Activities for the Elderly
Volume 2
Sandra D. Parker
Carol Will
Idyll Arbor – Smashwords Edition
Idyll Arbor, Inc.
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Cover Design: Original Photography: Sarah Blaschko
Original Drawing: Linda Anderson
ISBN 9781611580013
Table of Contents
Activity Categories and Benefits
Matching Environments to Tools
Chapter 1: Introduction
Those of us who serve seniors have made great strides in caring for their bodies and the physical environment. We have rules and regulations that govern residential and long-term care facilities. We have established programs to help care for elders in their homes. We are gaining knowledge to help older people live longer, in better health and in more comfort through their declining years. Time has come to explore the quality of life in old age. With declining function (either physical or cognitive) many of our elderly question the purpose and meaning in their lives.
In ages past, most people who suffered acute illness or accidents died fairly quickly. Today we have conquered many of the acute illnesses and can often prevent death from accidents. This leaves us with a two-fold problem: 1)many victims of accidents are left with severe functional limitations, and 2)people who are older have more chronic conditions (both physical and cognitive) that limit their ability to participate in “normal” activities.
Activities are very important in maintaining quality of life which includes independence, enjoyment, physical, cognitive, and emotional fitness. In addition, participating in activities tends to give us the chance to engage in socialization and to help others. Preparing and presenting activities for elderly who are well or even many elderly who are ill is rewarding and usually straight forward. Those folks can tell us what interests them and what they are able to do. They enjoy sharing past experiences that help us to plan activities relating to their past and which are meaningful for them.
Activity planning becomes more difficult when the people with whom we are working are not able to communicate or participate in the usual activities. Yet, we recognize the importance of involving these people in activities. Organizations and agencies who regulate and monitor long-term care facilities also recognize the importance of meaningful activities in maintaining quality of life. There is increasing emphasis from survey teams concerning activities for the adults who are low-functioning—emphasis for activities that reflect life-long interests of the adults and on activities that will have meaning for them.
In conversations with activity staff, long-term care administrators and families, we found a hunger for information on activities for adults who are low functioning. A search for written resources of activities reveals few references specific to the topic. It is our hope that this book will fill that need.
This book is intended to help find interesting and meaningful activities for the adults who are low functioning whether they are in long-term care facilities or at home. It is our hope that the information we present will help not only activity directors, but other long-term care workers, volunteers and family members to provide a higher quality of life for the adults in their care.
Who Is “Low Functioning”?
In conversations with activity staff, each seems to have a slightly different definition of “low-functioning.” In the general older adult population functioning levels are described as follows:
1) High to Moderate Functioning—independent, able to do own personal care. This includes:
Activities of daily living—bathing, dressing, tolleting, transferring, controlling waste, and feeding self
Instrumental activities of daily living—able to use the telephone, shop, prepare meals, do housekeeping, do laundry, travel independently (either drive self or use public transportation), take own medications and handle finances.
Cognitive abilities—able to express values and goals, able to communicate and understand information, make decisions, understand actions taken, take care of personal property and assets, recognize and understand relationships with others, demonstrate emotional stability and show reasonable long and short term memory.
In general, these adults have adequate vision and hearing, minimal chronic disease and are active physically and socially.
2) Low functioning—those older adults who for any reason cannot completely care for themselves. Help in one or all of the above areas is required for survival.
When one considers the residents in long-term care facilities or those cared for in the home on a full time basis, they all could be considered “low-functioning” in terms of the general population. All need help to survive. Hence we need to define low-functioning as it applies in home care or long-term care situations.
Generally (in terms of activities) low-functioning would include those who are very limited physically or cognitively and are unlikely to improve. This would include those with dementia, with severe arthritis, with a stroke with extensive paralysis, with multiple amputations, or, in other words, those who require staff assistance for most or all activities of daily living. Those with highly impaired vision or hearing might also qualify if the losses are recent. Those with long-term losses have usually made adequate adjustments, hence their impairment does not normally interfere with functioning.
The most difficult limitation for most activity staff to deal with is cognitive impairment. Cognitive impairment may be due to Alzheimer’s or related disorders or to reversible conditions such as mental illness or depression. Many times these people appear normal physically, but are unable to function in normal activities because of limited understanding, inappropriate interactions with others, withdrawn behavior, or other cognitive reasons. They simply cannot or will not participate in normal activities.
Whatever the cause, planning and implementing activities for these adults is a challenge!
Memory
Research indicates that there are two main types of memories. Declarative memory stores facts while procedural memory enables us to learn and perform tasks and skills. Most of us use both types of memory at the same time. However, declarative (fact) memory can be affected by injury or disease while procedural (skills) memory still functions. This explains why a person with dementia might not remember his/her name, but will still be able to read signs—even if s/he does not understand what the sign says.
The cognitive activity involved in the process of storage and retrieval of information is extremely complex. Memories are stored in several places in the brain and the more that memory is used the stronger the storage network becomes. This is called long-term memory.
Short term memory is for new information. That information is stored in short term memory until we decide if it is important enough to store in long-term memory. When we are young we store many things in long-term memory. As we age, we become more selective—we only store things that are relevant and have meaning to us.
In dementia of the Alzheimer’s type, the brain cells that process and store short-term memory are slowly destroyed. The individual with dementia is unable to store new information. Old memories remain much longer. The more important those memories are, the longer they are remembered.
The resident with Alzheimer’s also has slower brain function. It is very important to give the person extra time to process what you have said before you expect a response. The resident may not recognize you even though you were just in the room or see him/her every day. His/her days are full of new experiences and people!
Before We Start
Childhood, youth, early adulthood, middle age, old age. All are important phases of our lives. Our families change as we age, as do our roles in life—child, sibling, spouse, parent, grandparent. As we near the end of life we look back at those roles with varying emotions. Memories of good times and bad times become important as we search for meaning in our lives.
The adult who is low functioning may lose recent memories and not be able to relate to recent roles, but may remember, and indeed seem to be living, in the past. For instance; the resident may not recognize a son or daughter as his/her child. The son or daughter may remind the resident of his/her brother or sister and s/he may call the children by the sibling’s name. By using activities that reflect the past, you are approaching the individual in his/her present.
The success of your activities will depend, to a certain extent, on conditions surrounding the individual’s formative years:
World, regional and local events
The area of the country where the individual grew up
The ethnic background of the family and neighborhood
Social standing of the family
Economic conditions of the region, neighborhood and family
Work ethic of the family and social group
Moral or religious values of the family and social group
Accepted recreational activities of the time
While it may be impossible to find specific information about the family, an understanding of the cultural values of the time, ethnic background, religious values, and recreational activities will help make your activities meaningful to the adult who is low functioning.
Some activities are appropriate for anyone within a certain age group or with similar backgrounds. For instance, sing-a-longs using songs from the twenties are appropriate for people who were young adults in the twenties. Watercolor classes may appeal to those with artistic interests. Travelogues are enjoyed by people who are curious about the sights and sounds of the world. Reading or writing groups appeal to the intellectually curious.
The activity professional knows the events and interests from each era represented by his or her residents. World events, music, entertainment or games, occupations, family roles, all make an impact—especially during teen and young adult years. By planning activities that represent those times, the activity professional appeals to the residents and indicates an interest in them (validates them) as important people.
Activity histories, taken for planning purposes, help to determine common interests of residents or patients receiving home care. When planning for adults who are low functioning, life and activity histories become even more important because the present often is painful or recent memory is impaired, making the past more real or meaningful. In long term care facilities activity histories must be part of the admission process. The same information can be helpful when planning for individuals at home.
First you need to find out all you can about the person, Age, place of birth, education, marital and family history, provide a basic view of the person. Life style history will further define the person. Occupation and hobbies, church and organizational affiliation, travel experience, etc. will give you guidelines for activities. You will want to know his/her normal schedule and activity participation (past and present). Was this person a participant or spectator? Leader or follower? Did s/he enjoy active or passive activities?