Ideally, activities should: 

• compensate for lost abilities;
• promote self esteem;
• maintain residual skills and not involve new learning;
• provide an opportunity for enjoyment, pleasure and social contact;
• be culturally sensitive.

Consider all that has made your person with dementia unique.

• This means knowing the person's former life style, work history, hobbies, recreational and social interests, travel, significant life events (eg. migration, war), spiritual and cultural preferences, family dynamics and relationships, and celebrations. An ongoing cognitive and functional assessment will reveal strengths and limitations in every area of daily living--mobility, showering, dressing, eating, seeing, hearing and communication. Humour is an important consideration, knowing the person's favourite funny stories, comedians and entertainers. It is also important to know a person's fears, eg. travelling on a train through a tunnel.

Activities should re-establish old roles.

• Make use of habitual, overlearned tasks. Examples include buttering bread, washing up, drying dishes, watering the garden. Utilise old skills, such as playing the piano or pianola. Activities provide a sense of purpose through being useful, eg. dusting, folding clothes, polishing brass or silver, clearing the table after meals, sweeping the patio, raking leaves, emptying the grass catcher, rubbish to the "otto" bin, hosing the car, washing and drying vegetables for salads and bringing in the washing. Encourage an area of responsibility no matter how small. In view of the person's changing abilities, the carer must be prepared to adapt and to create something of a lesser responsibility when considering realistic expectations for the person in care.

Encourage "being helpful".

• Examples of this include unloading the car, carrying parcels, wheeling the shopping trolley, feeding the dog, birds, cat.

Caregivers need to know what has contributed most to a person's self esteem and how they might continue this.

• Basically, this is loving and accepting them for who they are. In the area of personal care, if the person has always been immaculately dressed, continue this. Encourage the person her to clean their own shoes with clear boot polish, pamper with a manicure, pedicure, hair set, after shave lotion, a preferred perfume, favourite dress or suit. If appropriate, the person with dementia should be encouraged to maintain fastidious care of teeth, dentures, glasses and hearing aids.

• Activities should give relaxation and pleasure. These do not require memory, eg. a person with dementia may enjoy an outing but not know where he/she has been. They may respond to a rhythm but not know the tune. The person may enjoy a spa bath but not recollect why it felt so good. It is important that the moment is enjoyed although the experience may soon be forgotten.

• Activities must have a meaning to the person. A person with some loss of carpentry skills, can still assemble and screw together a pre-cut project with pre-drilled holes such as a spice rack. He needs to see a sample of the completed spice rack first to relate the parts to the whole and touch and smell the spices and herbs within the jars. Carers could perhaps arrange with a carpenter or TAFE instructor to provide small projects such as plant troughs, children's toys, stools, bread board or a gift for a relative or grandchild.

• Equipment should be dignified. A person who retains bowling skills may well enjoy playing carpet bowls or skittles. Seek out your TAFE College wood turning instructor or students to make your own set of timber skittles.

• Activities should be simple and unhurried. Particularly at meal times, focus on one thing at a time. Communicate one instruction at a time, eg. peel these hard boiled eggs, shell these peas- demonstrate, praise and encourage. Break down activities into simple, manageable steps.

The person may be involved as part of assembly line cooking eg. preparation of pizzas, spread tomato paste, grate cheese, wash and dry parsley, capsicum or mushrooms.

• Prepare a safe work area. Ensure it is uncluttered with a minimum of distractions and noise. Good lighting without glare, individual seating preferences and correct work height are also important. Break down the activity into stages reinforcing what is happening and about to happen. eg. a person who retains some card skills may play a simpler game without any new learning involved.

• Activities must not reinforce inadequacy or increase stress. Abilities fluctuate from day to day. Activities can be adapted and tried again another time. eg. watering the garden. Options include allowing a fixed length of hose; replacing a jet nozzle with a fixed gentle, fan shaped spray; watering when clothes are not on the line; securing removable hose fittings and containing the scope of the person watering by offering a watering can, in place of the hose.

• Activities should be done at a time to suit the person's best level of functioning. Examples of this are walking in the morning or the quiet time of early afternoon. If possible, they should be structured to the same time frame each day. Routine is security and is more reassuring than variety.

Many caregivers find that short walks become part of the routine many times a day. Some benefits include a reduced level of stress and agitation, and improved sleep. The best time for walking may be when his/her behavioural need is greatest. eg. sundowning, or when the day seems long and meaningless.

• Activities should not overstimulate. Be selective with outings. Avoid crowds, constant movement and noise ie. shopping centres at peak times, sports arenas and popular times at clubs, which can cause withdrawal. A ferry ride can be calming. An outing to the library can be quiet and meaningful. There can be quiet times at church for prayer during the week or arrange for a minister, priest or rabbi to visit the home at a regular time.

Picnics with family and friends allow sociability, flexibility, in a setting suited to the needs of a person with dementia, provided there is the same amount of comfort outside as inside.

• Activities should allow an emotional outlet. Music, including the use of percussion instruments, or contact with babies, children and animals provides positive feelings of joy, tenderness and laughter.
• Activities should include sensory experiences. These require little interpretation to be fully appreciated, eg. hand, neck and foot massage, brushing hair, smelling fresh flowers or pot pourri pillows, using essential oils and fragrances, the aroma of freshly cooked apples, stroking an animal, the aroma of bees wax or floor polish. Visit a herb farm, a flower show, or stores like the Body Shop for ideas.

• A sense of movement and rhythm is retained longer than most other abilities. Try having the person sit in a rocking chair or hammock low to the ground with sand underneath. Hire an exercise bike or a walking machine for rainy days. Be a spectators or participants at a ballroom dancing class or walk the dog together.

• Emphasise reminiscence. Capitalise on remote memory. Visit a museum. Recollect with coloured slides. For some, a good stationary image is more easily interpreted than a reminiscence video or TV "classic" because the movement and messages of these may be too fast moving to be processed. Old newspaper cuttings, diaries, letters of recognition or significant relationships and experiences, photo albums can be comforting when prompting remote memory. If reading skills have deteriorated, make individual audio tapes enabling a response to a calm, familiar carer's voice. Record from a favourite novel or prayer book, poem or music. Many benefit from a walkman and individual headphones.

• Recreation is related to former life style. As this varies from one person to another, it is suggested that carers write out an activities care plan, if respite care will be provided by different carers. This will enable consistency of approach and care with ideas for recreation suited to the needs of the person with dementia. Recreation may include an adapted version of a game of cards, seeking answers together for crosswords, residual craft skills, collage, outings to the zoo, walking barefoot along the beach, visiting an art exhibition or taking a train trip.

• Activities play a significant part in the prevention and intervention of challenging behaviours. Know what can be effective in calming or diverting, particularly at "sundowning". Again this is very helpful information for a respite caregiver. Sometimes it can be something very simple, eg. holding onto or stroking a fur fabric pillow, a net bag with marbles or coins, drying cutlery.

These general guidelines are based on abilities characteristically retained. Only the caregiver, through trial and error, can be specific in offering appropriate activities. The caregiver has an intimate knowledge of their person with dementia and what are realistic expectations for that person and an appreciation of his/her individuality.