Improve the patient’s quality of life

Often, we are so busy coping with what the dementia patient has lost (memories, abilities), that we forget that there are still many things persons with dementia can do. They still remember some things, they can enjoy company, and do simple things. It is possible for them to lead a satisfying life where they feel competent enough for what they are doing, and enjoy the people and things around them.

With the patients happier and better adjusted to their surroundings, the caregivers can also relax and enjoy the company of the patient.

On this page:

• Helping the dementia patient feel safe and comfortable for normal activities
• Providing a relaxed environment and emotional support
• Activities that are meaningful for dementia patients
• Activities for having “fun times” with dementia patients
• Time patients can spend with the family, talking and reminiscencing

Helping the dementia patient feel safe and comfortable for normal activities

If we remain alert about the patient’s abilities,  we can adapt the home and adjust the daily routine of the patient so that the patient is comfortable and safe. We can change our way of interacting with the patient so that the patient does not feel frustrated because of the growing dementia problems.

Essentially, our aim is to make the patient feel oriented in terms of time and space (by using various reality orientation techniques) and also ensure that the patient’s day has enough structure to seem predictable to the patient. Assistance for all activities must be at a level where the patient gets a sense of accomplishment and independence but does not get frustrated, and is not at risk. (see also: Adapt the home for dementia patients and Helping with activities of daily living)

Tools to do these have been discussed on other pages in this section.

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Providing a relaxed environment and emotional support

What constitutes a relaxed environment for a patient would depend on the patient’s personality, likes, and dislikes. Here are some things to consider:

• Lighting incenses / aromatherapy
• Instrumental music
• Bhajans
• A small altar for worship
• Having a small garden or a set of potted plants with flowers or tulsi or any other plant the patient likes

Some persons may be fond of pets, and may respond well to pet therapy. Some proponents of pet therapy (also called animal-assisted therapy) say that the unconditional love a pet gives can be very soothing and fulfilling for a dementia patient. Pets are not as common in India as it is in other countries, and many Indians have never owned pets; again, the suitability of using pets to make patients feel happy would depend on the patient.

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Activities that are meaningful for dementia patients

Most people want to feel useful and creative. Before they were struck by dementia, they may have led useful, active lives, and their current problem may make them feel useless and worthless.

It may be possible to find activities that the patients can still help in, or at least activities that make them feel they are being useful. The activities can be chosen depending on the state of their dementia. For example,

• spreading clothes to dry, or picking them up and folding them
• removing stones from daal/ rice
• shelling peas, destringing beans
• making rangoli
• helping in the garden
• placing flowers in the vases
• rolling out dough for gujjiyas
• sharpening pencils, stacking newspapers
• filing newspaper cuttings
• helping children with their craft projects
• dusting
• explain a recipe to a grandchild
• walking a pet
• giving clothes to the dhobi/ taking them back
• filling filter water in bottles
• re-arrange photos in photo albums

One important thing to remember while chosing a meaningful activity is that it should be an activity the patient will feel good about doing. A patient who has been fond of cooking and proud of doing housework will be happy if asked to shell peas or roll out dough for gujjiyas; someone who always disliked cooking and considered it a chore may not. Persons who have always used servants for housework may feel insulted and demeaned if asked to do housework, such as fold clothes or remove stones from daal.

We must also remember that the patients will make mistakes. Or they may lose interest midway of a task, or be very slow. Caregivers should not push them to complete the task or expect them to do it faster and perfectly. The purpose of these activities is that the patient feels useful and engaged with normal life.

It is also important to include some activities that involve exercise, such as walking or yoga. Besides the health benefits, they are known to reduce chances of frustration and aggression because of the sense of well-being they provide.

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Activities for “fun times” with dementia patients

Activity room at Nightingales Centre for Ageing and Alzheimer’s, Bangalore

Just because someone has dementia does not mean the person can’t have fun! Creative activities, social outings, games–all provide great occasions for the patient to feel happy and fulfilled, if they are chosen with care. While choosing an activity, make sure it is something the patient likes, and that the skill needed fits the patient’s current abilities.

Patients often enjoy playing games and painting and other such activities, especially if they have company, such as grandchildren or other family members. There should be no pressure on them to be perfect; mistakes should be accepted and there should be no attempt to “correct” the patient, and no insisting that the patient remembers a complex set of rules. The idea is having fun.

Here are some activities to consider:

• Painting
• Using crayons
• Playing board games like Ludo and Snakes and Ladders
• Simple games like stacking coloured rings
• Antakshari

Even with dementia, a person can enjoy an outing if it has been planned well. Patients may still enjoy meeting other people and talking to them, or seeing new places, but may not be able to handle too much of it. It is a tricky balance. We should choose times and places that would be interesting for the patient but not make him/ her feel crowded in or inadequate. Some patients may no longer want to eat food served in a restaurant, or use unknown cutlery. Patients are also likely to tire easily, and get disoriented, so outings have to be shorter, and we have to be ready for the patient suddenly wanting to return home.

Visitors at home can also be a welcome change for a patient, but only if the visitors understand the patient’s condition and know how to handle it. In India, where dementia awareness is low, visitors may not understand that the patient is facing a genuine problem and may start lecturing the patient about using “will power” or say things like “you must do crosswords to improve your memory” or “you should not take so much help from your daughter-in-law; you should do your own work.” Such visitors may end up stressing the patient instead of providing company and fulfillment.

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Time patients can spend with the family, talking and reminiscencing

Often, busy with caregiving, we forget to spend relaxed time with the patients. Yet, if we are able to set aside our need for being correct and our tension about the patient’s dementia, it is possible for the family to spend time together in a relaxed way, just talking or sharing memories.

Dementia patients have gaps in their memories, but they do remember some things. In a relaxed setting, when they start recollecting things, they are often able to remember more things of the past.

Pleasant memories of the past may be easier to trigger by using music popular in the older days, childhood jingles and poems, bhajans, lullabies, and stories that often told to children. Smells of spices or the aroma of favorite foods can also help. Family members can exchange notes on what sort of pleasant memory triggers are effective for the patient, and use these.

Some ways the family can spend time together:

• Listening to old music and talking about favorite songs
• Watching old movies together
• Seeing family albums, or re-arranging photos in them
• Just sharing anecdotes from the past

Again, the focus of these is to relax together, not to be accurate and complete in the memories. If the patient starts talking of things that did not happen, this is not the time to correct the patient. This is the time to listen and try to understand the patient’s reality, while also remembering that the patient may say something totally different the very next day.

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See also….

Caregiver resources in India and Other dementia/ caregiving resources: Many of these sites contain suggestions on quality of life for patients. The following is particularly helpful:

• Meaningful activities

A very valuable resource that illustrates how patients’ quality of life can be improved is found in the photo-exhibitions of Cathy Greenblat, that illustrate how, with quality health care, patients can sustain connections to others and to their own past lives. Cathy Greenblat’s site is here and more on her project, “Love, Loss and Laughter: Seeing Alzheimer’s Differently” can be checked here and here.

Some relevant searches on this site: pet therapy, reminiscence therapy