Agewise: Making meaningful connections with persons experiencing dementia

Ellen Phipps

 

We all interact with the environment through our daily activities—working, reading, talking, running, shopping, making coffee, doing laundry, preparing meals, or taking a shower. These activities have meaning for us. They either provide opportunities for enjoyment and creative expression or serve a specific purpose. We all have a basic need to feel productive and engaged. The same is true for those with dementia, although they may need help in organizing and structuring activities. The activities that people with dementia are encouraged to pursue should continue to have meaning to them and not just provide “busy” work.

The Connections activity program helps anyone, from family and friends to professional care providers, to engage people with cognitive impairment in meaningful activities. Connections is an evidence-informed activity intervention for people with cognitive impairment. Field-testing has shown that using the approach can promote higher levels of communicative behaviors and engagement in life.

What makes the Connections approach unique? Developed collaboratively by professionals with expertise in therapeutic recreation, gerontology, developmental psychology, and speech-language pathology, the approach’s core principles are based on theoretical underpinnings from three practice fields:

•        therapeutic recreation

•        Montessori-Based Dementia Programming™ (Camp, 1999; Judge, Camp, & Orsulic-Jeras, 2000)

•        cognitive intervention

Recreation therapy is a systematic process that incorporates activity-based interventions to address the assessed needs of individuals with illness and/or disabilities. The purpose of the process is to improve or maintain physical, cognitive, social, emotional, and spiritual functioning to facilitate full participation in life

Most therapeutic recreation assessments begin by gathering information about the person, such as past leisure interests and hobbies, education, career, and family and spousal history. The idea is to match a person’s past interests with current level of functioning. For example, an expert Bridge player no longer able to process the complexity of the card game may enjoy a simplified game of cards, such as Go Fish or War. Or a person with severe physical limitations interested in bicycle riding might enjoy an adapted bicycle. Research on therapeutic recreation in nursing homes shows great benefits, including reduced falls and injuries related to falls; reduced challenging behaviors among those with dementia, which in turn reduces the use of psychotropic medications and chemical restraints; decreased symptoms of depression and anxiety; decreased apathy and increased engagement; and improved subjective well-being and quality of life.

Montessori-Based Dementia Programming was developed in the early 1990s by Dr. Cameron Camp of the Myers Research Institute at Menorah Park Center for Senior Living. The approach draws from the early work of Maria Montessori, a physician in Italy. An example of a Montessori learning material is “dressing frames,” which are fabric with zippers or buttons stretched over 5″ x 5″ frames. Practice with zipping and buttoning can help with dressing oneself. Materials are designed in “control of error” and allow a person to determine if he or she has completed an activity correctly.

Cameron Camp and his wife developed the Montessori approach while caring for their daughter who had a learning disability. Eventually, Camp began to use the approach with older adults living with dementia by building on their current strengths and abilities as well as modifying the environment to best support engagement in activities. This unique programming incorporates rehabilitation principles, including guided repetition, task breakdown, and progressing from simple to complex. An example of a Montessori-Based Dementia Program activity is the seashell match, where seashell pairs are outlined on a template, one seashell is placed on the matching outline, and the person engaged in the activity finds the matching seashell that completes the pair.

Cognitive intervention involves assessment and treatment approaches that improve and/or maintain an individual’s functional cognitive and communicative abilities in everyday environments. In dementia care, cognitive intervention approaches often capitalize on the person’s cognitive strengths and are guided by care providers trained in providing verbal cues as well as modifying the environment. Environmental modifications can include visual aids to assist people with attention, orientation, memory, and problem solving. Cognitive intervention may be guided by family members to minimize error responses and feelings of frustration.

The new Connections Activity Program for Persons with Dementia guidebook will be published in May 2017 and author, Ellen Phipps will be presenting a session for caregivers (family members and direct care workers) as well as the general public on the topic on Feb. 25 at 10 a.m.at the Culpeper County Library.

Ellen Phipps is the Vice President of Programs and Public Policy with the Alzheimer’s Association, Central and Western Virginia Chapter. You may reach her at 434-973-6122 or ephipps@alz.org

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