Because people with Alzheimer’s disease are a diverse group of individuals from different backgrounds and different lifestyles, activities need to be tailored accordingly. However, there are reasons why some activities may be better than others depending on which stage of Alzheimer’s the person is experiencing. A way of thinking about this is to consider a ‘reverse childhood’ model. Some academics have adapted the highly influential childhood development model put, forward by Jean Piaget (1896-1980), in order to illustrate the process of cognitive decline.
The progress of Alzheimer’s is often described in seven stages starting from no cognitive impairment, to early stage, early to middle, middle to late, and late (severe) stage. The term ‘cognitive’ refers to mental processes such as thinking, attention, perception, learning, memory, reasoning, problem solving, decision making, and planning.
In the early stages of the disease where there is little damage to cognitive processes most people with Alzheimer’s still enjoy goal-directed activities such as quizzes, crafts and hobbies. Reminiscence activities are good as they access well rehearsed memories.
The middle stages can be equated to the representational period of childhood. During this stage the person becomes more self-centered, or as Freud would say, “egocentric”. The person can find it difficult to relate to their loved ones and it can put a great deal of strain on their relationship. During this stage activities can be more effective on a one-on-one basis. Unfortunately this is often impractical in nursing homes and day care centers with restricted staff numbers. As brain damage takes its toll, reflective activities become more difficult and can cause considerable anxiety as the person struggles to use their failing memory.
Listening to music, walks, small participant gardening activities in which people with Alzheimer’s disease are encouraged to smell flowers and enjoy color, not only gives the day some structure but also helps validate people as individuals. It can give purpose to a day, help relax people and promote sleep.
Delusional thoughts are more common in the middle stages of Alzheimer’s. Delusions can seem as having a positive function in as much as they appear to help maintain a person’s feeling of self worth. However they can make activity very difficult. Delusions can lead to accusations of stealing and blaming others for their own mistakes. I have vivid memories of a patient who firmly believed she was the caregiver. This lead to periods of great confusion during group activities
Activities best suited to people with Alzheimer’s experiencing delusions are (one-on-one if possible) music, dance, drama and art. These types of activities use the freedom of expression that is part of this developmental stage in Piaget’s model.
Late-middle and late stage Alzheimer’s can be equated to the sensori-motor period of Piaget’s model of child development. Here it is the immediacy of the physical senses that are most prominent. During this stage of concrete thought processes, activities should concentrate on things such as ball games, massage, dolls and pets.
The late stage, the most advanced stage of Alzheimer’s disease, is called the reflex period. Stroking, rocking, singing and most importantly, smiling, should be involved in the activity, just as at the beginning of all our lives.
Effective communication is the key to all activities at all stages of Alzheimer’s. Two-way communication is vital to wellbeing and self-worth. Communication is a fundamental human need that never goes away and should never be under-estimated in terms of its value to Alzheimer’s patients.