by Heather Rahrig, RN, BSN ~
Cognitive health is focused on a person’s ability to think, learn, and remember. The most common cognitive health issue facing the elderly is the loss of those cognitive functions, otherwise known as dementia. According to the Alzheimer’s Association, dementia is the decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Approximately 47.5 million people worldwide have dementia – a number that is predicted to nearly triple by 2050. The most common form of dementia is Alzheimer’s disease with as many as five million people over the age of 65 suffering from the disease in the United States.
As an RN and the Director of a home care agency, all too often I have gone in to do an initial homecare assessment on clients that have dementia only to have their families tell me their loved one “can’t do anything.” Unfortunately, the stress of watching a loved one spiral downward, losing cognitive function, and at times not even recognizing their own family takes a toll. Eventually the day-to-day essentials of eating, bathing, and dressing are all that seem to matter.
That’s where homecare can truly make a difference during the remaining years of a person’s life. Before homecare can begin, an initial assessment is needed, which is typically done in the client’s home. Part of this assessment must focus on who the client is (and once was), their occupation, spouse’s name (even if deceased), children, grandchildren, as well as hobbies and any other interests. People with dementia tend to remember things that happened in their distant past, usually during their teens, 20s and 30s. From there, a customized care plan is created to encompass all of these important elements of his/her life. Not all care plans are created equal! The better the care plan, the better the picture of who this individual is, which in turn fosters more meaningful interactions between client and caregiver. A thorough initial assessment is so important because it can truly be the difference between your loved one living a richer, more active life and merely existing.
The care plan can be followed not only by the home care staff but also by the family members in order to help them develop a routine with their loved one. Completing an activity from start to finish is not always the objective. The process and stimulation that the client gets from the activity is what is fulfilling, not only for the person with dementia but also the caregiver. We never know exactly what the person with dementia is able to process, which is why the ability to spark a memory from the past and possibly bring out an emotion is satisfying and makes him or her feel useful again even if only for a short period of time.
Cooking is an example of something that many older women were known for and can identify with, and often times the family misses the traditional goodies mom used to make. Typically, a person with mild to severe dementia can no longer follow a recipe from start to finish. A solution is for the caregiver to use task breakdown to help the client focus on the senses and individual steps in the cooking process rather than just the end result. For example, baking cookies requires all five senses, including motor function and can be modified by the caregiver to incorporate the person with dementia, allowing them to feel useful. Stirring the dough requires motor function by holding the bowl and rotating the arm, shaping and rolling the dough utilizes the sense of touch and fine motor skills to achieve proper size and consistency. The smell of cookies baking is not only pleasing, but recalls past memories, while hearing the oven timer go off provides audible stimulation, and, of course, seeing and tasting the cookies before and after baking is very satisfying.
Men who previously enjoyed card games can benefit from sorting poker chips, holding and laying out cards, feeling the edges of the cards, and looking at the different suits. The task of sorting by suit, number, or color can have positive impacts by utilizing parts of the brain that may not have been used in a long time. For others, utilizing various objects such as small pieces of PVC pipe can be stimulating as well as a relatively inexpensive activity to assemble. Simply picking up, putting together, and observing the different shapes can be an enjoyable activity. Again, it’s all about the little things that engage a person with dementia in order to spark past memories and to get them thinking and communicating.
A seemingly uneventful task such as folding towels can provide a sense of accomplishment for people with dementia. Keep a small collection of towels that are just for folding and unfolding. You can do this as many times as necessary. Simply take the towels into another room, unfold them and bring out another “load of laundry” to fold. It is surprising how even during the late stages of dementia, folding towels is still something that can bring about a memory with an added feeling of purpose.
Balloon volleyball is another great activity that can be played even by late stage dementia clients. Bright colors are appealing to the eye, and the automatic response of hitting the balloon works large motor skills as well as hand-eye coordination. Listening to music from the from their period, say the 1930s or 40s, can bring back a world of memories (happy and sad) and summon emotions in everyone. If they are able, try having them dance to the music. This typically enhances the experience and brings about many smiles.
Remember, when it comes to older adults with dementia, it’s not always the end result that matters most. It’s the process of getting there and the time spent with them. A thorough assessment is so important because it can truly help your loved one live a richer, more enjoyable life. After all, little things like a smile, a laugh, a word that is mumbled because something sparked a memory or even a tear are what become most important during life’s late stages.
About the author: Heather Rahrig is a registered nurse, earning her Bachelor of Science in Nursing from Ohio State University. She is the Director/Managing Partner of Carepoint Homecare on Carmel Road in Charlotte. For more information about homecare services, please contact Heather at firstname.lastname@example.org (980) 226-5516 or visit her website www.carepointinc.com.