Activity Engagement with person with dementia

1. Tele-Continuing Nurse Education
conducted by GeriCare
Topic: Activity Engagement with Persons with dementia
Date: 14 Oct 2019
Speaker: Ms Giang Thuy Anh
(Senior Occupational Therapist, KTPH)

2. Administrative
• Send your nursing home attendance and any feedback to:
– ktph.gericare@ktph.com.sg
– Attendance with SNB No. Within 1 week ( with staff designation and SNB no.)
• Next Tele-CNE Presentation will be:
– Topic: Approach to Shortness of Breath
– Target audience: NA, HCA, RN and EN
– 13 Jan (Mon) 2020 @ 2.00 – 3.00 pm
– By: Palliative Care Nurse (Khoo Teck Puat Hospital)

3. Activity Engagement with
Persons with Dementia
Giang Thuy Anh
Senior Occupational Therapist

4. Theories &
Activity Engagement in
KTPH
Enriched Model of Dementia | Psychological Needs | VIPS | Benefits of Activity
Engagement | Activity Engagement in KTPH

5. Enriched Model of Dementia
Dementia = NI+H+B+P+SP
‐ NI = Neurological impairment
‐ H = Health and physical well-being
‐ B = Biography – life history
‐ P = Personality
‐ SP = Social Psychology
(Kitwood, 1993)

6. Psychological Needs
Malignant Social
Psychology
Positive Person
Work
(Kitwood, 1993)

7. Brooker & Latham, 2016

8. VIPS
‐ V = Values the person and their families and carers
‐ I = Individual needs
‐ P = Perspective of the person with dementia
‐ S = Supportive social psychology

9. The Power of Meaningful Engagement
‐ Everyday activities that are meaningful, enjoyable and doable
‐ Leisure, Productive, Self-care

13. Horticulture Therapy (HT) – Evidence Review
‐ Psychological
‐ QoL and well-being
‐ Anxiety and depression
‐ Agitation
‐ Mood and engagement
‐ Social relations
‐ Physical and functional
‐ Psychological

14. Prototype Designs & Development

15. Mobile Horticulture Therapy

17. Group Horticulture Therapy

18. Principles & Tips on
Activity Engagement
Pool’s Activity Level | How to Run a Group | Communication Styles /
Environmental Setup

19. Pool’s Activity Level (PAL)
‐ Life History Profile
‐ PAL Checklist
‐ PAL Activity Profile
‐ Individual Action Plan

20. Life History
Profile

21. PAL Checklist

22. PAL Activity Profile &
Individual Action Plan

23. Purpose of PAL
‐ To integrate into day to day care
‐ Provide information on individual’s strengths and abilities
‐ Ensure activities are meaningful and appropriate
‐ Enable caregivers to engage PWDs in meaningful activities

24. Stages of PAL
Planned Exploratory Sensory Reflex

25. Can work towards goal directed activities with tangible result, but may not be able
to solve problems that arise in the process
To facilitate participation:
‐ Keep sentences short
‐ Be present to help solve problems
‐ Show how to avoid possible errors
‐ Encourage initiation of social contact
‐ Focus on activities that achieve tangible result
Planned Exploratory Sensory Reflex

26. Can carry out familiar activities in familiar environment, but is more
concerned with the experience than the end result
To facilitate participation:
‐ Need task to be broken down into smaller steps if it’s too complex
‐ Very simple instructions with visual cues
Planned Exploratory Sensory Reflex

27. Primarily concerned with experiencing the sensation of the activity and
moving their body in response to those sensations
To facilitate participation:
‐ Single step tasks
‐ Can still engage in more complex activity but requires step by step, one
on one
‐ Provide visual, verbal and physical cues
Planned Exploratory Sensory Reflex

28. Maybe unaware of surrounding environment or own body. Movement is sub-
conscious, reflex response to sensory stimulation
To facilitate participation:
‐ Need to use direct sensory stimulation
‐ Excessive or multiple stimuli might cause distress
‐ Language play a minor role, keep to one word instructions
‐ Use of body language (tone, facial expression, touch)
Planned Exploratory Sensory Reflex

29. Essentials in Conducting Group Therapy
Preparation Implementation Evaluation

30. Before Activity – 4S
Setting up
- Activity analysis
- Equipment
- Manpower
- Space

31. Before Activity – 4S
Say it, Show it
- Explain procedure
- Point and
demonstrate

32. Before Activity – 4S
Start
- Offer an invitation or request
help such as “Would you like
to help me to….”

33. During Activity - 12 Key Principles
1. Activity should have a sense of purpose
and capture interest
2. Invite the person to participate
3. Offer choice whenever possible
4. Talk less. Demonstrate more
5. Physical skills. Focus on what the person
can do
6. Match your speed to theirs. Slow down!
7. Use visual hints, cues or templates
8. Give the person something to hold
9. Go from simple to more complex
10. Break as task down into steps
11. To end, ask: ‘Did you enjoy doing it?’
‘Would you like to do it again?’
12. There is no right or wrong. Think
engagement!

34. After Activity - Evaluation
‐ Self
‐ Did you give client chance to do
more?
‐ Did you give client appropriate
instruction level?
‐ Client
‐ Was the selection of clients
appropriate for the session?
‐ Objective
‐ Was the objective appropriate to the
clientele group?
‐ Activity
‐ Did the activity meet the objective set?
‐ Was the activity appropriate for the
clients?
‐ Environment
‐ Was the environment conducive?
If not, why and how can it be better?

35. Outcome Measures
‐ Well Being Profile
‐ Menorah Park Engagement Scale
‐ Constructive Engagement – motor / verbal behaviour exhibited
‐ Passive Engagement – listening / looking behaviour exhibited
‐ Non Engagement – staring into space, eyes closed, sleeping
‐ Other Engagement – self-engage, engagement not related to task

36. Activity Tracking Sheet

37. Leisure Activities

38. Table-top Games/ Activities
Large- Print Scrabble
- Forming the most words in a crossword fashion
- For memory recall, letter recognition
Additional Ideas
- DIY Scrabble Pieces
- Forming short words if needed
Planned or Exploratory Level

39. Table-top Games/ Activities
Large-Piece Jigsaw
- Forming a picture with jigsaw pieces
- For problem solving, fine motor practice, visual
recognition
Additional Ideas
- Forming the border of the puzzle if needed
- Having pictures the person can relate with
- Tangram Puzzle Pieces
Planned or Exploratory Level

40. Table-top Games/ Activities
Playing Cards using a Card Holder
- For persons at a planned activity level, card
activities involving attention and problem solving
Additional Ideas
- Chinese Chess/Checkers
- Pick Up Sticks
- Five Stones
- Marbles
Planned or Exploratory Level

41. Table-top Games/ Activities
Large-Piece Dominos/ Mahjong
- Tile-based game for symbol recognition and
problem solving
Additional Ideas
- Playing in pairs
- Sharing reminiscences of playing dominoes/
Mahjong
Planned or Exploratory Level

42. Social Games Activities
Ring-Toss Set
Additional Ideas
- DIY ring-toss set with bottles/paper towel rolls
- Optional: Collecting points depending on where
the rings land
Planned, Exploratory or Sensory Level

43. Social Games Activities
Sing-Along Tape and Song Book
Additional Ideas
- Providing small musical instruments (e.g.
tambourine, drum, shakers)
- Varying the volume (loud/soft) and rhythm
(fast/slow)
- Requesting songs from persons
- Using a microphone for Karaoke
Planned, Exploratory or Sensory Level

44. Social Games Activities
Skittles/Bowling Set
Additional Ideas
- Forming teams
- Game variety:
- Bowling front pin first
- Using different pins out of household materials,
e.g. empty paper towel rolls, bottles, empty cans
Planned, Exploratory or Sensory Level

45. Social Games Activities
Bean Bag Target
Additional Ideas
- DIY with paper plates, hula hoops, cardboard box
- Include quiz questions after a bean bag is thrown
- Forming teams
Planned, Exploratory or Sensory Level

46. Art Activities
Persons at the Planned Level – Art Ideas
Still-Life Work
Self-Portrait
Drawing Past
Memories
Greeting CardsCreative Writing
Origami
Paper Fan

47. Art Activities
Persons at the Exploratory Level - Art Ideas
Simple Scenes
Chinese
Calligraphy
Painting to Music
Art Corner
String Painting

48. Art Activities
Persons at the Sensory Level - Art Ideas
Guided Coloring String Threading
Handprint Painting
Modelling Clay Craft

49. Sensory Activities
Relaxation Music CD
- Music can be an activity to initiate movement
or to relax.
- Music Ideas:
- Old Chinese/ Hokkien/ Malay Songs
- Christian Songs
- Classical Music
Sensory or Reflex Level

50. Sensory Activities
Colored Light Sphere
- Slow-moving light with different colors allows
person to focus attention, track movement
and relax
- Additional Ideas:
- Use of Relaxation Music CD
Sensory or Reflex Level

51. Sensory Activities
Scented Lotion
- Provides sensations including smell and
touch.
- Additional Ideas: Massage
Sensory or Reflex Level

52. Resources

53. Resources
https://www.youtube.com/wa
tch?v=fso9ovVW4zE
Click to dd text

57. Humanitude
Eldercare with Human Touch

60. Video
60
Gaze
Touch
Speech
Upright position

62. Thank You
giang.thuy.anh@ktph.com.sg