Cognitive Interventions
Cognitive interventions must be blended with a perspective allows us to understand a person not only as someone who suffers from illness or unhealthy conditions, but also as someone who inhabits healthy parts and personality that remains even though it seems to be hidden by illness . For staff and families, engaging the person behind the impairment will allow everyone to feel good about participating with the residents in the activity experience.
Alternatives for Cognitive Intervention:
A therapeutic, multi-faceted interdisciplinary approach to activities, social and leisure programming provides specialized stimulation to create structure and support in meeting the physical, psychosocial, cognitive and spiritual needs of each participant. This is especially important for people who are confined in a locked unit and unable to freely experience the outside world where most of the rest of us readily access a wide array of activities and stimulation during the course of our everyday lives. The best practices components listed below allows providers to focus on residents' wellness and their holistic needs, rather than the losses the disease causes. The following research-based programming should then be scheduled to align therapeutic activities with common dementia behaviors as they typically occur during the day. This provides stimulation within each resident's capabilities that is failure-free and success oriented, at specific times when they are most likely to respond favourably.
Failure-Free - Activities that encourage participation at any functioning level, from low functioning to high functioning while still building self esteem of the participants. Participants are not at risk in these activities of being singled out or embarrassed. (Recommended frequency = Daily).
Exercise - Seniors with dementia tend to be less careful ambulating than their non-demented counterparts who are constantly aware of and fear the consequences of a fall. Unfortunately seniors suffering from dementia are at a significantly higher risk for falling than the general elderly population. Morning exercises and physical activities at least every two hours throughout the day keep joints limber and reduce the frequency of devastating falls. Elderly people need to support their own weight and/or walk at least every two hours. This helps them to maintain body strength and muscle mass while improving their coordination, circulation and avoid pressure sores. Elderly can also experience dizziness when standing up. This is caused by blood pooling in their lower extremities (orthostatic hypotension). It is vital to let them stabilize on their feet for a minute after they have been sitting, or lying for an extended period to prevent dizziness and a potential fall. (Recommended frequency = Daily).
Grooming - Residents who are well groomed feel better about appearing in public than those who do not dress appropriately and groom for their day. People with dementia are at risk of remaining in their rooms in bedclothes without grooming are more at risk for isolation and vulnerable to depression. (Recommended frequency = Daily).
Current Events - It is important to provide residents a window on the world and keep them informed regarding top stories in the news. This connects them to important events outside their senior living community and stimulates them to maintain cognition. (Recommended frequency = Daily).
Reminiscence - This is the act or process of recollecting past experiences or events. Programs such as trivia, finish the phrase, memories that relate to holidays or the current month, or taking them back to "the Good old days" can help to connect them to their past and ease the fears they experience daily in failing to remember people, places and things. (Recommended frequency = Daily).
Long-Term Memory - These are memories that many people hold onto until late in their disease progression. These are activities that encourage working with familiar life-long tasks of everyday living such as sorting laundry, setting a table, winding yarn, reminding them what they did in their life, by cueing and using memory stations, and encouraging interaction with these familiar items. Programs that cue residents to access their long-term memories can highlight to them what they can still do which builds self-esteem and confidence. (Recommended frequency = Daily).
Short-Term Memory - These are memories in the immediate past present of days or weeks. Normally the first symptom noticed by families. Programs that offer structure, a calendar or written daily agenda, note cards to refer to. Using familiar photos, family albums, pictures of favorite foods or activities recently completed can help build confidence and reduce fear and anxiety. (Recommended frequency = Daily).
Cognitive Stimulation - This is the intervention that offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory, normally in a small social group setting. It is aimed at general enhancement of cognitive and social functioning. These activities include word games, puzzles, music and practical activities like baking or indoor gardening. All activities were designed to stimulate thinking and memory. Improvements for participants following cognitive stimulation show a much higher functional status. (Recommended frequency = Daily).
Psychosocial - Synaptic reserve, neuroplasticity, and perhaps other factors such as neurotransmission, and neurogenesis may be impacted by lifetime intellectual achievement. The relationship of leisure activities or other forms of intellectual stimulation such as social interactions to diminished risk for dementia suggests several mechanisms including stress reduction and overall cognitive stimulation are at play. Offering stimulation that reaches back to life-long love and work for others, helps to reflect on the past and validate the present. Creating activities surrounding lifetime accomplishments, travel destinations and other bucket list accomplishments gives a sense of life purpose to participants. (Recommended frequency = Weekly).
Eye-Hand Coordination - Exercising the participant's creativity and fine motor skills can help build a sense of accomplishment. The more you build upon remaining abilities the higher the quality of life they will enjoy. (Recommended frequency = Weekly).
Socialization - Humans are social creatures, but as people begin to lose their memory and become aware of their losses, they tend to seek isolation to avoid embarrassment and confrontation. Programs designed to be delivered in small groups will enable each participant to offer what they can without being singled-out. Programs such as a group exercise activity (parachute) or finish the phrase or wheel of fortune all offer a venue for socialization with other residents while allowing them to express themselves within their individual comfort zone. (Recommended frequency = Daily).
Arts and Crafts - These activities can build self confidence and offer a sense of accomplishment. Creating a door hanger or artwork each month is fun and helps to build self-confidence. Higher functioning residents who help lower functioning residents with their art projects feel a sense of pride and contribution. Assisting others helps to overcome their own insecurities. Art therapy also helps to restore brain synapses through eye-hand coordination. (Recommended frequency = Weekly).
Multimedia Interaction - Researchers surveyed people with dementia and reported that travel and engaging with nature and science were most important to them in terms of their quality of life. Surveying families can help identify life-long interests such as travel, nature, sports, ancient history, oceans, cooking or science. PBS or Nature series programs available to download from the internet and a great commercial-free way for people to access this. Programming exposure to these themes helps participants remain connected with their passions. (Recommended frequency = Daily).
Sing-a-long - Many people with long-term memory remaining will respond well to sing-a-long programs and music therapy where they can participate at will and often surprise themselves with how well they remember popular songs of their younger days. Music bingo, holiday sing-a-longs and other singing games offer a great social and confidence building venue to residents to access past fond memories. (Recommended frequency = Weekly).
Spiritual and Religious - Remaining active spiritually is very important for elderly people who tend to become more religious later in life. A balanced program which offers interdenominational services or even religion specific services can help residents remain connected with their faith. At the heart of our being exists a core set of virtues – gifts that represent the essence of the human spirit and the content of our character. These gifts are universal, not defined or limited by gender, nation, race or religion. They are inherent in the human experience. Research shows that seniors need to keep in touch with their spiritual self to live life fully. Living virtues provide empowering strategies that inspire the practice of virtues in everyday life through simplicity which support our residents to cultivate their virtues – the gifts of character. (Recommended frequency = Weekly).
Low-Functioning - Sensory stimulation is needed for even the lowest functioning participants to offer distraction and engagement. Programs that offer simple exposure to stimulate participant's sense of touch, taste, smell, site and hearing can provide engagement and reach into the spirit of someone who may be otherwise catatonic. In many cases it is impossible to tell if a participant is responding mentally to these stimuli, but research has shown that many people with advanced dementia are engaged by sensory stimulation even though they may be unable to physically respond to it. Bubble painting, name that smell, feels like, sounds like, tastes like, or edible art like Hello with Jell-o can all bring stimulation and quality to life. (Recommended frequency = Daily).
Sequencing - Sequencing and muscle memory are among the last cognitive skills to erode for a dementia patient. Sorting silverware, folding napkins, word-find, or playing with musical instruments can restore confidence that participants can still access those skills and be successful in manipulating their form and function. (Recommended frequency = Weekly).
Non-verbal Communication - much of what we perceive about each other is not what is said by how it is communicated. Activities designed to have fun with non-verbal cues can offer both verbal and non-verbal participants a fun and engaging experience. Introduce the topic by talking about body language. Define it for them if needed. Tell the residents that you are going to communicate non-verbally with your face and body and ask them to guess your mood. Use Happy (smiling and joyful) Sad (mouth turned down and sorrowful) Afraid, amorous, hurt, and yes confused! Have fun with it and ask the residents to show you how they look for each of these emotions. (Recommended frequency = Daily).
Behavior Modification - Many residents with dementia also experience anxiety disorder. This is typically manifested in the afternoons and often referred to as "sundowning." Physicians normally treat this disorder with medications from the Benzodiazapine family. For many residents, these medications, while effective, can leave patients depressed, dispirited and even catatonic. There has been ample research with essential oils and auditory artifacts that have offered evidence to moderate behaviors without chemical intervention. Aromatherapy is the art of using essential oils to benefit ones physical, spiritual and psychological well-being. Aromatherapy can provide sensory stimulation or relaxation, increase self-esteem, and work against a sense of self-isolation. It can provide opportunities to communicate non-verbally, and enhance reminiscence, memory retrieval, and mood stabilization. Binural beats or delta tones are very low frequency auditory processing artifacts, or apparent sounds, the perception of which arises in the brain for specific physical stimuli. Delta tones have been used extensively with people who suffer from insomnia to induce relaxation, meditation, creativity and dissimulate the brain activity. Binural beats reportedly influence the brain in more subtle ways through the entertainment of brain waves and have been claimed to reduce anxiety and provide other health benefits such as control over pain. (Recommended frequency = Daily).
Other therapies - Horticultural therapy is an interaction between people and plants. This process has a powerful benefit that gives someone receiving care the opportunity to become a caregiver themselves, as they nurture their plantings. The benefits to a dementia population are many. Not only the physical benefits of utilizing fine and gross motor skills, but also the emotional benefits of working with plants include the sensory and mental stimulation, decreased anxiety, and improved orientation to reality with the stimulation of long-term memories. Pet therapy is another way seniors can stay connected to their past and is for many an opportunity to be the caregiver that is calming to both resident and pet alike. (Recommended frequency = Monthly).
Saint Louis University Mental Status Examination (SLUMS) - a method of screening for Alzheimer's and other kinds of dementia. It was designed as an alternative screening test to the widely used Mini-Mental State Examination (MMSE). The idea was that the MMSE is not as effective at identifying people with very early Alzheimer's symptoms. Sometimes referred to as Mild Cognitive Impairment (MCI) or mild neurocognitive disorder (MNCD), these symptoms occur as people progress from normal aging to early Alzheimer's.
Conduct your own assessment:http://www.memorylosstest.com/dl/slums-english.pdf
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