SBB University Caregiving Resources | Engaging an Aging Adult with Dementia

SBB University Caregiving Resources is provided courtesy of Seniors Blue Book and Kathleen Warshawsky, BSN, RN.
Benjamin Surmi, MSG, Director of Education and Culture with Koelsch Communities presents Engaging an Aging Adult with Dementia: Top Dementia-Friendly Virtual Strategies and Tools for Professionals when Consulting with Families.

This article is a quick summary with links of the content shared during a 2020online event.You may watch the event by clicking here.
Why Are Every Day Tasks and Household Chores Important?
Our loved ones have spent most of their lives maintaining their own living environments. From changing the paint color on living room walls, to washing grass stains out of their kids baseball uniform and cooking for 20 family members on holidays. They were active participants in all those things and more. So, despite cognitive or physical decline, its important that we help create situations throughout the day so our elders can feel useful and helpful and offer more moments where they can be active participants in their own worlds.
What Abilities Are We Adapting For?
In most cases, you can modify a task or household chore, or at least parts of them, to accommodate our elders specific needs despite physical or sensory challenges. For visual impairments you might focus more on tasks that you can navigate through other senses like touch. For physical limitations you might focus more on modifying tasks that can be done sitting or within that persons personal space. For elders who struggle with multi step tasks you might break a task into simpler steps, one at a time as well as using prompts and demonstrating how to do those steps.
Be Mindful of:
1) Identify the person's needs both cognitively and physically.
2) Then, assess how you can break the task into simpler steps
3) Begin planning modifications that the person can use to complete a task safely and successfully. We want to be sure as best we can, that in all situations, our loved ones are safe.
4) Encouraging our elders to engage in any activity requires time, patience and the understanding that its not about how well the task is executed, but, rather that your loved participated and feels accomplished and useful.
Outside tasks - Gardening Planting Seeds / Transplanting - You can grow almost anything in almost any container, the idea isnt for perfection but for participation and enjoyment. A raised garden, of any kind, is ideal. A person doesnt have to repeat the action of bending down to touch plants. They also minimize the risk of loosing your balance and becoming unsteady. Garden pots that are easier to move and lift can be situated closer to your back door, on table tops for the easiest access for elders using wheelchairs or folks who get easily tired from walking
Adaptive Devices / Modifications - aside from shovels, hand trowels, tools like water resistant mittens with a Velcro attachments can be worn by those who may not be able to open their hands to put on a typical garden glove. Indoor pots with heat lights, or even automatic times watering systems for small gardens. Have all our supplies ready and, depending on the need of your loved one, prompt them on where or how to start. Planting seeds and transplanting root bound plants into bigger pots - holding the root ball in their hands and using their thumbs to separate it into two parts - this action that theyve done so many times before can start to become familiar again.
Gardening Upkeep - Try verbal prompts or reminders clip off the spent flowers while pointing to the flower so they hear the words and connect it with the visual. Or, hand over hand model to get started.
Adaptive Devices / Modifications - Aprons with a pocket or even wearing a belt with a plastic bag attached - a hands free tool for collecting garden waste is useful and eliminates the need to drag around a garbage can or having to continuously bend over to pick up the scraps. Easy to squeeze garden sheers come in all kinds of sizes. Try a few things before you settle on one tool
Raking Leaves Fall Tasks - Raking leaves is similar to vacuuming though we might have broader reach through our legs, back and arms. Think about these questions regarding the environment and your loved one: Is the ground flat and easy to navigate safely? Is your loved one steady on their feet, be able to balance and bend? Or, do they need a chair to sit in? You can rake up small piles at time, or do a portion of the yard each day.
Adaptive Devices / Modifications: To avoid repeated lifting, modify a tarp by cutting one in half then fold a corner up towards the center and tape it to make a pocket. Lay the tarp down and sweep the leaf piles on top of it. Gather the edges to lift the tarp so it can be emptied into the trash can. Avoid raking on rainy days, so theres no added weight to your leaves. You can also purchase tarps with pockets and handles. Asking your neighbors to help is always fun too.
Sweeping Patios and Porches - Our elders can sit in chairs that are easy to move around. They can sweep dirt into one general area and then move to the next spot and continue. If physically, the task of sweeping the porch is too tiresome, ask your loved one to simply open the front door or the back door and sweep out seem of the door. Choose a broom that is lighter to carry and an appropriate size. Again, it doesnt have to be executed perfectly, the focus is on their engagement.
Caring for Birds Refilling birdfeeders can be modified in many ways, place the feeder on your table and ask your loved one to brush it out and then scoop birdseed to refill it. If you have a few birdfeeders, you and your loved one can wear aprons. Fill the pockets with birdseed and scoop seed as you visit each feeder. If you dont have birdfeeders, you can make your own to hang in the yard or on your balcony and, its a great activity that can be repeated all year long. Building a bird house together, whether its made out of milk carton or a premade kit, the enjoyment also comes from doing it together. When finished, you can sit back, watch the birds flutter around, and listen them sing and chirp and maybe even practice a few bird calls for fun.
Caring for Tools - Cleaning hand tools from the shed can be a task thats broken up into days, weeks or just once at the end of the season. If your garage or shed is filled to the brim and hard to navigate, bring tools onto a table. Pick tools that are lighter and safe to hold from all angles. Ask your loved one to start cleaning a hand shovel and offer them a small towel. If they are visually impaired, sometimes a sock on their hand (instead of holding a towel) can work better as they can feel and follow the shape of the tool as theyre cleaning it. When finished, simply put it into the clean pile on the table so you can safely store them away afterwards. If your loved one used to be passionate about cars, ask them to sit with you as you refill your washer fluid. They can sit safely, an arms-reach away if needed, but close enough to hand you a funnel or cloth to wipe up spills. You can encourage them to offer advice on how to fix something or what the best brand to use is. Standing or sitting, our elders can still help wash the car or at least spray the hose. And, its a great opportunity to reminisce about the first car you shared or, about the time you went on longest road trip.
Watering the Garden - On flat even ground, your loved one can sit a sturdy armed chair, and hold the hose with the nozzle pointed at the garden. Some hose attachments need a strong grip that might not be too easy for our elders use but, you can clip the handle so it stays in the on position until theyre finished. Safely move the chair to the next section of garden to continue watering, if needed. Also, some hoses are heavier and bulkier than others, so choose a hose thats lighter and easier to manage.
Watering cans are often cumbersome and the placement of the handles can aggravate our wrists and forearms more easily. Try using a plastic iced tea pitcher, theyre easier to lift and suspend in the air. If your loved one is visually impaired, and not able to clearly see where the water is hitting, use a ruler or a dowel or stick and place it in the center of the plant. Ask your loved one to hold the top of the ruler and then they can start pouring the water so they feel it on their hand this means theyre watering the center of the plant.
Sanding and Repairs - Picnic tables and benches, anything that needs to smoothed out or to remove old paint or even craft projects. Try stapling sandpaper under a small block of wood. This is a great modification as its easier to hold the block on top then to tightly grip it in your hands. Use a black sharpie to mark the area that your loved one should work on. This is a great visual cue once the marker is sanded off, that area is done. Encourage them to use their hands to feel for a rough area, this can be another physical prompt for the next step. Use larger brushes to swipe away dust or shavings, as well as, the dusting off newly sanded pieces.
Adapting Household Chores - If balance, bending or lifting are areas of concern for your loved one, they can sit in a chair beside the open dishwasher and stack clean dishware on to counter or table. If youre doing it together, they can pass you each plate and cup as you put them away in the higher cabinets. Place the utensil holder from inside the dishwasher on the table, so our elders can try to organize the spoons, forks and knives back into the slots of the utensil tray. Sometimes negotiating between the three different utensils all at once can be confusing. Try a visual prompt an outline of a fork and place it in the bottom of the organizer. You can model placing utensil to match the image Washing and Drying Dishes - You can take turns, who washes and who dries with hand towels. Try all kinds of different smelling soaps. Some of our elders they can dry dishes seated at the counter or table. Wiping down counters, tables, cabinets and the fridge all these tasks are easy to modify and can be accomplished standing or siting. Different tools can be used to match your loved ones needs, towel mittens or extended handles on swipers can help.
Organizing Pantries - Helping to organize pantries can be done with the goal of removing items that are past due or not going to be used. Or, you can ask them to simply help by turning all the jars and cans so the labels (the words and pictures) are facing out. Demonstrate this action if needed. Or by the size of jar or can, the smaller ones go in the front and maybe just by the color of the labels. Your loved one might want to focus just on stacking cans and that is okay too.
Polishing Silver Polish - Many polishes available today arent as harsh on our skin as they used to be. There are also options for homemade polish recipes online or on YouTube. Or, your loved one can wear gloves. As youre doing it, reminisce about past holidays or celebrations - the different family events that you used the good china and silverware for, talk about the old pink silver polish how strong it smelled and notice the detailed pattern of the silver tea set.
Making Simple Sandwiches - Break the meal preparation down into simple steps: perhaps the ingredients should be visible on the counter, or even set up in the order of when youre going to use them. Offer reminder prompts for each step take two pieces of bread out of the bag. Next, place them on the plate. If needed, hold the bread bag open while prompting and then point or touch the plate as you cue them where to put it. As can openers can be challenging to get started , perhaps you could do the first rotation and then pass it to your loved one. Demonstrate or model hand over hand how to hold the can while twisting the handle. As always, some things are easier than others. For some cutting celery might be easier as it stays in one place and requires less force to complete the cut where cutting carrots can be more difficult because the roll and are harder / more dense. Continue to be mindful of your loved ones needs and what tasks are appropriate for them. Seated or standing, encouraging them to use their non dominant hand if necessary, and ask your loved one to scoop out mayo and to stir the ingredients together or cut a sandwich in half to share.
Sweeping, Vacuuming or Dusting - Take notice - is the floor level, will the rug or carpet buckle or catch on the cord? Is the vacuum to big or heavy to maneuver? Can your loved one balance while pushing the vacuum? Or, do they need a chair to sit in? Even seated, your loved one can vacuum or push a light weight broom to help. For some elders, extending their arms while holding the broom, reaching past the scraps of paper on the floor and then dragging the broom back towards them is easier and less strenuous. Some elders enjoy sweeping , and are comforted by the repetitive motions, the back and forth actions. A vacuum could be the last step after sweeping to quickly use the hose to clean up the small piles scraps instead of bending over to sweep them into a pan.
Sorting and folding laundry - Can be done almost anywhere, on your lap, couch or table. You might need more than a verbal command or prompt. You might stand or sit beside them and model how to do each step, one at a time. Saying cue clearly, what your doing, as your doing it fold the towel in half. When that step is done, say the next prompt out loud while modeling the action. And always keep in mind that loved one is far less likely to become overwhelmed if you give small clear steps. One at a time. Also, consider that the towels dont have to be folded perfectly, as its more about your loved one participating and helping. Sorting laundry by color instead of by article of clothing can be easier as you are just focusing on color instead of action steps. Try matching and pairing socks by color or pattern and rolling them.
Go Through Old Telephone Books Old Recipe Books - As you turn the pages, talk about old friends from past neighborhoods, or how phone numbers have changed and what party lines were. Look at the handwriting and the different shades of ink used. Planning your holiday card list and practice signing your name. When you go through old recipes books, its the same idea; talk about family recipes, and who made the best stuffed cabbage and where each recipe originated from. Compare groceries stores to butcher shops and who had the best selection for the best prices. Maybe make a plan to prepare one of your favorite recipes together
Organizing Fashion - Pairing winter gloves by color or size, mens or womens, and rolling scarfs in a drawer or folding scarves to use as headbands. Encourage your loved one to tie your tie. Prompt when needed and laugh when you both make mistakes. Pulling out a jewelry box and untangling necklaces from earrings and bracelets from watches is often a easier task to complete. Although a necklace may have a knot in it, you can loosen it up more and more as you continue to play with it. Rolling costume jewelry on the table surface can help loosen knots as well.
Caring for Shoes - Both men and women can Polish shoes, even if your loved one is doing it for another family member. Demonstrate by using the rag wrapped around your finger, spreading on the polish and working it into the leather using a circle motion. These actions, often times, come right back to our elders, even if they havent done it in a long time. Using the brush, buffing the marks of polish out, the rhythm of the back and forth motion, this can also be self soothing for your loved one. Replacing a broken shoelace can be challenging for anyone, try a yarning needle with a larger eye and thread the needle with the shoelace. Or wrap tape around the end of it so its sturdier and wont fray. If needed, you can lace the show while explain to you the steps.
Coupons - Every Sunday, you can go through the circulars with your loved one and cut coupons out. As youre both flipping through the pages, encourage reminiscing by announcing the current price of milk! Compare it to a time when it was much much cheaper! Or the price of a new television compared to what they used to be. Plan what meal youll make for dinner and make a list of ingredient s you need. Encourage your loved one to write it out if they can, and you can read it no matter what it looks like. Then, ask your loved one to look for coupons for few items that youll be shopping for later when they find one, prompt them to cut it out Or fold and rip it out the best they can. Ask things like how much is the ice cream in the ad you have there and then announce the cost of the ice cream you see in your section. Yup, Waldbaums IS cheaper! When youre finished, sort our your coupons either by dry good from produce, or store or maybe your elder wants to sort by size or color, and that works too. You can even donate them.
Key Take Aways - Despite cognitive or physical decline, always be mindful of:
1) Identify the person's needs both cognitively and physically.
2) Then, assess how you can break the task into simpler steps
3) Begin planning modifications that the person can use to complete a task safely and successfully. We want to be sure as best we can, that in all situations, our loved ones are safe.
4) Encouraging our elders to engage in any activity requires time, patience and the understanding that its not about how well the task is executed, but, rather that your loved participated and feels accomplished and useful. Be aware of their needs and that their needs will change. And to always have fun.
Links for Top 10 Dementia Friendly Online Activities (virtual resources): https://www.notion.so/Top-10-Dementia-Friendly-Online-Activities-f16e0ecee09f44c6a794eee082051222

#10 - Engage the Senses
Finding ways to connect different senses - beyond listening to words - is the pillar of powerful engagement. One step in that direction is to use technology to connect with the senses in new ways.
Favorite Sensory Apps

Dropophone - create unique melodies through touching drops of water.
Fluid and Fluid 2 - responds to touch with interactive liquid visualizations.
Wa Kingyo Goldfish Pond - watch and interact with gold fish.


Get Inspiration for Hands-on Kits
Instead of connecting online, use internet resources to find inspiration to make physical sensory kits. Search Pinterest, Google, and Instagram for sensory kits, reminiscing kits, memory boxes, sensory boxes, and theme hands-on kits.
#9 - Volunteer
One of our most important needs is to matter to other people. We need to have a sense of meaning and purpose.
Even though we cannot always get out to volunteer and serve, there are so many things we can do right from our home or apartment!
#8 - Experience the Opera
What: Watch HD opera from the Metropolitan Opera.
Why: A team in the UK has shown surprising responses to opera among people living with dementia. The unique vocal arrangements and brilliant compositions connect even with people who never listened to dementia earlier in life.

Home
#7 - Watch & Discuss
Too often, we turn on the TV or a movie. Yet, it's much more effective to watch 6-8 minutes of a very familiar clip or musical number. Stop. Discuss and reminisce. Then, watch another clip.
Meet Me at the Movies is an exceptional program in various cities. And, we can all do this at home!
Example Format

#6 - Play Games
One of my favorite games to play with ladies and gentlemen living with dementia is a modified trivia game. Instead of asking them to guess or remember names, I prompt with lots of clues and tell them the answer. I don't ask them, "Do you remember who sang this?"
We have lots of fun because the visuals and audio bring back so many memories.
The Media for Elders YouTube channel has all sort of playlists to inspire.
Musicals
Play 30 seconds - 1 minute of famous songs from musicals.
Tell parts of the story in between each snippet. If you each remember the words to the chorus, sing the whole song.
Animals
Who doesn't love animals? Using YouTube or Spotify, play animal sounds. Using Google, show photos of certain animals. Then, remind them of the name and discuss facts about the animal.

Jingles and More
Old commercials, sounds of cars and nature, classic TV theme songs, historic places, singers, artists, and household items in detail - all deserve a spin at your house! Just use Spotify, YouTube, or Google.

MemoryCo.org
[Free Trial / $9 per month]
Try Family Feud, Matching, WordPeck, Wheel of Fortune and all kinds of personalized games with family photos. www.memoryco.org

#5 - Ask Beautiful Questions
It's easy to get in a rut when we talk to someone we've known for years.Try asking Beautiful Questions from TimeSlips. Go beyond the hear-and-now to questions that bring out the unexpected in those you love.

#4 - Talk with Old Friends
You can find almost anyone through Facebook, Skype, Google, or the college or church you used to attend. Video chat makes it possible to re-connect with people you haven't seen in years.
Skype, WhatsApp, Facebook Messenger, and FaceTime are popular apps for computer or smartphone. Skype is likely the most versatile as it permits screen sharing, multiple callers at the same time, and works on all devices.

#3 - Create Stories Together
Dr. Anne Bastings designed a method of inspiring anyone - but especially those with dementia - to tell stories about unique, expressive photos. Print a photo and ask open ended questions with no right or wrong answers. Write down what each of you say.
Learn more at www.timeslips.com

#2 - Explore the World
Google Arts and Culture
Time Explorer
Select different dates from far into the past up through the present; discover art and artifacts from each unique time period.

Collections
Collections from museums, galleries, and historical sites around the world are at your fingertips. Search by name or by map.
For reminiscing:

The Time Life Collection
Getty Images


Google Street View
Visit iconic monuments, behind-the-scenes sporting events, museums, cathedrals, opera houses, libraries, heritage sites, science labs, and recreations from the past.

Explore in 360
Short videos that let you see 360 degrees while watching the video. Get close to a dinosaur, go on stage with at Carnegie Hall with the Philadelphia Orchestra, visit the bedchamber of Marie Antionette, and visit the Hubble Telescope.

#1 - Cue Familiar Memories
Use the endless resources online to trigger memories.
Media for Elders YouTube Channel
Check out these playlists curated by a Master's level Art Therapist and Special Needs Educator, Lisa Klich.

Dementia-Friendly Sing-a-longs with words on the screen
Life in the '50's, Life in the 60's, etc.
Music Quiz
Videos and live cams that inspire the senses

Sing-a-long
Start with the music from the decades in which your friend was 18 - 28 years old. Play songs with words on the screen and sing-a-long.

Show Images for Reminiscing
Nestle
Nestle has created a packet of downloadable vintage images for recalling foods and beverages many elders remember well.

Automatic Slide Show
Just enter a few key words and slideshow.net creates a slideshow using Google Images immediately.
You can try animals, travel, antiques, trains, quilts, or any other topic that has interested your friend. You might also try specific places, workplaces, organizations, and hobbies.

Google Maps and Street View
Take your friend to the home they grew up or the first home they purchased. Move through their town to the parks, libraries, and shops using Google Street View.
Find a Home

Walk through the Park

BBC Remark
The BBC has curated images, audio, and video from its vast archive. Choose a theme or decade. While many images are UK-specific, the look-and-feel will likely stir memories.
https://remarc.bbcrewind.co.uk/


WRITTEN BY



Benjamin Surmi




Listening to stories of elders in my neighborhood inspired me to take the journey I am on now designing fresh ways for elders living with dementia to thrive.
Learn more about Koelsch Communities:
Arbor Hills Memory Care Community |Saddle Brook Memory Care Community
Meadowbrook Memory Care Community |Riverside Inn at Fossil Creek


Watch the presentation video