Three stages of dementia – Tips for successful stage appropriate activities

A recent study with older adults supports common sense by suggesting that engaging in leisure activities may have a protective role against cognitive decline, and that different types of activity may affect distinct cognitive functions.

But what can one do when cognitive decline has started with an individual? How do you engage seniors and residents that are already at a certain stage of their cognitive journey? How can an activity director take into consideration the stages where the residents are, still manage to make programming relevant and keep the population engaged? The answer lies in building stage appropriate engagement.

First and foremost, it is very important to make a distinction between age appropriate and stage appropriate activities as the first one will only result in stress and frustration from the resident and the staff.

Here are tips for successful stage appropriate activities:

1. Early Stage

In the early stage, people with dementia can still follow rules and work towards a goal but remember that they live with frequent confusion. This is why one must:

  • Take the time to assess all residents. This should always be the case but it is extremely important during the intervention with dementia residents as their attention is shorter and they will walk away quicker if they do not relate to what is going on
  • Simplify games and activities that take a long time to achieve.
  • Provide detailed and repeat guidelines of the activity
  • Be ready to coach people and be the referee
  • Have a “service attitude” turned towards the resident
  • Always keep the activities meaningful and remind often what the intentions are

2. Middle Stage

As the Dementia progresses and thought processes and language are further impaired, it is difficult to follow rules and work towards a goal. However, familiar routines are retained, as is the ability to use familiar objects.  Based on this, here are tips that one should keep in mind:

  • Keep a friendly, positive and patient approach
  • Remove distractions in the environment
  • Place yourself and the tools in the person’s visual field
  • Break down the activity down into single steps
  • Speak in short phrases and add visual and tactile cues in combination with verbal cues
  • Wait for a response
  • Provide objects and activities that are in the person’s long-term memory

3. Later Stage

It is still possible to provide activity for a person in the later stages of dementia. As it becomes more advanced, activities need to focus on other tasks and mechanisms and we may need to try different communication approaches when trying to connect with a person who is very withdrawn. Here are the ideas that one should keep in mind:

  • Care workers and family members will need a lot of support to persevere in trying to connect with a person who may be unresponsive.
  • Stimulate the senses and encourage one-step and simple rhythmic and repetitive movement.
  • Sensory based activities should include the fundamental senses of seeing, tasting, hearing, smelling and feeling.
  • Remember that the person’s world is only experienced through reflex responses to direct sensory stimulation.
  • Learn to give full attention, as many people with dementia will sense when you are not fully present and are less likely to connect with you in any meaningful way if this is the case.
  • Just be with the person, as this in and of itself is an activity

One should always remember that a successful activity is an activity that maximizes function while staying person centered.