How to Create Person-Centered Memory Loss Activity Groups
By Beverly Sanborn, LCSW and Nancy Schier Anzelmo, MSG
The psychological needs of memory care residents should be addressed daily, and therapeutic activities are the best outlet. Even if a resident is in the later stages of dementia, the capabilities that are still remaining can be stimulated in small or large group activities. But designing group programs that are both fun and interesting while offering a therapeutic challenge that stimulates the body, mind, and spirit of residents with memory loss can be a challenge.
Paradoxically, this group work must be offered within a context of person-centeredness, in which the needs of the group are somehow balanced with the needs of the individual. However, a well-designed program that takes all of these factors into account is the foundation for a comprehensive wellness program in senior living.
To understand how to design group programs, it is important to remember that having dementia is a profound wound to the self. Every person afflicted with dementia is desperately searching for a way to preserve identity, a formidable task as dementia damages the ability to initiate activity, to stay focused on a task, or to understand a fast-paced environment. Belligerence, seemingly disruptive behaviors or apathy, wandering, and pacing are typical symptoms of a person who feels lost and is groping for a way to cope with a bewildering, oftentimes frightening world.
Fortunately, the emotional devastation of memory impairment can be transcended when a person feels competent and connected to life again. Therapeutic activities can create a sense of personal connection and meaningful structure to a person’s day. They also boost self-esteem and foster a sense of belonging in a group. Therefore, the first principle of a person-centered activity program is to help each resident regain competence, mastery, and a renewed sense of self through participation in a structured program and a modified environment that is adapted for remaining abilities.
A person-centered daily program designs stimulating and interesting activities around residents’ preferences; it is based upon common interests and should be reflective of the residents who reside in a particular community. Within this program, a variety of activities need to be balanced that stimulate a person in a variety of ways: physical, emotional, spiritual, intellectual, vocational, and social. What’s more, activities can be adapted so that they are successful for all levels of dementia in a small group setting.
To achieve this goal, the program must do the following:
Assess residents for remaining abilities, skills, interests, and life stories
Divide residents by homogeneous groups of similar skills, abilities, and interests
Present an activity that is of interest to the individuals in the group
Ensure success by adapting the activity to the remaining skills of each individual
Let’s start with an activity that will stimulate the frontal lobe (reasoning, logic, planning, judgment and language) such as discussing a current event in the newspaper. This is a great activity choice for a community of residents who are particularly involved in current events or civic issues.
However, the activity leader or a resident should not simply read the paper out loud. Not only is this boring, but it is not cognitively challenging, and it hasn’t been adapted to the skill level of the residents. None of the goals mentioned previously will be achieved this way.
Instead, begin by dividing the group into mild, moderate, and late stages, and provide each group with a modified approach as follows:
Mild Dementia
Select a provocative or controversial topic. For this example, we’ll use the ongoing debate regarding California’s water supply. Should more water be allotted to agriculture in California—a $36.6 billion industry that creates another $100 billion in related economic activity—or should more water be allotted to cities where 83% of the population lives?
Present some basic facts from news articles and the internet to the group. Write the facts on a white board, and ask residents to write notes as the activity proceeds.
Provide the group with a laminated map of California, and ask them to identify where the large agriculture areas are located and where the major cities are located.
Divide the group into a PRO and a CON team in preparation for a debate. Members of the PRO and CON team are assigned arbitrarily to one of the positions.
Ask group members one by one to present their position—allow the opposing team to counteract it.
Choose yourself or an outside observer to judge which team had the strongest case.
Moderate Dementia
Use the same article, but write the PRO vs. CON facts on the white board.
During the discussion, ask questions with yes/no responses, point to facts, and prompt participants. For example, “Ruth, you come from Fresno and have lived close to farming communities. Do you think that agriculture should be given more water when we have a drought? Why do you think so? Do you think agriculture needs the water because it is such an important business for the economy?”
Prompt residents with questions and repeat residents’ answers so that the whole group can understand: “Ruth, do you agree with Al when he says cities need the most water because that is where most people live and they need to use a lot of water to survive?”
Ask residents to make a list of the largest cities in California. They can also make a list of the rural areas in California. Write the list on the white board and ask residents to write the list on a piece of paper. Making lists is a therapeutic and enjoyable challenge for individuals with moderate stage dementia.
Ask residents to find the cities and the agriculture areas from their lists on the map.
Residents can be asked other questions about the cities: “Have you lived in one of these cities? Have you lived in rural areas? Which ones?”
Late Stage Dementia
The activity at this level will primarily be sensory. Thus, the current events article will be transformed into a series of sensory experiences.
Say, “We are experiencing record rain and snowfall in Northern California. Let’s think about wetness and dryness.” Give residents a box of dry soil and a box of damp soil to feel. Ask, “How does that feel? Do you like the dry soil? Do you like the damp soil?”
Compare a dry flower and a live flower, a dried fruit and a ripe fruit. Let residents feel and smell each example.
Play a CD with the sounds of water and rain. Ask, “Do you remember that sound? Is it rain? Did you like to be out in the rain? Does rain make you happy? Sad?” All questions should be yes/no response so that they can be answered with a nod.
Provide residents with fruit to taste. Play a CD of birds chirping while they taste the fruit. Say, “Alice, I bet you are very glad we still have enough water to grow this lovely peach because you love peaches.” Keep up a conversation, but include each resident based on his or her life story so that residents feel like they are participating. Give each person an opportunity to nod or say “yes” or “no.”
There are endless possibilities to structure a person-centered program that honors the self and the commonalities of the residents who reside in our communities. If we think out of the box and structure activities according to residents’ abilities, the resulting person-centered programming can help to create a connection with others in a shared experience that honors the self.
