Activities to Encourage Engagement in People With Dementia

Young woman conversing with her grandmother who has dementia.

As Alzheimer's disease progresses, accompanying behavior changes can cause distress for family members. It's important to know that these so-called "behaviors" are an expression of their loved one's needs. Aggression, sleep problems, anxiety and agitation usually draw the most immediate attention. But apathy is another common effect of the disease. It may be the first sign that something is wrong, when families begin to realize that their loved one seems emotionally blunted and no longer seems interested in things.

In a recent in-depth study on the topic, Penn State University assistant professor of nursing Ying-Ling Jao reported that 90 percent of people with dementia will experience apathy. She cautioned that apathy is not to be ignored. Patients who suffer from apathy are more likely to experience a rapid decline from mild dementia into severe memory loss.

Apathy should be discussed with a patient's healthcare provider. It's important to rule out depression; although apathy can be a symptom of depression, it can exist on its own. Explained Dr. Yonas Geda of the Mayo Clinic, "Depression causes changes in mood, thinking, physical well-being and behavior, while apathy is loss of motivation without associated feelings of being depressed or blue." The National Institutes of Health says that because the recommended treatments for apathy and depression are different, it's important to get a correct diagnosis.

Jao explained, "My interest in apathy was mainly driven by my clinical observations in nursing homes when I was a nurse practitioner student. I remember that no matter which nursing home I visited, I often saw a crowd of residents sitting in the living room or hallway with no interest in the surroundings and no emotional expression."

The opposite of apathy is engagement—a sense of connection and interest. Jao set out to discover what could promote engagement in people with dementia. She recommended "clear and strong environmental stimulation" that is "intense, persistent and interesting." Jao explained, "Clear stimulus is found in an environment without competing background noise, and with a single straightforward stimulus. A good example of this is a therapist leading a music therapy program for residents in an otherwise quiet room."

This research suggests that when selecting mentally stimulating activities for your loved one, look for the happy medium—activities that hold your loved one's attention without being overstimulating and confusing. An activity that is comfortable and inviting for one person might be overwhelming for another, so be attuned to clues as to whether your loved one is withdrawing or responding.

Keep in mind, say experts, that active participation is not always necessary; sometimes your loved one will be content to observe. Also keep in mind that as the disease progresses, your loved one may enjoy things they might have dismissed as "boring" in the past—while old favorites might cause frustration and a sense of failure.

Here are some suggestions from the Alzheimer's Disease Education and Referral Center of the National Institute on Aging:

Household chores. Doing household chores can boost your loved one's self-esteem. Your loved one could wash dishes, set the table, help prepare food, sweep the floor, polish shoes, sort socks and fold laundry, and help with cooking and baking. Emphasize the process, not the result.

Children. Being around grandchildren and other young people often gives people with dementia a mood boost. It may bring back happy memories and can help them realize how much they still can love others and be loved. Visit family members who have small children, or invite them to your home. Your loved one can read to children or have children read or tell stories.

Music and dancing. Music can bring back happy memories and feelings. Some people feel the rhythm and may want to dance. Others enjoy listening to or talking about their favorite music. People who have trouble speaking may still be able to sing songs from the past. You might play recordings of well-known songs, talk about the music and the performer, and what your loved one was doing when the song was popular.

Pets. Many people with Alzheimer's disease enjoy spending time with dogs, cats, birds and other animals. Living creatures can bring people out of their shell. They offer a chance to succeed—a cat who loves to be petted and an elder who enjoys the tactile sensation of fur and the sound of purring is a win-win. Pets offer unconditional love and reduce feelings of anxiety. Your loved one might help care for, feed, groom or walk a pet.

Gardening. Gardening is a way to be part of nature. It also may help people remember past days and fun times. Your loved one can help take care of indoor or outdoor plants, plant flowers and vegetables with you, and discuss this garden and those of the past.

Going out. In the earlier stages of Alzheimer's disease, your loved one may still enjoy the same kinds of outings they enjoyed in the past. Keep going on these outings as long as you are comfortable doing them. Your loved one might enjoy trips to a favorite restaurant, the zoo, a museum or a park. Plan outings for the time of day when your loved one is at their best. Don't stay out too long; be sensitive to whether your loved one is getting tired after a certain amount of time.

Learn about local programs for people with dementia

Across the country, senior services agencies, parks departments, senior centers and cultural organizations are offering activities that are tailored for people with dementia. Alzheimer's cafés are gatherings where people with dementia and their families can socialize in a safe, nonjudgmental environment. Museums and music groups offer programs to help people with memory loss express themselves creatively—a powerful tool in overcoming apathy. Intergenerational programs provide benefits for children and for seniors with dementia alike. Professional in-home caregivers can provide transportation and facilitate a schedule of enriching activities.

Learn more about the research of Dr. Ying-Ling Jao; Dr. Jao's study appeared in the June 2015 issue of The Gerontologist. Find more suggestions for dementia-friendly activities in Caring for a Person with Alzheimer’s Disease from the National Institute on Aging.


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