Meaningful Activity

EngagementFrances Campbell Advanced Recreation Officer frances.campbell@health.qld.gov.au

The Person

The Patient View

Recreation Role

n It’s not about treating boredom or keeping those living with dementia occupied but rather to identify how to increase feelings of well being by providing therapeutic intervention to motivate, include and reinforce a sense of self

n My diagnosis does not define me I am defined by my history my occupation and my culture

Be a part of the solution, NOT the problem.

n Individualising the approach to the needs of people living with dementia is person centred

n Focusing upon non pharmacological behavioural interventions before resorting to medications

n Appropriate environmental design within care facilities is relationship centred

n Developing strategies to minimise unnecessary cognitive and functional decline

(Reference: Dr Tom Kitwood)

Cognition components

Basic componentsn Orientation to time and placen Attention and engagement n Memory to recall past interests Higher componentsn Planning and organisation versus set up n Decision making/problem solvingn Insight /judgement, self awareness, reasoningn Mental flexibility/abstractionn Initiation

Cognition or something else

n Hearing n Visionn Communication n Premorbid cognition

What is BPSD ?

n The person doesn’t do what you want them to don The person does what you don’t want them to don The person evokes a response or feeling in you that

you don’t like

Wellbeing versus Ill-being

Signs of Wellbeing

n Communicates wishes/needs successfullyn Engaged with people, things and events around themn Sensitive to the emotional needs of othersn Positive mood shown in smiling, laughing

Signs of Ill-beingn Negative mood (shows upset in facial expression, posture and

sounds such a whimpering, calling out, screaming or crying)n Walks into other peoples‟ private space” or into unsafe areasn Grieving, sadn Listlessness, apathy n Withdrawaln Unable to enjoy thingsn Physical discomfort or painn Verbally refuses caren Suspicious of othersn Physically threatens others

Communication

It starts with gaining attention

We minimise distraction

We use short simple and direct

sentences

We ensure that our expression and

body language match

How to build rapport

Commence assessment of patients to address preferencesn Encourage to engage in occupation “The ordinary and

familiar things that people do every day”n Support the individuals participation in activities that are

meaningful to themn Provide behavior management strategies that support

the person living with dementia in the care setting n Reality orientation

q Do Not disagree or engage in debateq Use orientation to place and time when appropriate

Engage to empowerAsk them to have a conversation with you

Mary I’d really like to talk with you today. Would you mind if I sat down beside you ?

Guide the conversation onto specific topics and redirectconversation back to the topic when patient becomes distracted

Reassure them and help out when they get stuck or cannot find the word they want to use That’s ok Bob what else can you tell me about your life

Smile and act interested in whatever they are talking about even if you are not quite sure what they are trying to say

Thank them for talking with you

What to avoid during reminiscence

Do not quiz the person or ask lots of specific questions

I.e. Now who is this person I know you know. Who is it

Do not correct or say the opposite to something that was stated as a fact even if you know its wrong

No that's not Elvis that's Clark Gable remember he was an actor in your day

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Creative ways of making a connection with someone who has dementia

Dignity through comfort

n Aroma therapyn Sensory modulationn Routinen Environmental adaptation and modificationn Communication strategiesn Sleep hygiene

Comfort Treatment – Specific behavioursn Fidgeting

q Mats and boardsq Folding activity/tying bagsq Sensory approaches

n Verbal/physical aggressionq Acknowledgementq Eye contact and communication q De-escalation strategiesq Use of body languageq Reduce amount of staff involvedq Never personalise and remove self from situation.q DO NOT Keep trying

Case Study Oswald

n History: pt was born in South Africa and grew up in Cape town

n Patient is divorced from his wife and has two children and grandchildren living locally

n Daughter describes Pt as a very private person with some tendencies towards stubbornness and eccentricity.

n Pt admitted to hospital due to diabetes mismanagement

n Pt diagnosed with Vascular Dementia

Interests

n Pt likes to participate in conversations regarding current events and has been receiving the newspaper

n Pt likes to read and although we identified this early on he has not been observed to be independently reading books offered.

n Pt has refused to engage in any Art or Cognitive game groups and is adamant that they do not interest him.

n Pt likes to converse in Afrikaans n Pt has enjoyed the Music sessions offered on ward.

Behaviours of Concern

n Pt can escalate suddenly and we have observed that these behaviours are driven by his frustration at being kept in hospital.

n Exit seeks n Refuses medications n Isolates selfn Resistive to caresn Nurses report he is bored

Meeting needs

n Pt responds well to strategies to initiate and complete tasks

n His change of tone and raised volume is an indicator that his tolerance has been reached and it is best to exit and return sometime later to facilitate task

n Engaging patient in autonomous medication management

n 1.1 activity engagement (Walking outside,coffee outings)

Cognitive challenges

n Pt has no insight and believes that he is well enough to return home to live independently.

n Reassurance at these times seems to settle him and usually he returns to his room to lie on his bed as a self soothing technique

Behaviours of Concern in the Relationship

n Pt become a prolific writer of letters addressed to the superintendent (NUM) to seek his release from the secure unit Staff believed that the title of superintendentreflected that he had spent time in prison

Relationship Building

n Collaboration with an OT from South Africa reported that in his organisation the superintendent would be equal to our CEO

n Pts primary language is Afrikaans and was able to converse with OT in his own language

n Pt expressed his longing for some South African foodn He attended university and obtained a Degree in

Engineering

Activities

Documentation

n Use language that describes behaviour not words like “aggressive, refuses medication, vocaliser, wanderer, or obstructive

n Give an account of the contextn Remember punitive behaviour/language is not person

centred and will be met with resistance

Environmental changes and Features

Questions