4.0 purposeful and meaningful engagement

Participant manual

4.0 Purposeful and meaningful engagementThis module explores the importance of keeping engaged in meaningful activity for a person with dementia.

Learning outcomes• Recognise the value of meaningful and purposeful engagement• Understand that activity is everything we do, all day and

includes activities of daily living (ADLs)• Identify ways of adapting activities to meet individual needs

Dementia EssentialsCHCAGE005 Provide support to people living with dementia

Module 4

IntroductionThis is a Dementia Training Australia (DTA) course, funded by the Australian Government and delivered by Dementia Australia.

DTA is a consortium led by the University of Wollongong and consisting of Dementia Australia, La Trobe University, Queensland University of Technology, and the University of Western Australia.

DTA is delivering a coordinated national approach to dementia training for individuals and organisations, with the ultimate goal of improving the care and wellbeing of people with dementia by upskilling the workforce.

For more information about DTA please visit dta.com.au

This course has been designed to provide the essential background knowledge needed to work more effectively as a support provider for people with dementia. It is an accredited course intended for delivery to staff in the aged care industry, rather than family carers. The underlying approach is from the perspective of someone employed to provide support in a professional setting. Examples and case studies used throughout reflect this focus.

Dementia Essentials delivers the national unit of competency, CHCAGE005 Provide support to people living with dementia, which is a core unit in CHC43015 Certificate IV Ageing Support.

AcknowledgementsDementia Training Australia is supported by funding from the Australian Government under the Dementia and Aged Care Services Fund.

4 Dementia Essentials

PRE-CLASS ACTIVITIES

Activity Completed

Design an engagement plan for the person with dementia

Watch video: Ageless friendships

Write your reflections on the discussion board in Communities of Practice (CoP)

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PERSON-CENTRED PURPOSEFUL & MEANINGFUL ENGAGEMENT PLANEngagement in activities that are purposeful has many benefits. It encourages us to feel good about ourselves, brings meaning to our lives, helps us to feel a sense of belonging, provides opportunities for using our skills and generally supports our wellbeing.

The benefits of purposeful engagement do not change with a diagnosis of dementia.

Developing personalised activities that use the person’s strengths can help them maintain skills and independence. Their self-esteem and wellbeing is supported when they engage in activities where they are likely to succeed.

To support engagement, it is important to know the person behind the dementia. This is what person-centred care is all about and requires knowledge about a person’s life story and what strengths and interests they have to create activities that are purposeful to them.

Engagement in purposeful and meaningful activities is an important factor to the provision of care. Engagement is directly related to Aged Care Quality Standards: Standard 4 Services and supports for daily living to optimise the person’s independence, health, wellbeing and quality of life. Reflect on the person you completed the Sunflower activity with in Module 3.0 Communication and complete the Engagement Plan for this individual.

1. List some possible engagement ideas and activities for each domain of wellbeing

2. List the person’s existing strengths and interests

This activity will be explored further in the classroom.


Engagement Plan

Domain of Wellbeing

What NEW activity do you suggest to improve their quality of life?

Person’s existing strengths and interests

Physical Example: Bar exercises – individual or group

Example:Good balanceCan copy instructions if someone demonstratesEnjoys movementEnjoys the company of othersCognitive

Cognitive

Social

Cultural

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Domain of Wellbeing

What NEW activity do you suggest to improve their quality of life?

Person’s existing strengths and interests

Spiritual

Sensory

Watch:video ABC Ageless Friendships 2019, Aged care home shares grounds with school to build intergenerational connections https://www.youtube.com/watch?v=l13qkC3vpHY

Write:your response to the reflection question on the discussion board in Communities of Practice (CoP).

Reflection question: The video highlighted the building of genuine connections through frequent and spontaneous interactions, as well as engagement in activities. Reflect on your work practice, what can you improve to enhance the self-esteem, pleasure in life and minimise boredom for a person with dementia?


KEY MESSAGESWellbeingWellbeing is enhanced by:

• Mobility and exercise

• Using remaining strengths and abilities

• Activity, in a way, and at a time that makes sense to the person with dementia

• Supporting independence

When supporting a person with dementia it is important to promote the maintenance of their physical and cognitive wellbeing, in turn delaying the loss of physical and cognitive skills. You should also promote independence and autonomy where possible.

Risk enablement – is based on the idea that the process of measuring risk involves balancing the positive benefits from taking risks against the negative effects of attempting to avoid risk altogether.

For example, the risk of getting lost if a person with dementia goes out unaccompanied needs to be set against the possible risks of boredom and frustration from being locked inside their home.

Person-centred – is an approach to risk and dementia which concentrates on identifying risky situations for the individual, rather than viewing the person as being at risk.

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ACTIVITY

ACTIVITY

What different types of activity do you do throughout the week?

What portion of your day would be allocated to these different types of activites?

It’s important to remember that a person’s life is individual and therefore, so are their experiences. Below are images of people from various backgrounds engaged in activities.


KEY MESSAGESSuccessful activities• Know the person’s story

• Use old skills

• Focus on the person’s strengths

• Routine – helps to reduce anxiety and stress

• Break tasks into small steps, one at a time

• Work together

• Adapt to current ability

Successful activitiesTo be successful, it is best if the activity appeals to both the caregiver and the person; with both parties actively participating. Activities should be individualised, meaningful and voluntary. They should stimulate the five senses and intergenerational activities are especially desirable.

When planning activities, it is important to know the person’s life story as well as their interests, skills and hobbies. You should not assume that they will always want to continue a skill which may have been a necessity in the past; such as knitting or cooking.

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KEY MESSAGESDomains of wellbeingCognitive: activities that engage maintained abilities in thinking, problem solving, planning, memory.

Physical: activities that engage and stimulate physical abilities.

Spiritual/Cultural: activities which engage the person through meaningful spiritual or cultural connections.

Sensory: activities which involve the use of the senses (sight, taste, touch, hearing, smell).

Emotional: activities that tap into emotions, happiness, memories, love, and reminiscence.

Social: activities that make the person feel as they belong, promote relationships and connections with others.

It is helpful to plan activities that support various domains of wellbeing. Some examples of suitable activities include:

• Cognitive – word games, reading, newspaper

• Physical – gardening, exercises, walking, sweeping, folding, house hold chores

• Spiritual/Cultural – celebration of special occasions, food, rituals, church, customs

• Sensory – music, massage

• Emotional – reminiscence, movies

• Social – clubs, lunches, games, groups

Domains of wellbeing


KEY MESSAGESChange that impacts the ability to engageA person with dementia may have difficulty engaging in activities. This can be caused by a lack of motivation to begin the activity, they could become easily distracted during, or they may no longer have the ability to retain information.

You should also consider other limitations such as their inability to engage and communicate with others, they may be experiencing disorientation, or they may not be able to recognise objects and people.

You should ensure the tasks you have set for the person are achievable and are not too overwhelming. Keep activities simple, repetitious and work with the person to achieve mutual goals.

Possible strategies to overcome these obstacles include:

• Accept the level of passive participation

• Include the person in more animated groups

• Try simple games and activities to music

• Use appropriate communication skills

• Try opening and closing rituals for activities

• Include walks and outdoor activities

• Tap into long term memory

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List other ideas for activities that connect with each domain.

Cognitive:

Physical:

Spiritual/cultural:

Sensory:

Emotional:

Social:

ACTIVITY Further activity ideas


Using the levels of engagement, choose an activity from ‘Further activity ideas’ and provide examples of how people with dementia can participate in this activity at all levels.

I can plan, initiate and complete all aspects

I can do it all if someone sets it up

I can do some part of it

I can watch and monitor

I can talk about it

I can critique

I can watch and be

ACTIVITY Levels of engagement

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KEY MESSAGESWhen dementia has progressed Eventually, with the progression of dementia, a person will require total care.

Connection with the person is still essential and activities may include:

• Talking with the person – this may provide comfort and reassurance. When providing direct care to a person we should also explain what we are about to do in a gentle manner.

• Gentle touch – simply sitting and holding a person’s hand can be reassuring.

• Hand or foot massage – a massage of the hands or feet may bring pleasure.

• Aromatherapy – the burning of essential oils may create a pleasant atmosphere. Oils can also be blended with a carrier cream and used when offering a massage.

• Playing favourite music.

• Spiritual support – continuation of familiar rituals may give comfort.

Other tools to support your connection and interaction with a person with advance dementia:

Tactile – sensory blankets and a variety of materials such as velvet, fur, or satin.

Music – rhythmic activities such as poems, rhymes, proverbs, or prayers.

Sensory – gentle breeze, sunlight, gardens and sounds such as birds chirping or children’s laughter.

Touch – where appropriate and has a positive reaction

Sights – a baby in a pram, a cat on a driveway sleeping, Autumn trees, spring flowers, or water running.


KEY MESSAGESCreating the right environmentImportant things to consider when planning activities for a person with dementia:

• Consider your existing skills during planning and delivery

• Create a safe and consistent atmosphere for the person

• Choose the right times of the day to undertake the activity

• Draw on the persons past experiences

• Be flexible in your planning and adapt the activity where required

Engaging with Activities of Daily LivingWhen engaging with ADLs it is important to focus on the individual and build trust. It is best to use exploratory questions and avoid asking “why”, which could challenge the person and cause a negative reaction.

Remember to always promote engagement, enjoyment and encourage the person to participate in ADLs. During the completion of ADLs you could also consider using cues to reminisce with the person.

By following these key steps, you will be assisting the person to maintain and possibly maximise their cognitive skills.

As a person’s dementia progresses, you may need to adapt your communication strategies, to align with the current abilities of the person.

In can be helpful to formulate strategies and share what works with other members in the care team and family.

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GlossaryThe following resources were used in generating this glossary: At your fingertips - Dementia Alzheimer’s and other dementias, H. Cayton, Dr. N. Graham, Dr. J. Warner; The Australian Oxford Paperback Dictionary, F. Ludowyk, B. Moore

Acetylcholine

Agnosia

Apraxia

Aphasia

AIDS

Alzheimer’s disease

Amyloid

Anticholinesterase drugs

Antioxidants

Antipsychotic drugs

Aricept

Blood pressure

Brain scan

Bradykinesia

Cerebral cortex

Cholesterol

Cholinergic

Cholinesterase inhibitor

Chromosomes

One of a group of chemicals known as neurotransmitters. Found throughout the brain, acetylcholine enables nerve cells to communicate with each other. In Alzheimer’s disease, the levels of acetylcholine are lower than usual.

Inability to recognise familiar objects, people, sounds, shapes or smells.

Inability to make familiar movements despite having muscular strength and co-ordination.

Impaired ability to produce, comprehend or use language.

Abbreviation for Acquired Immune Deficiency Syndrome.

The commonest cause of dementia. It usually begins after the age of 65 and results in gradual, progressive loss of memory and other functions of the brain.

A protein that is found in the brains of people with Alzheimer’s disease. It is deposited throughout the brain in microscopic clumps known as plaques. Its function is unknown and it may be the cause of the deterioration of brain function.

Also known as cholinesterase inhibitors, these dementia drugs stop the breakdown of acetylcholine. Aricept and Exelon are examples.

Substances such as vitamin E, C and beta carotene are thought to protect the body cells from the damaging effects of oxidation.

A range of tranquillisers, also known as neuroleptic drugs, that help to reduce symptoms of aggression.

The brand name for donepezil, a cholinesterase inhibitor.

The amount of stress placed on the walls of the arteries, veins and heart chambers by the flow of blood.

A general term to mean any investigation that produces pictures of the brain. A CT scan or MRI scan shows slices through the brain. A SPECT scan shows the brain’s blood supply.

An abnormal condition that features slowness of speech and movements.

The outer layers of the brain, involved in thinking, memory and the interpretation of perception or the senses.

Substance found in animal fats and oils, and is also made in the body. It is necessary for the making of vitamin D in the skin and for making various hormones. Too much cholesterol can be responsible for deposits in blood vessels and eventual restriction of blood flow.

Referring to acetylcholine. For example, a cholinergic neurone is a brain cell that contains the chemical acetylcholine.

An alternative name for anti-cholinesterase drug.

Microscopic thread-like structures that are present in all cells. They are collections of genes, which contain the genetic information that is transmitted from generation to generation.


CJD (Creutzfeldt Jakob disease)

Cognition

Cognitive tests

Community care

Complementary medicine

Confabulation

Confusion

Dehydration

Delirium

Dementia

Depression

Diabetes

Diagnosis

Disinhibition

Disorientation

Donepezil

Down syndrome

A very rare form of dementia caused by an infectious agent called a prion. As well as loss of memory, CJD commonly causes muscle jerking, blindness and problems with walking. Death occurs within a year or so.

The faculty of knowing or perceiving things.

Tests that assess how well a person can think and how well his or her memory is working.

A term covering health and social care services delivered to people in the community, usually in their own home.

An approach to health care that explores alternatives to conventional treatments. Acupuncture, homeopathy, aromatherapy and spiritual healing are examples of complementary therapies.

Producing false memories to replace memories that are no longer capable of being stored. A person may guess an answer or imagine an event and then mistake it for an actual memory. Although it may be seen by others as lying, the person is unaware that their memories are false or inaccurate.

A state in which problems with memory and concentration impair the function of the mind.

A state in which there is insufficient water in the body. It occurs when a person’s fluid intake fails to balance fluid loss through sweating, vomiting or diarrhoea.

Features confusion, speech disorders, anxiety and sometimes hallucinations. Often has a rapid onset and lasts from hours to weeks. Fluctuations in conscious state.

A term used to describe impairment of brain function, involving memory, thinking and concentration. Dementia usually becomes progressively worse, eventually making it impossible for someone to cope with living without help. There are many causes of dementia, including Alzheimer’s disease, vascular dementia, Lewy body disease and Pick’s disease.

An illness in which the main symptoms are feeling low, tearfulness and loss of enjoyment. Depression can affect sleep, appetite, motivation and concentration. It is treatable.

Occurs when the amount of sugar in the blood cannot be regulated. There are several types of diabetes.

The process of identifying and naming a disease from a person’s symptoms and signs. Getting a diagnosis may only involve talking with the doctor and having a physical examination. In other cases, special investigations may need to be done as well.

Loss of feelings of shame or embarrassment that normally help control a person’s actions. Disinhibition results in inappropriate or improper behaviour.

A state in which someone loses their awareness of time and place. For example, they may fail to recall the date or even the year, and may not be able to say where they are.

The generic name of Aricept, a dementia drug that is a cholinesterase inhibitor. It works by increasing the amount of a certain substance (acetylcholine) in the brain.

A genetic condition caused by an extra copy of chromosome 21 that results in slowed growth, abnormal facial features and intellectual disabilities.

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Enduring Power of Attorney (EPA)

Epileptic seizures

Exelon

Frontotemporal dementia

Frontal lobes

Galantamine

Generic

Genes

Geriatrician

Hallucination

HIV

Huntington’s disease

Incontinence

Korsakoff’s syndrome

Lewy body disease

Limbic region

Memantine

A legal document in which one person gives another the power to handle his or her financial affairs. An EPA can only be drawn up if the person handing over this power can understand what he or she is doing. The EPA comes into force only after it has been officially registered.

Caused by a group of nervous system disorders that produce an uncontrolled electrical discharge in the brain.

The brand name for rivastigmine, a dementia drug that improves the function of nerve cells in the brain. It works by preventing the breakdown of a chemical that is important for the processes of memory, thinking, and reasoning.

A dementia in which the disease process mainly affects the frontal lobes of the brain. Memory is affected less than in other dementias, but there may be major problems with loss of motivation and disinhibition.

Parts of the cerebral cortex situated at the front of the brain. This is the area of the brain that controls movement of the body. It is also involved in ‘higher functions’, such as planning ahead, problem-solving and initiative.

The generic name of Reminyl, a type of dementia drug that is a cholinesterase inhibitor. It works by increasing the amount of a certain substance (acetylcholine) in the brain

A generic drug is a drug that is sold under its official medical name (its generic name) rather than under a patented brand name.

Material contained within the chromosomes. Genes carry the blueprint for the body; information that dictates how our bodies are built up, including the colour of our eyes and skin, how tall we are, our gender and many other details. Some genes have defects, or mutations, that cause disease.

A doctor who specialises in the treatment of physical illnesses in older people.

A perception (hearing, seeing, smelling or feeling something) without appropriate stimulus. For example, hearing voices when there is no-one there. Hallucinations are quite common in people with dementia.

Abbreviation for Human Immunodeficiency Virus.

Also sometimes called Huntington’s chorea, a disease in which mental deterioration is accompanied by involuntary twitching and muscle spasms.

Involuntary or inappropriate passing of urine or faeces. Help is available from continence advisors.

A memory disorder caused by lack of vitamin B1 (thiamine) sometimes caused by alcoholism.

A type of dementia in which abnormal collections of proteins called Lewy bodies, occur in the brain. People with Lewy body disease typically show more variation in their mental abilities from day-to-day than is usual with other dementias.

Situated deep inside the brain, this region is responsible for functions such as eating, sleeping, consciousness and emotions.

A dementia drug, which works by altering chemicals called NMDA receptors in the brain. It may slow the progression of dementia in some people.


Memory

MRI scan

Neuroleptic drugs

Neurologist

Neurone

Neurotransmitters

Occiptal lobe

Parietal lobes

Parkinson’s disease

Person-centred care

PET scan

Pick’s disease

Posterior Cortical Atrophy

Prevalence

Progressive Supranuclear Palsy

Reality orientation

Reminiscence therapy

Reminyl

Rivastigmine

Temporal lobes

The retention in the mind of information that may be recalled later.

Abbreviation for Magnetic Resonance Imaging scan. A type of brain scan that creates pictures using a powerful magnetic field rather than X-rays.

Another name for antipsychotic drugs.

A doctor who specialises in the diagnosis, treatment and management of diseases of the nervous system.

A nerve cell.

A group of chemicals in the brain that enables nerve cells to communicate with each other. Groups of adjacent nerve cells tend to use the same neurotransmitter. Examples include acetylcholine, serotonin and dopamine.

Part of the cerebral cortex situated at the back of the brain, responsible for interpreting what is seen.

Part of the cerebral cortex situated on either side of the brain above the ears. Responsible for anything to do with order and structure.

A chronic disease of the nervous system that is characterised by slowness of movements, a tremor and an expressionless face. Some affected people also develop dementia.

A holistic approach to dementia care focusing on the individual and utilising aspects such as the person’s past history, routines, personal preferences and needs.

Abbreviation for Positron Emission Tomography scan. A sophisticated brain scan which is able to look at the brain in great detail. It is not generally available in clinical practice.

A rare dementia which commonly affects younger people than Alzheimer’s disease. It affects language and personality before there is any significant change in memory.

Refers to gradual and progressive degeneration of the outer layer of the brain (the cortex) in the part of the brain located in the back of the head (posterior).

Rate of occurrence.

A rare condition that causes problems with control of gait, balance and vision.

A psychological treatment in which every opportunity is taken to make people with dementia aware of the time, where they are and the world around them.

A treatment that aims to stimulate people’s memories by means of old films, pictures, music, etc.

The brand name for galantamine, a dual-action dementia drug. It is anticholinesterase drug and also works by stimulating areas of the brain called nicotinic receptors.

The generic name for Exelon, a dementia drug.

Parts of the cerebral cortex situated behind the temples, and responsible for our memory.

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Sedative drugs

Side effects

Snoezelen

Stroke

Syndrome

Thyroid

Tranquillisers

Validation

Vascular dementia

Vitamins

Drugs used to reduce symptoms of anxiety and agitation and to help people sleep. Sedative drugs increase confusion in people with dementia.

The unwanted ‘extra’ effects that occur in addition to the desired therapeutic effects of a drug. Most drugs have some side effects. These will vary from person to person and commonly disappear when the body becomes used to a particular drug.

A special room designed to gently stimulate the senses and to calm people who are agitated.

A result of a haemorrhage in the brain, or of a blood clot in an artery of the brain, leading to paralysis of part or all of one side of the body, or loss of speech, or loss of consciousness or death. The paralysis may be sudden or gradual in onset.

A group of signs and symptoms that occur together and are typical of a particular disorder or disease.

A gland in the neck that produces a chemical known as thyroid hormone. This hormone is essential to the workings of the body. Thyroid hormone deficiency is a rare cause of dementia.

Drugs used to help people who are very anxious. These drugs can cause increased confusion in people with dementia.

A technique used in caring for people with dementia that focuses on feelings rather than confusion.

A type of dementia associated with problems affecting the circulation of blood to the brain, such as may result from a series of small strokes.

Chemical compounds essential to health that are found in many foods. Vitamin deficiency is a rare cause of dementia.

4.0 purposeful and meaningful engagement

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