Dementia affects approximately 4 to 5 million people across the United States and is one of the leading causes of death among seniors over 65. Dementia differs from general cognitive decline due to aging in that functioning decreases more rapidly and interferes significantly with daily activities.
Fortunately, there has been a significant amount of research done on interventions to slow mental decline and, in some cases, restore cognitive and physical functions. And the way researchers and caregivers measure the impact of these interventions is by observing the quality of life of patients.
From the early onset stages of dementia through to the later stages of the disease, the quality of life of patients is affected in profoundly adverse ways that can vary by individual. Memory loss, cognitive impairment, behavioral changes, and social changes all play a role in diminishing the quality of life of patients.
Some factors that affect the quality of life in dementia patients include general mood, engagement in enjoyable activities, ease of physical functioning, and the ability to perform everyday tasks. To help improve your patients’ quality of life, here are 10 activities and strategies you can implement with your patients today.
Music is a resource for treating a variety of neurological disorders and diseases due to the physical effects sound can have on the body and the connection between sound, cognition, and memory.
Music can improve memory recall, improve mood, allow patients to regain a sense of identity, and even reduce the need for pharmaceutical pain management.
In a famous video by the Music & Memory organization, a senior named Henry who is living in a nursing home is given an iPod preloaded with music from the era of his youth. The change in Henry’s demeanor is instantaneous as he recognizes familiar tunes and positive memories come flooding back to him.
Music therapy can involve exposure to familiar music to evoke powerful memories or patients creating their own music solo or as part of a group. However, for the therapy to be effective, the music must be customized to each patient.
Dementia can leave patients disconnected from themselves and from those they love. Art therapy for dementia patients can put them in touch with their creativity to encourage them to tell their stories and facilitate memory.
Programs, such as Bringing Art to Life through the University of Alabama, connect students trained in dementia care and creative arts with dementia patients to create a series of artworks collated in a leather-bound book centered around the life experiences of the patients. The program has been shown to foster interpersonal relationships and enhance long-term memory recall, the effects of which are suggested to slow the progression of the disease.
This program and many others are centered around more than just the fine arts, since crafting, cooking, and creative expression of all kinds are encouraged. The simple act of producing art allows patients to make meaning from the confusion in their minds and gives them the ability to control the world they are creating with their art.
Changes in mood and behavior can often lead dementia patients to shy away from social engagement, leaving them feeling lonely and isolated. Pet therapy allows them to interact with animals free from social judgment and pressure, and the result is calmer, more engaged patients.
Pet therapy not only brings joy to patients, but it can also increase their frequency of physical activity, provide emotional support, and an outlet for communication issues, and even restore a sense of purpose and order to their lives when caring for an animal.
Pet therapy should always be conducted by a trained professional to ensure the safety of both the patient and the animal, and for the therapy to be the most effective. Patients can interact with the animals in different ways according to their therapeutic needs, whether they want company for a walk or to simply cuddle and pet the animal.
Throughout their life, your patient had meaningful social connections with friends, family, colleagues, and others. It is essential they maintain these social interactions, even as the disease progresses — and even if they have trouble remembering the people they interact with.
Another important reason for encouraging social interaction is that loneliness has been linked with cognitive decline. Conversation, even the most basic of daily exchanges, stimulates the brain because your patients need to think of appropriate responses and reactions to the conversation.
Patients who are more social also tend to do more physical activities and have better nutrition than patients with little or no social contact. Socializing also fosters better communication, which is something many patients with dementia struggle with. As a caregiver, you can facilitate meaningful social interactions for your patients. Choose the best time and place for your patient. Organized social groups, such as bridge clubs, volunteering, or exercise classes, can be an excellent way for your patient to engage with familiar people regularly. Just ensure you monitor their comfort levels in whatever social situation they are in and keep an open line of clear communication between the two of you.
We all know regular exercise is essential throughout all stages of life. However, studies have shown that exercise can be especially beneficial for dementia patients.
Regular exercise improves the quality of life at all stages of the disease. Maintaining physical fitness allows patients to remain independent for longer, allowing them to perform daily tasks with more ease and leading to an improved emotional state. It also increases cardiovascular health, which improves blood flow to the brain, as well as skeletal and muscular strength that can reduce the risk of falls.
However, the benefits extend further than just the physical. Exercise gives patients the opportunity for social engagement, improving their self-esteem, and confidence. Physical activity can also improve cognition and slow down mental decline. This doesn’t mean your patient needs to hit the gym every day. Simple tasks like gardening, walking, and housework may be enough to get their heart pumping. Otherwise, local community centers are an excellent resource for gentle activities for seniors with dementia, such as swimming, indoor bowling, tai chi, and dance.
Before your patient starts any form of exercise, request permission from their doctor because some physical symptoms of dementia, as well as other health problems, may preclude your patient from rigorous activity.
Dementia patients always experience memory loss to varying extents, which significantly impacts their quality of life. However, studies indicate that reminiscing about past events can slow cognitive decline, improve mood, and stabilize general behavior. As a result, in the last 15 years, reminiscing therapy has become a popular intervention for patients with dementia.
You can introduce reminiscing therapy to your patient through visual stimulation, such as photographs, objects and books, or audio stimulation, like their favorite songs from their youth. Another more extreme method is total room transformations, as many nursing homes have implemented, for a more immersive experience in the patient’s past. Entire rooms are decorated and furnished as though they were straight out of an earlier era such as the 1950s, and this has a significant positive effect on patients’ sense of self, as well as their memory.
An area that many dementia patients and their caregivers tend to struggle with are mealtimes. Physical and cognitive changes can make choosing what to eat at meals overwhelming. Patients with cognitive impairment may also have trouble manipulating utensils to feed themselves, which can damage their self-confidence and lead them to avoid eating altogether or lash out behaviorally.
However, there are ways you can make the process easier for both yourself and your patient. Make mealtimes pleasant and calm, eat together to add a social element to the meal, and use gentle encouragement rather than forceful persuasion.
Take note of their favorite foods and try to combine them with more nutritious food sources. Often large portions can be difficult for patients to manage, so changing to smaller more frequent meals can ensure they are getting enough calories and nutrition throughout the day.
If they have a physical problem with managing utensils or chewing and swallowing, provide soft, small finger foods, purees they can sip through a straw, or utensils designed specifically for them. Studies suggest that reducing strict diets for dementia patients can have a positive effect on their overall wellbeing. While your primary focus should be on ensuring your patient consumes adequate nutrients, a bowl of ice cream now and then may improve their quality of life.
A Safe Living Space
As a caregiver, it is important you take a careful look at your patients’ living space to avoid any potential hazards and to make it easier for them to achieve everyday tasks as independently as possible. Simple items like floor rugs can become a falling hazard due to lack of mobility and reduced depth perception. Removing these items or securing them better can help reduce the likelihood of falls. Electrical devices and sharp objects also pose a hazard and should be moved to a more secure location in the room.
Ensure there are adequate lighting options and household assistance devices available as your patient becomes less mobile.
A Calm Environment
The agitation and irritable behaviors many people associate with dementia can often result from discomfort with their environment. What may seem normal to you or me can be frightening or confusing for a patient with dementia.
Pay attention to behavioral patterns to identify triggers and times of day your patient may find disconcerting, such as dusk. Items that make sudden noises, like doorbells and clock chimes, can be upsetting, so it may be a good idea to disable them. Reflections in mirrors and people on television can be mistaken for real people — which can cause problems if the figures are considered unfriendly by your patient. Cover mirrors and switch off the TV if you notice your patient becoming agitated. Arrange for calming activities such as reading together during the periods of agitation to help regulate mood and behavior.
Memory loss and impaired cognitive function can lead to some challenging behaviors from patients. Many researchers have suggested this can come from an inability to reconcile their current state with their previous sense of self. A failure to communicate their needs or a fear of judgment can further limit their quality of life, so it is essential caregivers use respectful communication strategies when looking after their patients.
Speak directly to your patient, ensure you address them by name to gain their attention, and never exclude them from conversations with others. Give them time to answer, as it can be difficult for them to find the right words to express what they need. Never discount their feelings or emotions as merely part of the disease. They deserve your attention and acknowledgment.
Humor is a great way to lighten the mood after an incident. It helps both patients and caregivers keep a positive outlook on life and helps to alleviate stress in most situations. Remember that communication is not just verbal. Facial expressions, gestures and body language all play an important role in communicating needs. Towards the later stages of the disease, your patient may progress to being non-verbal. This does not mean they have nothing to say, or they cannot be receptive to your attempts at communication. Just your presence, a calm tone of voice, or a gentle touch of the hand can be reassuring.
Though dementia is a debilitating disease, it does not mean your patient has lost all sense of self. Many patients who have dementia admit the condition can make things challenging, but they still find pleasure in the activities and interactions they used to enjoy and can find joy and hope regardless of their diagnosis. Maintaining a good quality of life is not only respectful to your patient as a person but can also be highly beneficial for slowing the effects of the disease.