By Holly J. Bean, Ph.D., LCPC, CRC, CTRS
In blog 5 we discussed behaviors that our loved ones may display; noted as disturbing behaviors. Disturbing behaviors include wandering, yelling out, rocking back and forth, agitation, aggressiveness, passivity, among others. Research has demonstrated that all behavior is communication. It is our job to put on our detective hats in order to understand what the behavior is communicating. This is not always an easy task. This blog takes a look at the behavior and the meaningful activity that could possibly help n decreasing the disturbing behavior. The most important component of this puzzle is YOU! Smile often, make eye contact on their level (do not stand over the client or loved one), speak in a clear, low tone, slowly, if possible reach your hand out to provide comfort. And then make a quick assessment on these areas:
Environmental – Check for over stimulation. Is the TV blaring? Ask if you may turn it down or off. Always ask. Are the lights too dim or too bright? How does the room feel? Are their noised coming from outside areas that could cause alarm?
Physical – Is the client or loved one comfortable or in pain? Always check for comfort. Are they warm enough?
Psychological – Does the client or loved one feel safe or feel heard? Are they afraid due to the confusion of their disease?
The areas (domains) we program our activities for include: physical, psychosocial, cognitive, and sensorimotor. Most of our programming will encompass some component of all domains. Prior to starting our program, a thorough assessment of the client’s interests is necessary as well as an understanding of the level of cognitive decline the client presents with. You will adapt the program to the client and their ability. Remember – the purpose is meaningful interaction, not the completion of the program!
Physical- physical activities are necessary for health (physical and mental). However, pain and mobility constraints can limit the activity. Various physical activities can include range of motion (slow movements focusing on certain areas – please go to this link: https://blog.hurusa.com/7-seated-exercises-for-seniors-to-improve-strength). You might try toe taps, using a squeeze ball for hand movements, or put on their music and chair dance! If walking is allowed, enjoy the outdoors while reminiscing on the season. Be sure you check for pain, take rest breaks, and hydrate! Research has demonstrated exercise combined with caregiver behavioral management techniques improved physical and mental health in community-dwelling clients with Alzheimer’s disease.
Psychosocial – Isolation is a real threat to our seniors. Isolation leads to apathy and depression. During COVID 19 we are isolating more than ever, yet it is our loved ones in nursing homes who have been hit the hardest as visitations have been limited. Using technology to provide adapted interactions is needed. IPads, cell phones, and computers can provide the ability, albeit not perfect, to help with the social contact our clients need. The challenge is to create an interactive program that our clients can participate in and will maintain attention with. Families must be included for this technique to work – either by purchasing the modality for the interaction or setting up the technology for the interaction. What meaningful activities can you provide via technology? Music, art, gardening, movies, reading books, playing word games, exercising, truly most anything can be adapted for the pandemic requirements of physical distancing. Many museums have offered free entry via computers to their site. It may take patience and time to help our clients learn how to use the technology, but it is well worth the effort and this instruction, in and of itself, is also an activity that connects you with your client! Please see this link for more information on technology for seniors: https://www.rightathome.net/blog/technology-for-seniors
Cognitive – All activities require cognitive involvement. Your task is to program for the level of cognition your client presents. Research demonstrates that helping to maintain the level of cognition of your client can increase positive outcomes. Cognitive activities include playing games, cards, reading, word search, cross word puzzles, fill in the blank of a sentence, a poem, singing, reminiscing, Bingo, and so many others. In this current environment, the use of computers for social interaction is needed. Research has shown that computers can help increase communication and reduce passivity (Sobel, 2001). Cognitive activities are listed on many websites, here is one for you to check out: https://supercarers.com/blog/games-for-elderly/ You can easily adapt any type of cognitive program for use over the computer. Research demonstrating efficacy with the computer for cognition can be found here: https://www.researchgate.net/publication/278047110_Computer_Activities_for_Persons_With_Dementia
Sensorimotor – This category works to evoke active responses from the client. The two major responses to work toward are passive or apathetic behavior and agitation. Sensory stimulation works to calm disturbing behaviors by focusing on the senses: sight, sound, touch, and smell (Cohen-Mansfield, 2001b). Face to face interaction with clients makes the touch and smell programming useful. You can reminisce about baking while preparing a favorite recipe as the aroma fills the house. This also can build into creating a cook-book of your client’s favorite recipes for their family as a keepsake. However, if you are working remotely, via computer, sight and sound are still viable options. Here is where the boundaries on programming domains may blur as they cross into cognitive, such as music, art, colors, and reading books. Please check out this website for information on the sensorimotor program called Snoezelen Room: https://www.snoezelen.info/who-can-benefit/snoezelen-for-the-elderly/
Research has shown that engaged older adults have the ability to retain cognitive abilities or slow the progression of dementia, maintain mobility or physical functioning, and a quality of life that brings purpose and meaning. You are an instrumental part of this wonderful design!