the positive interactions program for people with alzheimer's disease (nissenboim excerpt)

Name /7890/fm 11/25/97 03:05PM Plate # 0 pg 5 # 3

v

SNL

7890 NISSENBOIM (HPP)

Contents

About the Authors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ixPreface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi

Overview of the Disease Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Stages 0.5–1: Questionable–Mild Cognitive Impairment. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Stage 2: Moderate Cognitive Impairment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Stage 3: Severe Cognitive Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Outline of the Positive Interactions Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

The Activities Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Activity Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Activities for People in CDR Stage 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Activities for People in CDR Stage 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Activities for People in CDR Stage 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Preparation of the Activity Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Implementation of the Activities Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Working with a Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Activities Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Your Approach to the Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Familiarizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Naming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Demonstrating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Encouraging and Rewarding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Guidelines for Clear Communicating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Dealing with Disruptive Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38


vi CONTENTS

SNL


The Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Creative Arts Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Baked Dough Art (Magnets, Beads, Garland) (CDR Stages 1 and 2) . . . . . . . . . . . 43Creative Drawing to Music (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Dried Flower Bookmarks (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Eggshell Mosaic (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Embossed Stationery (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Fabric Printing (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Leaf Prints (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49No-Bake Dough Art (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50Painting with Marbles (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51‘‘Stained Glass’’ Pictures 1 (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52‘‘Stained Glass’’ Pictures 2 (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53String Art (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54Vegetable Prints (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Wet Paper Watercolors (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56Woodworking (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Daily Living Skills Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Baking Cookies (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Brushing Hair (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60Brushing Teeth (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Caring for Pets (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Clipping Coupons (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Dressing (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64Dusting Furniture (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Enjoying the Mail (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66Food Preparation (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67Labeling Cabinets and Drawers (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . 68Laundry—Sorting (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Laundry—Folding (CDR Stages 1, 2, and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70Making Beds (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71Setting the Table (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72Showering (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Vacuuming (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74Washing/Drying Dishes (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Physical Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Ball Games/Balloon Games (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . 77Balloons/Punch Balls (CDR Stages 1, 2, and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Bean Bag Toss (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Bouncing Balls (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80Gardening (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81Kick Ball (CDR Stages 1, 2, and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Raking Leaves (CDR Stages 1, 2, and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83Squish Ball (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84Stretching and ‘‘Kvetching’’ (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . 85Sweeping Floors (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86Velcro Darts (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Walking (CDR Stages 1, 2, and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Walking a Par Course (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Watering Plants (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90


CONTENTS vii

SNL


Sensory Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Color Matching (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Colored Cubes—Creating Patterns (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . 92Colored Cubes with Patterns (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Comparing Different Balls (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Connect the Dots (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Familiar Sounds (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Family Photographs/Videotapes (CDR Stages 1, 2, and 3). . . . . . . . . . . . . . . . . . . . . . 97Find the Incorrect Shape (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98Finding Objects in Sand (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99Finger Paints in a Plastic Bag (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . .100Flavor Identification (CDR Stages 1, 2, and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101Fruits and Vegetables (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102Hand-Cut Puzzles (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103Hand–Eye Integration with Markers (CDR Stages 1, 2, and 3). . . . . . . . . . . . . . . . .104Hand–Eye Integration with Scissors (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . .105Height Discrimination (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106Identifying Objects by Touch (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . .107Identifying a Scent (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108Latching/Unlatching Locks (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . .109Listening to Music (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110Lotion and Massage (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111Matching Foods and Ingredients (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . .112Matching Jars and Lids (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113Matching Object to Outline (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . .114Matching Related Objects (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115Measurement—Rice and Jars (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . .116Modeling Clay (CDR Stages 1, 2, and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117Number Matching 1 (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118Number Matching 2 (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119Number Matching 3 (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120Nuts and Bolts (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121Object Matching (CDR Stages 1 and 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122Outlining Shapes (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123Pattern Matching (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124Peg Board (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125Petting Animals (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126Replicating Sounds (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127Shape Determination (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128Size Discrimination 1 (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129Size Discrimination 2 (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130Sound Discrimination (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131Tea Aromas (CDR Stages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132Tea Tasting (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133Texture Matching (CDR Stages 1, 2, and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134Topical Pictures (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135Zippers, Buttons, and Velcro (CDR Stages 1, 2, and 3) . . . . . . . . . . . . . . . . . . . . . . . .136

Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137


xi

SNL


Preface

The Positive Interactions Program was conceived in 1984 out of our interactions andfrustrations in working with older adults with cognitive impairment in adult day cen-ters. The catalyst was a client named Ruth. Ruth would sit at a table each morning,welcoming staff members and program participants as they entered the room. Al-though she was able to initiate this pleasant social interaction, she was unable toprocess the verbal information she received in return. Ruth was the first client in ouradult day program to be identified as having Alzheimer’s disease.

Before our encounter with Ruth, we simply did not have programs suited to theneeds of people with Alzheimer’s disease or a related dementing disorder; we did littlemore for our participants than to maintain them in as comforting an environment aspossible. Slowly, day center staff became aware of the growing number of incomingparticipants who, like Ruth, were in varying stages of dementia. This awareness of thelack of suitable caregiving tools justified a conscious shift in programming in order tobetter serve these participants.

Conventional programming in adult day settings incorporates various discussionsand verbally centered activities. Because verbal skills deteriorate early in people withdementia, this type of programming is far too complex and demanding. Our responsewas to develop a program that did not depend solely on an individual’s verbal skills.Through much trial and error, we identified four activity categories in which positiveinteractions can be achieved: creative arts activities, physical activities, daily livingskills activities, and sensory activities.

The Positive Interactions Program provides the person who is cognitively impairedwith opportunities to achieve success and to interact appropriately with other people.Success is not based on completing a task but on the positive dynamic created as aresult of participating in an activity. The by-products of this success are enjoyment,excitement, and feelings of self-worth. This structured, individualized program consistsof various activities in four categories that focus on providing these opportunities.Creative arts activities stimulate and reinforce experiences of generativity and ability.Activities of daily living, such as meal preparation, household chores, and personal


xii PREFACE

SNL


grooming, may still be familiar to the person with cognitive impairment and, throughthese activities, can be reinforced. Physical activities are both enjoyable and reduceagitation, and they are staples of any successful activities program for older peoplewith a dementing disorder. Sensory activities, which focus on sight, hearing, touch,taste, and smell, can stimulate experiences in a nonverbal mode. We have found thatthis program has not only positively affected people with cognitive impairment buthas indirectly benefitted people who are cognitively intact.

The Positive Interactions Program and this book of activities help professionalcaregivers—social workers, activities directors and staff, home health caregivers,nurses, nursing assistants, and volunteers in adult day programs—to recognize andcapitalize on the remaining abilities of their clients or residents. Also, because thisline of work requires an endless supply of compassion, enthusiasm, humor, and hopein the face of clients’ decline and deterioration, the many types of activities provideprofessionals with ways to avoid burnout and to take care of themselves, therebyfreeing them to provide older adults with high-quality care. Finally, the realization ofsome success and satisfaction in working within their remaining abilities may set offother positive occurrences in the midst of the escalating sense of impotence, anxiety,and confusion felt by people with dementia.

No less a focus of this book are the families of people with Alzheimer’s disease andother dementing illnesses, because they, too, struggle to find ways in which to partic-ipate positively in caregiving. They need help in restructuring the means available tointeract with their loved ones with dementia, so that it becomes supportive of andpositive for the loved one and themselves. Often, they look to the professional care-giver for this help. It is the responsibility of the professional reading and using thisbook to relay information such as that contained here that will assist the family infinding ways to interact positively with the person with dementia and to meet theircaregiving challenges.

. . .

As a final note, for the sake of clarity we have chosen to refer to the person withcognitive impairment as ‘‘he’’ or ‘‘him,’’ rather than to use unwieldy constructions orpejoratives such as ‘‘victim.’’

the positive interactions program for people with alzheimer's disease (nissenboim excerpt)

Documents