Joy A. Glenner
Page 10
Basic travel safety precautions include:
• checking with your physician and obtaining anti-anxiety medication to give to your partner if her or she becomes anxious and confused (have your partner try out the medication in advance to evaluate his or her reaction)
• looking for unisex, family, or single-stall restrooms so you can help your partner easily; be aware that some bathrooms have two or more exterior doors
• obtaining “handicapped” assistance on planes, in airports, on trains, and on cruise ships
• checking connections ahead of time (make sure you can get home from transfer points or your destination quickly if necessary)
If your partner is only mildly impaired, a cruise may be a good choice because you can stay in one place once you get there. Be sure to purchase trip insurance in case you must cancel or leave the trip partway through.
Involve Your Partner in the Flow of Daily Life
To help your partner use remaining memory skills, involve him or her in the flow of daily life. Unless your partner has severe dementia, try to include him or her in many ordinary, everyday activities. Being involved helps the person feel secure and part of life, encourages the use of the remaining short-term memory, and may help the person retain it longer. Choose the time of day your partner is at his or her best for special events, especially those involving children.
When you go to bed at night, you probably think of all the things you need to do the next day, and often the tasks are interrelated. For example, you may plan a salad for dinner, go buy ingredients, prepare the salad, set the table, and serve the salad for dinner. Try to integrate activities for your partner into the flow of your day. For example, Mary Stevenson involved her husband, Charles, in preparing for a family visit.
Tuesday morning the Stevensons’ daughter calls to say she will bring her children to visit on Thursday afternoon, the best time of day for Mr. Stevenson, who is a moderately impaired AD patient. Mrs. Stevenson, Mary, involves Charles in the plans:
• deciding what snack to serve, buying groceries, and then fixing the snack;
• setting out some toys the children keep at their grandparents’ home;
• cleaning up the living room and yard so there is more room for play and visiting.
Mary tells Charles about the visit. She tells him she needs his help to get ready. She also:
• keeps reminding him of things they need to do and about the visit;
• decides what Charles can do to help, and how to do it;
• allows lots of extra time for anything he does.
Tuesday morning Mary includes Charles in choosing a snack. She shows him pictures in the cookbook so he understands. They decide on chocolate chip cookies and make a grocery list.
Tuesday afternoon they shop. They are buying only cookie ingredients and drinks. Charles puts items in the cart, then into the car, and carries them into the house. Mary reminds him of the things they are doing and the visit. She tells him they will make cookies the next day, Wednesday.
Wednesday morning she reminds him of all the following day’s events, and they make the cookies together. Wednesday afternoon they look over toys, choose some, and Charles puts them on the patio. She again reminds him of the next day’s events.
Thursday morning they straighten up the living room and patio. Charles moves some things out of the way and sweeps the patio. Mary reminds him of everything they are doing to prepare for their family’s visit several times.
Thursday afternoon there are more reminders from Mary and the very special time with their daughter and grandchildren.
Caution: Some patients become very nervous thinking about events in the future. They may dwell on them and talk about them over and over. If this is the case with your partner, involve him or her in getting ready but don’t mention the event until the actual day or even just before it takes place.
Enjoyable Activities for Your Partner and for You
Reminiscing boxes are great and can be made for free! Collect things from your garage or attic and from friends. Put different types of objects in each box. These are “no fail” activities, with no “right” or “wrong” way to do them.
Like the IADLs, reminiscing boxes can also be used for great one- or two-step activities. Persons with dementia do single-step actions over and over. It is sometimes difficult for them to stop. This is perseveration (as discussed in chaps. 1 and 3).
Perseveration can turn some activities into behavior problems (banging on the table, undoing buttons over and over) or can be useful for therapeutic activity (stirring cake batter or sweeping). Most people with mild or moderate impairment can do oneor two-step activities alone once they’ve been engaged, but they may need occasional reminders and prompting, or reengaging.
Box 6-1 describes successful one- or two-step activities. Mildly impaired patients can do some of them alone; others are designed for you to do together. Box 6-2 lists some “tried and true” games that can be fun for both of you.
Some Hints for Successful Activities
Now that you have activity ideas, there are basic rules to follow. Be sure to use the techniques below with any AD patient (persons with mild impairment as well). Activities will be much more difficult if you don’t.
Always allow plenty of time.
Simplify activities to only one or two basic steps. A step is an action that is complete in itself. It does not require a memory of the other steps to complete it (also see chap. 3).
Jane used to knit. Knitting is now too complicated for her because it cannot be divided into single steps. Her sister had some old sweaters that were unraveling. Jane got hold of one, unraveled it more, and wound the yarn into balls—a two-step activity. Her sister now collects old sweaters from friends and gives them to her. Jane enjoys her work, and her sister admires it, saying that someone will really enjoy making new sweaters from the yarn. (It often is reusable.)
* * *
Box 6-1. Enjoyable Activities for Your Partner and for You
Reminiscing Boxes
Your partner can simply handle and move about the contents of the boxes; less-impaired patients may enjoy doing specific one- or two-step activities. Be sure to do the following:
• Put only one type of thing in each box! This helps prevent boredom and lets your partner enjoy specific things more. It’s good for stimulating conversation, too.
• Let your partner use a large surface, such as the dining room table, to spread items out.
• Put one box away before getting out a new one, to avoid confusion.
• Choose items for boxes carefully. For example, avoid including small objects if your partner may swallow them.
Some ideas for boxes include:
• Old greeting cards, postcards, photos, calendar pictures—Use a separate box for each type. Try having your partner cut out pictures and make scrapbooks.
• Fabric squares, felt, or colored paper in random designs or geometric/abstract wooden puzzle pieces—Some patients can cut fabric. Encourage your partner to arrange items into geometric or abstract designs.
• Plastic jars and lids
• Heavy-weight plastic or real flatware and divided tray (one that keeps knives, forks, and spoons separate)
• Locks and keys
• Nuts and bolts
• Office items (pens, paper, different sizes and colors of paper for sorting, clipboards, cards and card file box)—Many different things in an actual desk would be great.
• Old jewelry (with pins off and stones secure)
• Buttons (not tiny ones)
• Ribbons and lace
• Artificial flowers and vases
• Seashells, perhaps with some sand in a dishpan; old sand toys (for “remembering”)—Keep it adult when you talk about it. For example, do not call it “playing in the sand.”
• Decorations and photos for specific holidays (each holiday in a separate box)
• Sandpaper and different types an
d sizes of wood pieces—Make cutting boards, wooden blocks, other household objects or toys; wax or oil completed projects.
• Game pieces such as playing cards, dominoes, Jenga, or Block Head to arrange randomly or play simple games for two or more players
• A selection of baby or children’s clothing
• Matchbox cars, small plastic toy animals, or other figures
• Large wooden or other types of beads and thick string (stiffened with tape or glue at the end for threading) or long shoelaces
Good One- or Two-Step Activities
If your partner has mild or moderate dementia and you engage and then reengage him or her occasionally, it can stimulate your partner to do some activities on his or her own. Others you can enjoy doing together.
Your partner may enjoy:
• Coloring an adult-looking coloring book—Take pages out of the book. It feels more like adult artwork that way. It’s usually not a good idea to call it “coloring”; perhaps call it “drawing.” Pick simple pictures or enlarge sections of bigger ones on a copy machine.
• Trying other types of drawing (using pencils, watercolors, chalk, colored pens, stencils, and different types of paper)
• Looking at pictures or a book or magazine with colorful pictures—National Geographic is a good choice. Avoid children’s books unless a child is with you or you are using them for reminiscing about times with your children or grandchildren. Although not a one- or two-step activity, reading poems or short stories together often works, too. The sound of your voice can be very soothing even if the person does not fully understand. Many patients also like to read out loud, even if they do not grasp a lot of what they are reading.
• Stuffing envelopes for local organizations, including (in some cases) folding, gluing, and stamping each envelope separately
• Kneading yeast dough (making bread, rolls, pizza dough)
• Cracking nuts
• Winding yarn—Stretch a skein between two posts or prepare pieces no longer than ten feet to keep it from getting tangled. Have your partner wind them into a single ball. Different-colored and textured pieces add appeal and look colorful when wound.
• Throwing or rolling and catching different types of balls
* * *
* * *
Box 6-2. Simplified Versions of Adult Games
Active Games
• Horseshoes—Use heavy plastic horseshoes, not metal or very lightweight children’s toys.
• Lawn darts—Use weighted, not sharp-pointed ones.
• Indoor dart games—Use plastic darts and a special dart board, not metal darts.
• Shuffleboard (available on a long plastic sheet for temporary use)—Play from one end only, letting the score be where the disk lands in the opposite triangle.
Jigsaw Puzzles
• Puzzles with five to twenty pieces with adult-looking pictures
• U.S. map puzzles, one piece for each state
• Attractive, simple puzzles made by mounting calendar pictures on cardboard and cutting them up—Your partner can help glue the pictures, too.
Word Games
• Children’s “hidden word games”—Make sure they don’t look childish. Provide plenty of hints.
• Simple crossword puzzles
• Simple word-association or trivia games
Table Games
• Jenga
• Block Head
• Dominoes—Divide color-coded dominoes among players, face up, so you can help your partner. Match them end to end only. The first one out of dominoes wins.
Card Games
• War
• Sequences—Mix cards, divide among players, play face up. Take turns; build suits one by one. The first one out of cards wins.
• Sorting—Assist your partner in sorting cards into suits or by color.
* * *
Show the person supplies or a finished sample (if applicable) to make sure he or she understands. Use short, simple sentences and repeat them as needed (see chap. 3 on interaction techniques).
Mrs. Costello has many pairs of socks to put together after doing laundry. Mr. Costello enjoys sorting and pairing them. Each time, she shows him some socks, puts them together, and checks to see if he is following the steps. She then gives some to him and asks him to do it.
He sometimes needs a little more help and then continues on his own for awhile.
Reengage the person in an activity as needed and repeat one-step instructions.
Mrs. Costello keeps an eye on her husband because he stops sorting once in awhile, due to his short attention span (remember the basic PALMER symptoms). She then reminds him of what he is doing (she reengages him), repeating instructions each time.
Note: A short attention span is not the same as your partner telling you, “No, I do not want to do this anymore!” Don’t push if the person really does not want to continue; there is a difference.
If supplies or equipment are used, present them only step by step and take them away when done to avoid confusion.
Mr. Herrera decided to make a cake, and his wife with AD, Julia, wanted to help. He got out a cake mix, eggs, oil, a measuring cup, mixing spoon, and baking pans. He put them out on the counter within his reach but out of his wife’s reach. He kept light conversation going about making cakes and this specific recipe but also stated steps clearly and repeated them as needed. Mr. Herrera’s steps were:
1. “Julia, sit down at the table” (pointing to the table and chair).
2. He then said, “We are making a cake” (pointing to the box, repeating the statement and pointing to the box often).
3. Next he said, “Open the box” (tapping the top of the box, assisting her as needed).
4. He then brought the bowl to the table and said, “Pour the mix in the bowl.”
5. After she poured out the mix, he put the box out of her reach so it would not distract her.
6. He continued, step by step, with only the specific supplies needed for each step set out in front of them. If Julia were more severely impaired, he might do most of the steps and have her do a single one, such as stirring the batter.
Try an activity based on a past interest. Simplify it and adapt equipment as needed.
Tom used to golf. He now enjoys putting in his backyard. He uses a standard golf club and hollow plastic balls (so they will not go too far) and hits them to large, easy-to-see targets, flags, or foam circles. (Computer mouse pads make great targets.)
What if your partner is not interested? You can try:
1. Starting the activity on your own but asking the person to sit beside you to keep you company or just to sit and watch.
2. To keep talking to keep the person there and alert.
3. If the person keeps watching, saying after awhile, “Here, help me” or “Your turn!” Don’t say, “Would you like to help?” because this often invites a no. If the person starts to participate, quietly give him or her short, simple instructions. Don’t ask “Is it okay?” or “Why did you not want to do this before?” because the person may then stop again.
Why is it hard to get your partner interested? There are many possible reasons. Your partner:
• may not be aware that you are even there, may not understand that you are suggesting something to do, or may not understand what you are suggesting. Reminder: Show the equipment and samples, let the person touch the objects. Watch the person’s face to see if he or she is watching and understands.
• may not understand, just by looking at the supplies or equipment, that the activity might be fun. Reminder: Start it in front of the person. He or she may then “catch on.”
• may resist because you are saying, “Do you want to do this?” Doing all the things we take for granted is very scary for patients with dementia, and they may have a negative response because of that. Try saying, “I’ll be there to help” or “We’ll do it together. It’s not so hard.”
• may get tired of having some
one always telling him or her what to do. (Wouldn’t you?) It may help the person maintain self-esteem to say no. Ask again later or do the activity in front of the person, and he or she may join in. If the person can not see you doing it, he or she will forget about it.
Rose’s husband, Ben, has always been very independent and is very negative much of the time now that he needs more help doing things due to Alzheimer disease. Rose gets him to help fix lunch or dinner by inviting him to sit at the kitchen to “just talk” while she prepares the meal. She then starts making sandwiches, for example, and “happens” to move a tomato that needs slicing in front of Ben. It is on a cutting board with a serrated knife with a rounded tip. She knows he can use it safely. She then pays no attention but starts slicing another tomato nearby. She doesn’t comment at all, but Ben usually then starts to do the task while they talk. She thanks him very briefly when he is done and then slides some other task in front of him.
Why does Ben finally help? He may respond because he has exerted his right to say no and then is able to start when he wants to. Rose doesn’t embarrass him by calling the task to his attention. He also may not have understood what she wanted him to do until he saw her begin. Observing her may have triggered his response.
Glossary
acetylcholine. A neurotransmitter that sends (transmits) signals from one nerve cell (neuron) to another. The transmittal is responsible for learning and memory. Acetylcholine is severely depleted in Alzheimer disease by an enzyme called acetylcholinesterase. Medications such as Aricept stop the acetylcholinesterase from depleting the acetylcholine.
active aging. A lifestyle of an older adult who makes a conscious effort to adapt to any deficits due to aging by keeping active physically, mentally, and socially.
Activities of Daily Living (ADLs). The most basic personal care tasks we must be able to do to live independently. They are transferring (moving from one position to another, such as getting into and out of bed, a chair, or a wheelchair), toileting and continence care (cleansing oneself after using the toilet), bathing, dressing, grooming, walking or getting about with an assistive device (wheelchair or walker, for example), and eating.