- There are many activities that can be beneficial and enjoyable for individuals with dementia.
- Popular activities for individuals with dementia include creating art, playing music, volunteering, playing games, etc.
- It is important to adapt activities based on individual needs, limitations and stages of dementia.
Maslow’s Hierarchy of Needs is a psychological theory that ranks human needs in the form of a pyramid. The theory considers safety and physiological needs (food, water, warmth, rest) as “basic needs” at the bottom of the pyramid. Higher up in the hierarchy are other important needs that individuals strive for once those basic needs are satisfied, including the need for “belonging”, love, and self-esteem. At the top of the hierarchy is also self-actualization, or achieving one’s full potential, through enjoyable activities. These needs, especially the need to feel loved, included, and valued, should be seen as equally important for senior adults with dementia as they are for all of us.
While dementia is by definition characterized by many declines and limitations, and it may sometimes be hard to see past these challenges, not all abilities are lost, especially in the early and middle stages of the disease. Seniors with dementia are capable of making meaningful contributions and experiencing joy, thus providing opportunities to facilitate such experiences is crucial.
There are many types of activities that research suggests can be beneficial and enjoyable for individuals with dementia. Benefits of such activities include opportunities for self-expression, greater social and emotional connections with others, engagement with life, stress relief, and the ability to stir memories and provide moments of greater clarity.
Often art teachers won’t let their students use erasers because every stroke, whether made mistakenly or intentionally, is part of the process that makes the work what it is. This sentiment embodies the unique value of art for seniors with dementia, in that there is no right or wrong. In a world full of neurological exams and “Do you remember…?” questions from family members, there can be something serene and liberating in the subjectivity of art, whether in its creation or appreciation. Art programs for individuals with dementia and their caregivers have been shown to improve quality of life and reduce some of the behavioral and emotional symptoms of the disease.
There are also art programs in which family caregivers can participate with the care recipient. Such experiences provide respite for them as well as a unique opportunity to interact with one another, not as patient and caregiver, but as peers and family. Some examples of these types of programs include Meet Me at MoMA, Memories in the Making (Alzheimer’s Association), and Here:now (Frye Museum, Seattle).
Film Recommendation: “I Remember Better When I Paint”
Music has also been found to be an enjoyable activity for many adults with dementia, again in both the active and passive sense. Seniors with dementia may enjoy creating music (singing or playing an instrument), and listening to their favorite tunes. The ability to play an instrument is an ability that may remain relatively constant, even as the disease progresses. And although adults with dementia may be unable to recall names or dates, they may still remember the music they’d played or listened to throughout their lives. One reason music may be so ingrained in the brain is that it typically involves a blend of memory, emotion, hearing, physical movement, and rhythm. In most types of dementia, procedural or implicit memory (memory of something we’ve performed almost unconsciously, like riding a bike or playing piano), is a type of memory that takes longer to decline.
The Music Goes On: A True Story
M. had a musical upbringing, learning to play piano and violin as a child and picking up other instruments throughout her life. She attained two degrees in music education and performed as an orchestra violinist. Music always played an important role in her life. She had a heart attack in her 80’s and was diagnosed with vascular dementia a year later. Now at 101, although she often forgets where she is and the names of those she met in recent times, she still performs regularly and can play nearly 400 songs by ear.
While M. is a unique example of a talented lifelong musician, research suggests that at least to some extent, musical abilities can remain into the later stages of many types of dementia. There are a variety of programs across the country for individuals with Alzheimer’s to pursue interests in music. For example, there are choirs made up of individuals with early stage memory loss and their care partners, such as the Unforgettables chorus (New York), or Sing Here Now (Oregon). In the UK, the Alzheimer’s Society sponsors Singing for the Brain, an interactive singing program that aims to improve self-esteem and quality of life in patients with dementia and their care providers. While much of the research on these types of programs is still in its infancy, participants report therapeutic benefits.
For individuals who prefer not to perform, or for whom such programs are not available, there are still benefits to be derived from just listening to music. The idea of music therapy for individuals with dementia has gained ground of late, in part due to the popularity of the documentary Alive Inside. Alive Inside depicts the potential that personally tailored music can have on “awakening” memories and providing moments of clarity in individuals with dementia. Music can be an extremely calming and soothing force, and it is also known to release dopamine, a chemical in the brain associated with feelings of pleasure. It therefore makes sense that music is a worthwhile pursuit for those with dementia, especially those who enjoyed music throughout their lives.
Film Recommendation: “Alive Inside”
All too often, an Alzheimer’s diagnosis is followed by social isolation along with restrictions on one’s independence and ability to meaningfully contribute to others. But dementia does not strip a person of a desire to help others, nor does it take away the ability to contribute. Facilitating these types of opportunities may be especially important for those who have demonstrated a desire to give back or help others.
Some cities have programs to help facilitate meaningful engagement and community involvement for individuals with dementia. For example, Seattle Parks and Recreation supports Dementia Friendly Recreation, which includes the “Remember the Hungry” volunteer program. In this program, those living with memory loss are able to give back to the community by helping at local soup kitchens.
If you don’t live in a city where such programs are available, volunteering may be a great activity for a caregiver and person with dementia to do together. If volunteering outside of the home doesn’t seem feasible, there may be small ways to encourage contribution around the house (e.g. watering plants, helping to prepare a meal). Feeling useful and feeling like one has a purpose in life have been shown to have substantial positive impacts on health and well-being. While contributing to others won’t cure the disease, research suggests that it might help improve mood and quality of life.
Is it better to engage dementia patients with a brand new activity or something they have done in the past?
Physical activity is beneficial for physical and mental health and can improve mood and quality of life in individuals in all stages of the disease. Research suggests that regular exercise (at least twice a week) may also help reduce or delay functional limitations in individuals with dementia.
Below are some examples of types of exercise that have been recommended for those in the early to middle stages of dementia (source: Alzheimer’s Society):
- Gardening: Gives chance to get outdoors, also provides a sense of contribution
- Dance: Provides a social and enjoyable way to get exercise
- Seated exercises: Can work on improving or maintaining balance and strength
- Swimming (under supervision): Provides a good and often calming type of exercise
- Tai chi/Qigong: Works on balance and stability, provides relaxation
- Walking: Can be an enjoyable (and potentially independent) form of exercise
In the later stages of the disease, individuals typically face increased physical restrictions. However, whenever possible, individuals should still be encouraged to move about regularly.
Reminiscence, or reminiscence therapy, is an activity that involves life experiences, memories, and stories from the past. Typically, exercises in reminiscence draw upon long-term memories, the type of memories that take longer to decline in Alzheimer’s disease and other types of dementia. For example, while dementia may affect patients’ abilities to recall names or what they had for breakfast that morning, it is less likely to cloud their childhood and early life memories, such as school years or their wedding.
Benefits of reminiscence include the potential to bring up happy memories and cultivate positive feelings. Reminiscing can also help instill in individuals with Alzheimer’s a sense of value and contribution, in that they are sharing stories with others who are interested in what they have to say.
In reminiscence therapy, a caregiver or family member will typically begin by presenting the person with Alzheimer’s with some multi-sensory items, selected to stimulate memories. For example, items could include old photographs, film clips, or personal items like a wedding veil.
While reminiscence therapy is often conducted in care facilities, it can also be administered at home. One suggestion for carrying out your own form of reminiscence therapy includes creating a “memory box,” filling it with items that mean a lot to your loved one, and spending time discussing the various items and what they mean to them. While this may be easier if you are a family caregiver, this activity can also be a great opportunity for professional caregivers to get to know their care recipients on a more personal level, including their life histories and values.
For individuals in late stage dementia, sensory stimulation is one type of activity that may be especially useful, particularly for those with Alzheimer’s disease. In the later stages of dementia, seniors typically experience greater declines in reasoning and language, but they still have their senses (sight, hearing, touch, taste, and smell), and caregivers can use them as ways to connect.
Sensory stimulation consists of anything that stimulates one of the fives senses. It can be easy to carry out with items found around the house. Examples can include auditory stimulation by playing calming music, tactile stimulation by massaging their hands with lotion, or stimulating the sense of smell with familiar foods or scented products. Aromatherapy, which is growing in popularity, may also help relieve some agitation.
Research suggests that sensory stimulation can have short-term positive effects on behavior and psychological well-being in individuals with dementia.
There are several games, products, and mobile apps on the market designed to help facilitate communication and stimulation for individuals with Alzheimer’s. Some popular games include:
Early/Middle stages of dementia
- Shake Loose a Memory, a game that provides prompts to stir positive memories
- Thumball, a memory game that also works on hand/eye coordination and dexterity
Middle/ Late Stages of Alzheimer’s
- Qwirkle, a Dominoes-like tile game
- “I Got It” card game
You may also want to suggest playing more traditional games, such as dominoes, cards, and checkers, as they are likely to remember how to play from when they were younger. Sometimes this may be easier than learning the rules of a new and unfamiliar game. Playing games together on a rainy day can be a good way to facilitate interaction and a greater sense of connection between the caregiver and person with Alzheimer’s.
View the following websites one day to learn more about games and other products:
When planning activities for individuals with dementia, it is important to keep the specific person in mind. It is important to consider their history, their likes and dislikes, and their individual needs and limitations. Just like for all of us, no one activity will appeal to everybody. If your grandmother was never an “animal person”, it is unlikely that pet therapy or interacting with animals will bring her great joy. If your father never liked art, there may be other activities he would prefer on any given day.
You may also have to adapt activities based on stage of Alzheimer’s, physical abilities, and available resources. Below are some thoughts on how to plan activities based on different scenarios.
Individuals in the early stage of dementia will likely enjoy activities that previously brought them enjoyment. At this stage, you should continue to encourage the person to do activities independently whenever possible. Again, this is important because it can help them maintain feelings of usefulness and self-worth. It may however be helpful to provide encouragement and cues. One activity that may be particularly valuable to those in the early stage of the disease is participating in a support group to meet others who are also dealing with the same diagnosis.
In the middle stage of dementia, individuals typically begin to need greater assistance. They are also at greater risk for wandering, so activities may require increased supervision. It can also be helpful to use shorter sentences when talking and suggesting things to do. Potential activities suggested for those in this stage include: going for a walk, helping with household chores, dancing and listening to music, and doing crafts projects such as scrapbooking.
When planning activities for individuals with late stage dementia, you should look for activities that are stimulating with not too many choices. Sense of humor often remains in the late stages of the disease, so try to find activities that will entertain them and possibly make them laugh. Since dementia typically affects ability to concentrate, you may want to plan take several breaks in a day. It can also be helpful to break instructions down one step at a time, waiting for them to complete each task before moving onto the next. Alzheimer’s may affect motivation, so be patient if an activity doesn’t elicit much interest and keep trying to connect. Potential activities suggested for those in this stage include: painting, sensory stimulation, and reminiscing.
It is also important to select activities with an individual’s physical abilities and limitations in mind. Generally, individuals will experience greater physical decline as the disease progresses, but the rate of decline of each stage will vary from person to person. Relatively healthy individuals should be encouraged to continue exercising and spending time outdoors on nice days. They may be able to maintain a greater degree of independence for a longer period of time. Individuals who are frail or have other physical limitations may need increased assistance and supervision. As mentioned, exercise is an important activity that can have a beneficial influence on their sense of well-being, but individuals should only exercise as much as their physical condition allows. Fortunately, there are also many activities for individuals with dementia that don’t rely as much on physical ability, such as reminiscence, painting, listening to music, and more.
Activities may also have to be adapted based on the type of dementia an individual has. For example, if one has vascular dementia (post-stroke) or dementia with Lewy bodies, they may have physical symptoms in the early stages that limit their involvement in certain types of activities. Dementia with Lewy bodies is also unique in that individuals in the early stage of this type of dementia may fluctuate in their level of awareness from day to day, or even from moment to moment. It can therefore be hard to know when to plan activities. It may be especially important to be flexible and always have a back-up plan.
Frontotemporal dementia also differs from other types of dementia in that it affects emotional and behavioral characteristics causing individuals to act uncharacteristically and sometimes apathetically. Individuals with this type of dementia may thus no longer enjoy activities that they had previously enjoyed. In comparison, individuals with Alzheimer’s and other forms of dementia will likely maintain their past interests and still get enjoyment from the things that they used to enjoy. For individuals with Alzheimer’s, every effort should be made to facilitate continued involvement in favorite activities.
One way you can go about finding the right activity depends if you are searching for something active or passive. Examples of active activities include things like going for a walk, doing a puzzle, painting, or cooking. Examples of more passive activities include things like reminiscence, listening to music, or watching a movie.
Another way activities can be differentiated is whether they take place indoors or outdoors. Several factors may influence whether you want to plan an activity indoors or outdoors, including physical limitations, risk of wandering, time of the year, weather that day, and transportation. While it may sometimes be safer to plan an indoor activity, there are also advantages to getting outdoors on nice days. For example, there are benefits of getting sun and fresh air including Vitamin D, which has been shown to positively influence mood. Spending time outdoors can also help us relax and experience lower levels of depression and anxiety. Getting outside of the house on a pleasant day may also means increased social interaction, an important aspect of life that often suffers when people have dementia.
Dementia Activity Calendar
When planning activities, make sure to plan ahead so that your loved one is not surprised or caught off guard. It can also be helpful to lay out all the weekly activities on a calendar that you can place on the fridge or somewhere else they can easily see. Remember, the anticipation of the activity can be just as rewarding as the activity itself.
Dealing with dementia is a challenge that is so often consumed by a focus on loss and decline. It can therefore be especially important to support individuals’ strengths, abilities, and personal desires throughout the disease. Although impaired individuals will undergo declines in various cognitive and physical abilities, several aspects of well-being are often relatively spared over the course of the disease, including pride, self-respect, humor, concern for others, helpfulness, creativity, and more. However, you’ll notice that almost all of these characteristics require social interaction and opportunities to help facilitate them. It is our responsibility to do what we can as caregivers, friends and family members of individuals with dementia to help support them and provide the best quality of life possible.