Dementia Gateway: Keeping active and occupied

Activity resources and approaches

Key messages

A number of different approaches and resources offer helpful ways to develop meaningful activity and improve quality of life for people with dementia.
Simple assessment tools can help staff to understand the types of activities that might benefit a person with dementia.
Using dolls in dementia care is generally considered to be very helpful particularly for individuals in the later stages of dementia.

Simple assessment tools can help

Explore the links below now to explore a range of resources and approaches:

1. Introduction Open

A number of different approaches within dementia care offer helpful ways to develop meaningful activity and improve quality of life for people with dementia.

Some depend on using a particular practical resource, some emphasise skilful assessment before planning activities. Others promote a programme, philosophy or therapeutic intervention.

In this feature, we'll look at some examples of each.
2. Practical activity ideas and resources Open

If you are keen to provide more of a range of activities to people with dementia, find out what resources are out there to purchase, such as reminiscence books, games, quizzes,sensory items and so on.

Click here for a list of companies and organisations that produce catalogues of products and resources that could inspire you.

You might also be keen for a 'recipe book' style of activity book that guides you through specific activity ideas (see Reading and resources in this feature). However, remember that you don't necessarily have to spend a lot of money to find things which stimulate an activity. Some things – such as hats, kitchen equipment, old coins, postcards or old calendars with large photographs – can be found at home or purchased from charity shops.

The Best Friends approach was developed in the mid-1990s by Virginia Bell and David Troxel in the United States of America. Simply put, the model suggests that what a person with dementia needs most of all is a friend, a 'Best Friend'.

This can be a family member, friend or staff member who empathises with their situation, remains loving and positive and dedicated to helping the person feel safe, secure and valued. You can download two documents ('The best friends approach to activities' and 'Thirty more things to do in thirty seconds or less') that summarise the philosophy in relation to activities and offer practical ideas. Two books of activity ideas are available to buy (for more information, see www.bestfriendsapproach.com)

The Spark of Life Club is an approach developed in Australia which is designed to improve the social, emotional and spiritual wellbeing of people with dementia. Membership of the club gives access to a range of practical resources and publications.

The focus of the approach is on providing meaningful activities that don't have to be structured but do need to stimulate the senses, encourage participation, boost self-esteem and fulfil one or all of the five universal emotional needs. For more information, see www.dementiacareaustralia.com.
3. Assessment tools Open

Simple assessment tools can help staff to understand the types of activities that might benefit a person with dementia. Two of the best-known examples are the Pool Activity Level (PAL) Instrument and CLIPPER.

To be successful, an activity has to match the personal interests of an individual and be pitched at the 'just right' level of challenge: too easy and it may be boring, too difficult and it will be frustrating. The Pool Activity Level (PAL) Instrument is a set of tools for activity providers developed by Jackie Pool, an occupational therapist specialising in dementia care.

PAL asks users to develop a profile of a person's interests and likes and dislikes and complete a simple checklist that reveals the level of ability of an individual. This information can then be used by activity providers to plan how to present activities to the person at the 'just right' level (see www.jpa-dementia.co.uk).

Another popular tool is theCLIPPERassessment tool by Jennie Powell. CLIPPER stands for Cardiff Lifestyle Improvement Profile for People in Extended Residential Care. The CLIPPER considers 41 activities that could occur during a typical day. Caregivers note which activities occur, how often, and how the person seems to feel about each activity.

This provides a unique profile of an individual's likes and dislikes. A care plan can then be carefully tailored to create the best possible quality of life for each individual. CLIPPER is published within Jennie Powell's 2007 book, Care to communicate (see Reading and resources).
4. A programme approach Open

Cognitive Stimulation Therapy or CST involves 14 sessions of themed activities which run over a seven-week period. Sessions aim to actively stimulate and engage people with dementia, while providing a positive learning environment and the social benefits of a group. CST groups can be led by anyone working with people with dementia, such as care workers, occupational therapists or nurses, and can take place in settings including care homes, hospitals or day centres.

Practitioners can learn to provide CST treatment for people with dementia by following the CST manual by Spector et al (2006) or attending CST training (see www.cstdementia.com).
5. An emphasis on philosophy Open

The Eden Alternative philosophy is based on the belief that growing old is a natural part of life, not a period of decline. It teaches how to combat loneliness, helplessness and boredom: the three things that cause so much suffering for older people. Creating a positive, vibrant atmosphere where things are happening – for example, children from a local school are visiting, animals are being cared for by care home residents – helps to put meaning back into people's lives. It also allows care staff to be creative and enjoy their work more.

The three steps to introducing the philosophy into a care setting are vision, education and implementation. The Eden Alternative UK offers education, national and in-house training and supports staff teams to achieve these three steps (see www.eden-alternative.co.uk).
6. A therapeutic approach Open

While individuals may have different views on the use of dolls and children's toys with people with dementia, it is now widely recognised that dolls can offer a very powerful therapeutic benefit if used at the right time and in the right way.

Contact with a doll or a soft toy fulfils the human needs for comfort and attachment and provides a focus for the person to be able to nurture and protect something else. There are also many reported benefits of enhanced communication between a person with dementia and staff members through the introduction of a doll.

However, it is not uncommon to find relatives, other older people, managers and staff members resistant to the idea of using dolls, because they think it seems patronising or demeaning in some way for the person, or they are worried about outside visitors' reactions.

There are a number of articles and studies in this area which can be helpful if you are finding some resistance in your care setting. These can help you to explain the benefits and ensure that you are approaching the issue sensitively (see extra reading on this topic in the Dementia Links section).
7. Get to know NAPA Open

The National Association for Providers of Activities for Older People (NAPA) is a membership charity that promotes the importance of activity for all older people. It offers members regular bulletins full of practical activity ideas including quizzes, discussion topics and art activities.

Membership of NAPA also offers valuable discounts on activity products from some key catalogues. Getting involved with NAPA can offer anyone with an interest in improving activities the support, encouragement and training they need to keep going.

NAPA runs a NCFE distance learning course, Intermediate Certificate in Provision of Activities in a Care Setting, and also offers open and in-house courses on a range of topics, including massage and seated exercise. Other further education colleges also offer the NCFE course.

Visit www.napa-activities.co.uk or contact 020 7078 9375 for more information about becoming a member.

Over to you!

Click here to do a quick activity that will deepen your understanding of this topic. The activity can be done alone or with colleagues and you can also download a copy. Trainer's notes have also been provided.