Purposeful Engagement and Activities for People with Dementia
A person’s strengths and abilities can vary greatly depending on what stage of dementia they are at. What stays unchanged, however, is the need for engagement and involvement to maintain a good quality of life.
By designing activities that promote meaningful engagement with a person who has dementia, we can ensure these needs continue to be met, long into the progression of their illness.
This engagement is not only essential to maintaining a high quality of life and prolonging aspects of the person’s independence and wellbeing, but it is also directly tied to Standard 1 of the Aged Care Quality Standards: Consumer Dignity and Choice.
The below article will provide carers with a foundational understanding of purposeful engagement and activity design, to ensure their clients with dementia receive effective person-centred care.
What is Purposeful Engagement?
People who have dementia will exhibit signs of apathy and withdrawal, such as falling asleep or becoming easily distracted (Dementia Australia n.d.b). This can make engaging clients particularly difficult.
Purposeful engagement is a person-centred approach to engaging the person with dementia so they can continue to participate in activities and contribute to what is going on around them. It utilises the person’s interests and strengths to tailor activities that the person is more likely to engage in (Alzheimer Society 2015).
The concept of purposeful engagement is based on the Montessori education technique. The concept, first intended for child development, has been adapted and is now widely recognised as an effective non-pharmacological intervention and engagement technique for people living with dementia (Dementia Australia 2019).
Montessori for dementia supports memory loss and encourages independence through the use of environmental cues and experimentation (within safe boundaries), and has been found to help the person with dementia make meaningful contributions to their community, increase their engagement in activities and, in some instances circumvent the effects of dementia (Montessori for Dementia 2019).
Benefits of Purposeful Engagement
- Purposeful engagement provides the person with dementia with a sense of purpose and routine.
- It acknowledges the skills and life experiences of a person and provides an appropriate outlet for these strengths.
- Purposeful engagement is an emotionally nurturing experience that increases self-esteem and helps the person to feel useful.
- It can be an opportunity for greater social contact for the person.
- It can help to maintain skills and independence, and in some cases improve capacity to perform certain daily activities.
- It provides the person with an opportunity for decision-making and choice.
- Purposeful engagements additionally help care staff to get to know their clients on a personal level.
(Alzheimer Society 2015; Dementia Australia 2019)
Dementia Australia defines these three components as essential for developing meaningful engagement:
- Your client’s life story and experiences;
- Your client’s strengths;
- Individualised supports.
- 1. Life Story
Getting to know the person behind the illness is an essential part of person-centred care. To develop activities your client may want to engage in requires you getting to know the person.
This can be achieved by interviewing the client about their life, and this is also a great engagement opportunity in itself. Ask your client questions such as:
- What did they previously do for work?
- What hobbies do/did they have?
- What makes them happy?
- It is also beneficial to involve the person’s family/loved ones in this process too, for additional insight or for clients where verbal communication is difficult.
(Dementia Australia 2015)2. Strengths
Assessing a person’s strengths is essential to tailoring activities to suit them. This can be done through simple observation during an activity. Consider the following strengths and how they can be utilised:
- Motor skills: carrying, cutting and pouring could be utilised by getting the person to help serve food and drink.
- Sensory strengths: listening, smelling and sight could be used in the arranging of flowers.
- Cognitive skills: counting, reading aloud and sorting could be utilised in reading groups, games or puzzles.
- Social strengths: making conversation, humour and leadership skills can be used in facilitating discussions, handing out name-tags, etc.
(Dementia Australia 2015)3. Support
Once a person’s strengths have been assessed, consider what gaps exist and what can be done to support them. For example:
- Environmental supports such as removing clutter, keeping spaces well-lit, removing distractions and unnecessary noises, using contrasting colours when designing spaces, clear signage, etc.
- Provide a warm, relaxed and positive environment for emotional support.
- Health supports for any comorbid conditions that your client may have.
- Staff allocations.
(Note that supports will change with your clients' needs and should constantly be reassessed and updated.)
(Dementia Australia 2015)
- Establish safe physical boundaries for the activity.
- Verbally invite the person to join in the activity, if they would like to.
- Break the task into small steps, or demonstrate how to do the activity first.
- Give the person something to hold or touch.
- Thank the person for their help and ask them if they enjoyed it, and whether they would like to do it again next time.
- Offer different activities at the same time, so the person can independently select which they would prefer.
- Don’t allow activities to reinforce inadequacy, overstimulate or increase the person’s stress.
- Consider timing (e.g. not too early or too late in the afternoon).
(Dementia Australia 2015; Alzheimer Society 2015; King 2003)Examples of Activities for People with Dementia:
- Painting, drawing,
- Jigsaw puzzles,
- Gardening, flower arranging,
- Engaging with children, dogs/animals,
- Reading groups,
- Social events,
- Photo albums,
- Discussion and group-reminiscing,
- Setting a table,
- Sorting items by colour,
- Folding clothes, pairing socks,
- Washing/drying dishes,
- Preparing food, pouring drinks,
- Distributing and serving food and drinks,
- Dancing or listening to music,
- Sensory experiences,
- Create a memory/rummage box,
- Untying knots,
- Box of different textured materials,
- Playing cards,
- Gentle massages,
- Short walks.
(Dementia Australia n.d.a; DailyCaring Editorial Team 2018; King, D 2003; Golden Carers Pty Ltd n.d.)
- Clinical Practice Guidelines and Principles of Care for People with Dementia: https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf.
- Age d Care Quality Standards: https://www.agedcarequality.gov.au/providers/standards.
- Purposeful activities for people with dementia: a resource by Dementia Australia: https://www.dementia.org.au/resources/purposeful-activities-for-people-with-dementia .
- A full mental health assessment.
- Knowing about the person’s life story.
- The person’s strengths.
- Additional support.
- Q2. Which of these should be considered when designing an activity for someone with dementia?
- A safe environment with boundaries.
- The person has several activities to choose from.
- Remove or limit distractions / unnecessary noises or stimulus.
- All of the above.
- Alzheimer Society 2015, Meaningful Engagement of People with Dementia: A Resource Guide, Alzheimer Society of Canada, viewed 9 September 2019, https://alzheimer.ca/sites/default/files/files/national/meaningful-engagement/meaningful -engagemen t-of-people-with-dementia.pdf.
- Alzheimer's WA 2018, ‘Benefits of sensory engagement in people living with dementia’, Alzheimer’s WA, 19 March, viewed 9 September 2019, https://www.alzheimerswa.org.au/benefits-sensory-engagement-people-living-dementia/.
- DailyCaring Editorial Team 2018, ‘10 FUN, NO-FAIL ACTIVITIES FOR PEOPLE WITH DEMENTIA’, Daily Caring blog, viewed 9 September 2019, https://dailycaring.com/10-fun-failure-free-activities-for-people-with-dementia/.
- Dementia Australia n.d.a, Activities for people with dementia, Dementia Australia, viewed 9 September 2019, https://www.dementia.org.au/about-dementia/i-am-a-carer-family-member-or-fri end/activities-for-people-with-dementia.
- Dementia Australia n.d.b, Diagnosing dementia, Dementia Australia, viewed 9 September 2019, https://www.dementia.org.au/information/diagnosing-dementia?gclid=EAIaIQobChMI-ueFhf bC5AIVwyMrCh31BgoHEAAYASAAEgL0lfD_BwE.
- Dementia Australia n.d.c, Purposeful activities for people with dementia: a resource, Dementia Australia, viewed 9 September 2019, https://www.dementia.org.au/resources/purposeful-activities-for-people-with-dementia.
- Dementia Australia 2015, Purposeful activities for dementia: Alzheimer’s Australia VIC, online video, 1 June, viewed 9 September 2019, https://www.youtube.com/watch?v=9Y6LCpL8HUU.
- Dementia Australia 2019, ‘Montessori principles prove promising in improving quality of life for people living with dementia’, Dementia Australia, 21 March, viewed 9 September, https://www.dementia.org.au/media-releases/2019/montessori-principles-prove-promising-in-impr oving-quality-of-lif e-for-people-living-with-dementia.
- Golden Carers Pty Ltd n.d., ‘20 Practical Activities For People Living With Alzheimer’s Disease’, Golden Carers Pty Ltd blog, viewed 9 September 2019, https://www.goldencarers.com/20-practical-activities-for-people-living-with-alzheime rs-disease/3778/.
- King, D 2003, Activities - a guide for carers of people with dementia, Alzheimer Scotland, viewed 9 September 2019, https://www.alzscot.org/sites/default/files/images/0000/0266/activities.pdf.
- Montessori for Dementia 2019, Montessori, changing the lives of people living with dementia, viewed 9 September 2019, https://montessorifordementia.com.au.
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