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Activities for Dementia Care: Unlocking What Remains

February 1, 2005
by root
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Nursing Homes visits a Montessori-based activities group at Menorah Park Senior Living Center in Beachwood, Ohio by Linda Zinn, Editor
As the rapidly falling snow swirls and blows around the courtyard outside the activities room at Menorah Park Center for Senior Living in Beachwood, Ohio, the atmosphere inside is warm and inviting on this cold December day. The weather outside might be frightful, but in here, there's a party going on!

Rose is sorting small, colorful pom-poms and placing them into the painted compartments of an ice-cube tray that match them. Milton is hard at work with a screwdriver, concentrating on driving screws into four holes that have been drilled in a smooth piece of wood, while Sadie places pegs of graduated sizes into their respective holes in a long wooden block.

Madeline, the most verbally expressive member of this group of residents, is adeptly-and with noticeable pride-sorting a large container of brightly colored, plastic alphabet letters into piles. Besides being pleased by her accomplishment, she also enjoys the fact that she's doing a mitzvah-an act of helping someone else. She is sorting the letters to be used in an activity other residents will enjoy later.

Another woman is putting together simple two-piece puzzles made from magazine photos that have been cut out and laminated, while the woman sitting beside her is using a plastic ice cream scoop to remove painted golf balls from a bowl and place them into the color-matched wells of a muffin tin. Rhea has several stacks of playing cards in front of her that she's sorted according to the designs on the backs of the cards.

Someone else is searching through a large plastic tub of unpopped popcorn for coins that have been hidden there. She's arranging the found coins by size on a paper template with circles drawn on it as visual cues to help with the sorting (figure 1). I learn later that digging through the corn for coins is not only a meaningful activity for her-meaningful because it employs familiar objects-but that it's also therapeutic, because moving her hands through the cool, hard kernels provides pleasant sensory stimulation. Presiding over this group of residents, all in advanced stages of Alzheimer's disease or other forms of dementia, is Samantha Porter, one of Menorah Park's eight activities coordinators (each residential unit has its own coordinator). She points out that these Montessori-based activities [see the sidebar, "So Simple, It's Genius," for a detailed discussion of this approach] are not meaningless exercises aimed at merely keeping residents occupied, but they're effective tools for improving and maintaining residents' cognition and fine-motor skills through the use of familiar, everyday objects.

"For example, the activity with the golf balls and the muffin tin allows residents to practice a motion similar to that of feeding oneself," Porter explains. "And an activity like finding and grasping small objects such as coins can help maintain the fine-motor coordination involved in buttoning buttons while dressing oneself," she adds.

Porter points out that these activities also give residents a feeling of success. The activities are designed to be failure-free; none of them can be done "wrong." If a square peg doesn't fit into a round hole, so be it. It's enough that residents are engaged in the activities and enjoying themselves. "What's important is the process, not the outcome," Porter emphasizes.

Residents are permitted to choose which tasks they're interested in on any given day, which gives them a feeling of independence and a sense of ownership. But because Porter, who has overseen activities at Menorah Park for three years now, is so familiar with the individual residents' capabilities, she might gently guide them toward an activity that will give them the greatest feeling of accomplishment-preventing frustration with too difficult a task or boredom with one that is too simple. And she helps residents by giving them more complex projects once they've completed simpler ones. True to Montessori principles, they go at their own pace because rushing them would cause frustration and, perhaps, agitation.

An aspect of the Montessori-based approach to working with residents that helps with cognition is the repetition of activities. Porter shows residents once how to complete a task and then, if they need help, reminds them how to do it the next time and the next, until they can tackle it without her assistance. With repetition, the residents learn how to do the activity instinctively, even though they might not consciously remember all the steps in the process.

Some of the activities are useful for evoking memories, such as one in which laminated magazine photos of smiling or frowning people are matched with cards that say, in extra-large letters, "HAPPY" or "NOT HAPPY." "For example, seeing a photo of a laughing baby during this activity can prompt residents to talk about their children when they were babies," says Porter.

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