When someone is living with advanced dementia it can feel like there is nothing meaningful they can do to pass the time. Working with people at this stage is one of the challenges of my job but also the most rewarding.
Michael (not his real name) was a 'wanderer'; an unhelpful description often used for someone living with dementia who can't sit still. Michael worked in the building trade all his life and so was used to being busy. His dementia had advanced to the stage that he had no verbal communication, an apparently limited understanding of the world around him and little interest in activities. Michael was, however, fully mobile and so spent much of his waking hours walking around the home. When I was introduced to the idea of using Montessori methods with dementia Michael sprang to mind and of all the things I tried shoe polishing was the stand out success.
Although it may be a generalisation I believe it was typical 50-60 years ago for the man of the house to polish the shoes. Assuming the same was true in Michael's house he will have polished a fair few shoes and boots during his life time.
I presented a pair of shoes, some polish and 2 brushes on the table in front of Micheal. He barely acknowledged them.
I put the brush in his hand but he put it back on the table.
The next step was to put the brush in Michael's hand and put my hand over the top. We started to brush the shoe together. I gently let go and straight away Michael slipped his hand in the shoe just the way he will have done all those years ago, and polished the shoe. This activity lasted a mere 3 minutes but throughout those 3 minutes Michael was smiling.
We know from research that the feelings experienced by someone living with dementia from a recent experience far outlive the memory of that experience so I felt sure that the satisfaction or pleasure that Michael felt for that brief time will have stayed with him for a longer than he will have remembered the activity itself. Now that we knew Michael was able and happy to do this task we were able to repeat it many times.
My tips for trying new tasks with someone living with advanced dementia:
- Acknowledge the individuals life history and past hobbies and interests, but don't be ruled by them. They may have hated gardening once but will now find pleasure in filling a pot with compost.
- Remember that muscle memory - the brain's ability to remember often practiced movements is a powerful (if not well understood) phenomenon so any physical tasks that someone has performed time and time again may still be useable even when their dementia advances.
- Choose your moment when introducing a new task. You are looking for a calm, wakeful time when the person is responsive.
- Don't be disheartened if the person doesn't show interest the first time. Unless you get a strong negative reponse you can try again another time.
- Gradually add support as required. i.e. start by presenting the task. Then, if necessary show how it is done, then hold over the person's hand as you do it with them. The final level would be to demonstrate only. This in itself can be a welcome distraction for the person you are working with.