tasks such as table setting or laundry. If they enjoyed gardening, find some tasks they can do outdoors such as pulling weeds or raking leaves.
Keep tasks simple as the disease progresses and offer things that are repetitive such as folding towels or washing a window. The fewest steps and least amount of decision making in the later stages will reduce frustration. As the stages continue, be aware that your senior may be a passive participant watching what you do, tapping their foot to music or clapping hands.
Don’t sweat the small stuff. If a task isn’t done perfectly, don’t worry. It is really about the process, engaging your senior and keeping them involved in their life. Activities can offer a feeling of being needed or having a purpose in life and not like they are a burden on the people who are in their life.
Keep on trying new things, give them an outlet for self-expression whether it is a creative activity that is old or new to your senior loved one and keep a positive outlook. Arts and crafts, music and singing are favorite activities.
The more engaged they are throughout the stages of Alzheimer’s, the happier the entire household will be.