Keeping active and staying involved

As a person's dementia develops, it is likely to have an impact on some of their abilities but there will still be lots that the person can enjoy doing, both individually and with others. Maintaining existing skills, as far as possible, can give the person pleasure and boost their confidence. For this reason, it is important to help them find activities that they enjoy doing, and to continually adapt them to meet the person's changing interests and needs, throughout the illness.

The word 'activities' is often associated with structured group activities, such as bingo or exercise classes, but not everyone enjoys this type of pursuit. In fact, many beneficial activities are the simple, everyday tasks that many of us take for granted, which may be enjoyed as a solitary pastime, or in pairs or small groups. Simple activities such as taking a walk, polishing a pair of shoes, listening to the radio or looking after a pet can help give pleasure and bring purpose to the day.

What is good for someone with dementia is often good for those who spend time with them too. Through helping maintain the interests of the person with dementia, family members and carers may be able to follow their own interests too. Keeping occupied and stimulated can improve quality of life for the person with dementia as well as those around them.

Benefits to the person with dementia

Remaining physically and mentally active can have a significant impact on a person's well-being. It can provide a welcome distraction from the stresses of the illness and can help the person focus on the positive and fun aspects of life.
Carrying out simple everyday tasks can help the person feel better about themselves by providing a structure to the day and a sense of achievement.
Some types of activity can help the person to express their feelings − for example listening to music or writing something down.

Benefits to loved ones and carers

Boredom and frustration are the two most common causes of challenging behaviour in people with dementia. If a person with dementia is occupied and stimulated, some of the behaviour that those around them find most difficult may lessen or even stop altogether.
Sharing an activity that both parties enjoy may bring them closer together, and help them find new ways to relate to each other.
Discovering new ways to stimulate someone with dementia can be satisfying, and may enable those around them to think differently about their caring role.

Finding suitable activities

If you want to help someone with dementia take part in some activities, talk to them about which activities they might still enjoy that they could achieve within their current capabilities. Try to find imaginative ways to adapt their activities to their changing capabilities and moods. Popular ideas include:

Exercise

Exercising together will be beneficial to the person with dementia and anyone accompanying them. Exercise burns up the adrenalin produced by stress and frustration, and produces endorphins, which can promote feelings of happiness. This will help both parties relax and increase their sense of well-being. Exercise helps develop a healthy appetite, increases energy levels and promotes a better night's sleep.

Walking is a great form of exercise that provides a change of scene and fresh air. Short walks can make a big difference, even if it is only to post a letter or go to a local coffee shop.
Swimming is another good all-round exercise, and the feeling of being in the water can be very soothing and calming.
Classes may be suitable if the person wants something more sociable. Find out if your local leisure or community centre offers suitable classes for older people. You may need to attend together to support the person.

Reminders of the past

People with dementia can often remember the distant past more easily than recent events. If you can find a way to help trigger the more distant, pleasant memories, the person may become more animated and interested. Not everyone enjoys reminiscing about the past, but the following suggestions might be useful for those who do:

Talk about the past together, while looking at old family photos or books with pictures, or listening to music.
Make up a memory or rummage box of objects that the person with dementia might be interested in. Physically handling things may trigger memories more effectively than looking at pictures.
A visit to a favourite place might also prompt happy memories and provide another opportunity to get out and about.
Be aware that talking about the past in this way can sometimes trigger strong emotions in the person you care for, so it's important to be sensitive. You may uncover painful memories as well as happy ones.
Dementia damages the memory and the thinking and reasoning parts of the brain, but the emotions still remain intact. It is not necessarily a bad thing if the person becomes emotional, but if they do, make sure you allow them to express their feelings, and acknowledge these.
Avoid asking very specific questions that require factual responses and could put the person on the spot − the main aim is to enjoy the memories rather than to make the person feel tested in any way.

Activities during the early stages of dementia

Someone in the early stages of dementia may probably want to continue doing the things they have always done. People with dementia retain memory for some activities, depending upon which part of the brain has been damaged. Activities such as reading, typing or playing the piano are not always affected.

If you are close to some with early dementia, be aware of the danger of taking over jobs and tasks too quickly in an attempt to minimise your own stress. For example, if they do the washing up accept that it might not get done to the standard that you would normally like, but recognise that they will feel that they have made a useful contribution − and that is what is important.

Other tips include:

Encourage the person to enjoy activities on their own.
Provide encouragement and reminders.
Put any equipment in a place where the person can see it and reach it easily. If you leave a potato out with a potato peeler, it might invite the person to pick it up and give it a go.
When you suggest what to do, use short sentences.
Set aside time in the day when you are going to focus on doing something enjoyable for both of you away from the normal routines of the day.

Involving others

Consider inviting other people (including paid workers, family members or volunteers) to spend time with the person to do something they both enjoy − for example, going for a walk or playing a game of cards. If you are the sole carer, you might find it hard to hand over and trust others, but they may bring a fresh approach that the person may resonate with in new ways. When you are a full-time carer it can be hard to have the energy to always give 'quality time' to the person if you yourself are exhausted and stressed.

Activity ideas

Craft activities − These might include simple craft activities, such as creating collages from magazines, or knitting. Someone who has been a skilful knitter may still be able to knit squares for a blanket.
Puzzles − Someone who has enjoyed doing crosswords may still enjoy a puzzle book.
Doing things together − The person may like to play cards or board games, or do some gardening or baking together.
Activities around the home − Men and women alike can enjoy helping with washing and drying up, setting the table or making beds. Again, the end result may not be perfect, but it can give an important sense of achievement. The person might be surprisingly interested in odd jobs, such as sorting through a drawer or a toolbox.
Music − Even when other abilities are severely affected, many people still enjoy singing, dancing and listening to music. Record a collection of the person's favourite pieces of music or songs for them to listen to, or ask a friend to help you.
TV and radio − Many people with dementia enjoy listening to the radio. Television, however, can cause problems. Some people with dementia lose the ability to tell the difference between what is real and what is on screen, and can become distressed. They can also become confused by too much noise. Try watching television together, and choose programmes with small sections of action or humour, rather than a programme with an involved plot. Some people have found using headphones can help them to concentrate better. However, for some people even a favourite soap opera may become confusing.
Communal activities − If the person has a connection with an organisation within the local community, whether it is a church, a pub or a club, then continuing to visit this place might be very important. It may help if a family member or carer has some gentle discussions with other attendees to encourage them to continue to welcome the person with dementia, and to minimise any embarrassment.

Some people with dementia come into their own in certain social situations, in a way that can surprise those close to them. However, others become daunted by being away from the safety of their own home and avoid going out. If the person seems reluctant to join in, don't always take the first 'no' for an answer, as people will sometimes just say 'no' as the safest option and will actually enjoy themselves if pushed a little to take the step out of the door. However, don't force them to do something that they clearly don't enjoy.

Activities during the later stages of dementia

As a person's dementia advances, they will still be able to carry out some tasks that are very familiar to them, but will probably be more interested in the process of doing the activity than in the end result. If this is the case with someone close to you, look for 'magic moments' throughout the day rather than trying to carry out sustained activities. Keeping your expectations realistic and enjoying these moments may help you at a difficult time of adjusting to the many changes in the person.

Tips: finding an activity

Look for activities that are stimulating but that don't involve too many challenges or choices. People with dementia can find it difficult to process options.
Many people with dementia retain their sense of humour, so look for activities that the person with dementia, and those caring for them, will find entertaining. Having a good laugh will do everyone good. This might mean discovering your own playful or silly side, which some people find easier than others.
Dementia often affects people's concentration so that they can't focus on what they are doing for very long, so it may be a good idea to do activities in short bursts.
Dementia can affect a person's motivation. You may have to help them get started, but try not to be disheartened.
Break instructions into small, manageable chunks, and make sure each step of the task is very simple.
Try to think of activities that involve an easy, repetitive action and simple steps, such as sweeping, dusting or watering plants.

Sensory stimulation

During the later stages of their dementia, people often develop severe difficulties with reasoning and language, but they will still have their sense of taste, touch and smell. There are various things you can do to stimulate these senses − for example:

Encourage the person to touch or stroke pieces of fabric, dolls or cuddly toys.
Try giving the person a hand massage, using a scented oil such as lavender. This can be very soothing for those who enjoy touch, although not everyone will like the feel of the oil.
Continue to take the time to sit and talk to the person or to read out loud. Much anecdotal evidence suggests that a person remains able to hear you talking very late into the progression of the illness.
Enable the person to see a fish tank, mobile or a window with a nice view. This may have a calming effect.
Make sure the person has a regular change of scene and the stimulation of the fresh air and the outdoor environment. If you are visiting a person living in a care home, you can still play a vital role in helping that person to feel included and active, even if it is only to take a short walk with them down the corridor or to bring in something of interest from outside the home.

For details of Alzheimer's Society services in your area, visit alzheimers.org.uk/localinfo
For information about a wide range of dementia-related topics, visit alzheimers.org.uk/factsheets

Useful organisation

National Association of Providers of Activity for Older People (NAPA)

Bondway Commercial Centre
71 Bondway
London SW8 1SQ
T 020 7078 9375
E info@napa-activities.co.uk
W napa-activities.co.uk

Voluntary organisation dedicated to increasing the profile and understanding of the activity needs for older people. Provides a range of activity ideas on its website and in publications. Produces guides for relatives and residents in care homes.