“You matter because you are you and you matter to the last moment of your life. We will do all we can to help you, not only to die peacefully, but to live until you die”.  — Dame Cicely Saunders

It is at the later stage of dementia such as Alzheimer’s that an individual is the most dependent. This dependency includes activities of daily living such as bathing, eating, etc. It also includes the basic human need to stay engaged and connected to oneself. Such activities must be initiated and directed by the caregiver or support system for the individual to feel respected, validated and given the opportunity to be at his or her highest functioning level.

Here are three guidelines to maximize later stage dementia engagement success:

1. In preparing the activity, here are suggestions to ensure success:

• In choosing between interest or challenge level, always choose interest
• Limit choices
• Provide a structure
• Enable routine and repetition
• Short span
• Provide cuing
• Use the person’s preferred sense

2. Here are environmental guidelines to check upon:

• If used, make sure that glasses are clean and hearing aids are functioning properly
• Check whether the person’s medication is appropriate or whether they might be ill or in pain
• Minimize environment disturbance such as noise, light, activity
• Make sure the person is comfortable – for example, not too hot or too cold, hungry or thirsty, or needing the toilet.

3.Recommended programs:

• Social interaction: Never discount social interaction. It is a consequential activity that is one of the critical elements of a person’s care. It can stimulate the mind, helps maintain the person’s functional abilities and can enhance their quality of life.
• Massage therapy and touch: Touch by others and touch by the person are ways to interact with people that are in a vegetative state. This can include touching or stroking pieces of fabric, dolls or cuddly toys.
• Pet therapy: People with dementia recognize a pet in the environment as friendly and non-threatening. When they have a pet with them, studies show they display more interactive behaviors.
• Aromatherapy: Several essential oils are effective for treating different symptoms of dementia, including anxiety, sleep problems and behaviors.
• Music therapy: Music can spark compelling outcomes even in the very late stages of the disease. When used appropriately, music can shift mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function and coordinate motor movements.