Some things you never forget – it's like riding a bike. Although that's not necessarily true for all Alzheimer's and dementia patients, directing their attention to familiar activities or things they enjoyed in the past does seem to have a soothing, therapeutic effect.
Having worked with Alzheimer's and dementia patients for many years in various senior residential care communities, AnnaMarie Barba, director of Summer House, an assisted living unit that specializes in dementia care, is always looking for new techniques to calm the patient's mind and re-direct their attention during times of anxiety, agitation or aggression.
"For those suffering from a memory loss disease, learning new things can be over-stimulating, creating stress and agitation," she explains. Attempting to learn a new skill can be extremely frustrating for Alzheimer's and dementia patients. Barba says, "I started thinking, why not use something that's familiar to them? Something that has personal meaning?"
As a result, when an Alzheimer's patient is agitated, irritated, anxious or aggressive, Barba uses "re-direction" techniques to focus the patient's attention on familiar activities from their past – tasks the person enjoyed in everyday life.
Using Familiar Surroundings
As part of the re-learning activities, Summer House has set up "life skill stations." These areas are set up with props to look like baby nursery, office space, workshop and other settings that people might have spent time in during their lives. The environment serves as a visual reminder of past life events. For example, the baby station has a crib with dolls, a stroller, a rocking chair and other items found in a nursery. By gently being guided to this life skills station when agitated, an Alzheimer's resident suddenly remembers being a mother. She may sit in the rocker and start a conversation about raising her children. The agitated state lessens. Re-directing the mind by focusing on familiar surroundings brings back memories of happier times and often stops the bad behavior.
"With Alzheimer's and dementia patients, we are constantly re-acclimating them to their environment. We make life familiar by sight, smell and touch," she says. One Summer House resident spent a lifetime planting roses. Now, at her new home at Summer House, this dementia patient is re-taught gardening techniques and even given a garden plot to work.
Another resident enjoyed playing the piano. Today, he plays the community piano at Summer House, and even puts on mini-concerts for other residents. "It's been my experience that re-learning is equally, if not more effective than learning techniques," she explains. "Re-learning an activity is more valuable for Alzheimer's patients than learning a new one, as it still provides a challenge, but one within their comfort zone."
But does the technique really work? According to Barba, the proof is in the subtle signs she sees in her Alzheimer's residents. "It's often the non-verbal clues that show the bad behavior is subsiding: The shoulders start to relax, the fingers stop twitching, the eyes become more focused."
In some cases, re-learning techniques have reduced medication usage. "Instead of giving my Alzheimer's patient medication for her anxiety, she goes to her flower bed. She often becomes refocused, redirected and calms down."
Finding the Right Fit
Re-direction techniques must be tailored for each individual. So Barba meets with each new resident upon their arrival, to learn as much as she can about that person's life: his or her favorite foods, hobbies, family events. She then develops a unique care strategy focused on activities that have played a significant role in that person's life.
Much of the input comes from family members. "I'll ask specific questions about their loved one's life. What are their hobbies? What is their favorite thing to do on a Sunday?"
Getting to the Cause of the Outburst
Copper Ridge, a Residential Care Community located in New Hampshire, also focuses their dementia and Alzheimer's activities on familiar daily tasks. "Outbursts and agitation could be a sign that the activity is too difficult, or too overwhelming for the patient," says Cindy Steele, RN, nurse scholar and behavioral management specialist for Copper Ridge, and Assistant professor of psychiatry at John's Hopkins School of Medicine. "Switching to a more familiar task may lesson the agitation, because it provides a sense of accomplishment, morale and self-worth."
Steele emphasizes that it is important to get to the bottom of why the person is having an outburst, and treat the conditions that may be causing it. For example, they may be trying to communicate a physical problem, such as a headache or urinary tract infection. Or they may too cold, too hot, or that the room is too noisy. Treating the root cause will alleviate the agitation."
Treating the Whole Person
Barba says she has found that using various techniques is the best approach. "We really try to develop a dementia management tool kit that contains a variety of therapy and behavior management techniques."
Summer House, a memory care community, is part of Walnut Village, a continuing care retirement community, located in Anaheim, California.
Copper Ridge, an outpatient and residential care community in Sykesville, Maryland, for the memory impaired, is part of EMA, a faith-based family of retirement communities.