With ongoing industry funding cuts placing huge pressure on cost cutting and staffing levels within residential care facilities, it is placing many facilities that care for our senior population with dementia under enormous strain, as frequently their complex behavioral needs require one to one care. Research shows that as many as 11.6% of residents on traditional units and 52.7% on Alzheimer’s units can exhibit behaviors such as wandering, agitation and a state of illbeing.
If not appropriately managed wandering and other symptoms associated with dementing illnesses can often negatively impact on care staff whom often feel time pressured resulting in frustration. This reduces overall levels of customer service and staff satisfaction. Additionally, unmet resident needs can be potentially harmful for residents and further lead to unnecessary escalation of behaviors. However, it’s important to remember that any action can be a means of communication. This is especially true for people with dementia, whose ability to communicate is frequently impaired and diminished by the disease. It is imperative that we resist the temptation to blame our residents for the symptoms of the disease and come to the understanding that the person is not the problem, the problem may lie in the way we are currently managing our client’s symptoms. Resident wandering, can be a sign that there something is wrong, it may indicate the presence of pain, a desire for activity and engagement or alternatively just be a case of being unable to find what they are actively seeking.
Boredom, frustration, loneliness and activities that are not suitable for a resident’s level of cognition can lead to residents exiting an activity, disengaging or wandering to seek out the stimulation they need. Ensuring that we have adequately planned activities that cater for different stages of dementing illnesses is imperative to the promotion of resident wellbeing, engagement and can significantly reduce common symptoms of the disease. There is much research available that shows the benefits of regularly scheduling appropriately staged activity and occupation within a resident’s daily care plan so as resident needs are being met prior to time of day in which symptoms commonly present. We’ve found that by responding to each individual’s needs and providing appropriately pitched, meaningful occupation we can engage their interest, so that they are calmer and more fulfilled.
Pitching at the right level
It’s vital to observe and understanding each person’s abilities, strengths and needs. We recommend and use the Pool Activity & Leisure (PAL )scale, devised by Jackie Pool to help us set activities at the right level. It’s a valid, reliable and evidence-based tool that can allow us to accurately assess ability so that we can offer each person different activities tailored to the level of their dementia and their individual strengths and weakness. Too easy and they become bored and switch off. Too hard and they become frustrated and upset. It’s a tricky balancing act-but by devising a program that is right for them, we can really engage them and get the best results. The research backs up what we’ve observed, when people with dementia are engaged and stimulated appropriately they move, function and feel better.
One size doesn’t fit all
Everyone is different and will respond to and be inspired by differing activities. Diversional therapists work with allied health staff to ensure the abilities of residents are being maximized. Offering them tasks that interest them, are pitched at their individual cognitive capacity and targeted to their specific needs.
A sense of purpose
We draw from the findings of Montessori. Maria Montessori believed that the key to success is to get to know and understand an individual and then offer activities that resonate with them. The method focuses on uncovering the abilities each person has, then working together to develop these so that the resident can make a meaningful contribution. Cooking, sorting items, arranging flowers or stuffing envelopes can all feel worthwhile and useful.
It helps to break down complex tasks into simple steps and gently support the resident to achieve their goal. They have a sense of genuine achievement at a job well done when they have finished the activity. The feeling of wellbeing continues afterwards. Even when they have forgotten all about the activity, they remain less bored, agitated and depressed. It’s all about boosting self-worth.
Individuals with more severe dementia can struggle and become lost in group activities with complicated instructions. They may switch off, withdraw or become disruptive. To engage their interest, it’s better to have a free and flexible approach. Less structured options such as dancing, movement to music or free motion can often be more successful.
Making a difference
Engaging in meaningful and appropriate activities can really help improve function in people with dementia. Even a small functional gain can result in a big improvement in the individual’s quality of life, their independence and their sense of wellbeing.
Instead of providing the activities that we think are best, we need to respond to each person and provide occupations that inspire, support their needs and engage them fully. Maybe it’s not the easiest, cheapest or most straightforward approach-but it is a method that can improve cognitive function, maintain self-care abilities and decrease frustration and distress.
Investing the time and care into properly engaging people with dementia can lead to calm, content residents. That’s got to be better for everyone working in aged care hasn’t it?