Activities are the things that we do, including getting dressed, doing chores, and even paying bills. They are a part of who we are and what we're about. For the person with Alzheimer's, they enhance the person's sense of dignity and self-esteem by giving purpose and meaning to their life. In most cases, structured, pleasant activities decrease agitation and improve mood when done with a failure free approach. The activity needs to be geared to the person's stage, their remaining ability and mental capacity. The nature of the activity and the degree to which the person completes it successfully are not as important as the pleasure and sense of accomplishment the person derives from it. Activities can be active or passive, done alone or in the company of others. They help to structure time and can make the best of retained and existing abilities.

While people with dementia experience a loss of many skills, there are certain skills that often remain until the later stages of the disease. These include long-term memory, gross motor skills, and social skills.  Well learned skills such as knitting and playing the piano can be maintained if you constantly work with the person. Below are activities that you can do with the person with dementia that will take advantage of the abilities that are left.

Long-Term Memory
People with dementia tend to retain their long-term memory until they reach the later stages of the disease.

Suggested Activities:

• Listen to music , especially music that was popular in the person's youth.
• Look at family photos
• Sing songs – many people love to sing Christmas carols.
• Reminisce about a favorite time ; summer, the first day of school, their first kiss - say "tell me more" when they start talking about a memory.
• Ask simple trivia questions
• Try reading favorite poetry or stories.
• For those in the early stages of the disease, remember great inventions, famous people.

Gross Motor Skills
Activities requiring exercise and the use of gross motor skills are enjoyable and can often reduce symptoms such as anxiety and agitation.

Suggested Activities:

• Play catch with a "soft" ball
• Take regular walks (to the grocery store) or around the local mall
• Do household tasks such as raking leaves, sweeping the floor, wiping off the outdoor furniture or using the carpet sweeper.
• Have a "dance party" – put on favorite music and dance

Social Skills
People with dementia usually retain their social skills. Allow time for socializing and enjoying each other's company.

Suggested Activities:

• Have visitors ; ask a friend, neighbor who has a baby or younger child to visit
• Invite a neighbor or friend with a calm pet to visit
• Read the daily paper out loud
• Schedule excursions – go out for lunch, take trips to the zoo, park, library or art museum.
• Involve the person through conversation - while you're polishing shoes, washing the car, or cooking dinner, talk to the person about what you're doing. Even if the person cannot respond, he is likely to benefit from your communication.

Well learned Skills
These are skills that the individual has learned and practiced so many times that the skill has become habitual. These activities can be very comforting to the individual with dementia since they do not require practice, planning or sequence.

Suggested Activities:

• Playing music or a musical instrument
• Painting and drawing
• Knitting, crocheting, rolling yarn in a ball and embroidering
• Sewing different types of materials together, such as terrycloth, denim, corduroy or cotton.
• Tracing and cutting out leaves , decorating paper placemats, cutting pictures out of greeting cards.
• Gardening – weeding the flowerbed and planting flowers
• Playing cards - people who once enjoyed playing bridge or cards might find pleasure in simple card games, or, depending on ability level, in separating different types of cards. Other possibilities include separating nuts and bolts from nails or sorting buttons and coins.

In addition, most people like being pampered. Give a back rub, manicure, or foot massage. These activities are relaxing and pleasurable

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It is important to emphasize activities that help the person to feel like a valued part of the household and to experience a feeling of success and accomplishment. Examples include dusting, sweeping, doing laundry, wiping countertops, folding napkins, emptying wastebaskets, folding clothes, putting away silverware, putting bird feed out for birds, straightening the underwear drawer, and matching a basket of socks.

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Take Stock of the Patient

• What skills and abilities does the person still have ? Examine the person's past activities and hobbies and then figure out how to adapt or simplify these activities to match the patient's abilities.
• What does the person enjoy? Consider the person's likes, dislikes, strengths and past interests.
• Can the person begin activities without direction?
• Does the person have physical limitations - difficulty seeing, hearing or performing simple movements, or tire easily?

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Select activities in which the process is more important than the final product:

Focus on enjoyment, not achievement. It doesn't really matter if the towels are folded properly. What does matter is that you spend time together and that the person with Alzheimer's feels as if he has helped do something useful.

Help to get the activity started:

most people with Alzheimer's still have the energy and desire to do things, but lack the ability to organize, plan, initiate and successfully complete the task.

Focus on one task at a time.

Don't criticize or correct the person:

if the person with Alzheimer's finds a harmless activity that seems significant or meaningful, encourage him to continue.

Help the person remain as independent as possible.

Look for activities that are dignified and appropriate for adults.

Substitute an activity for a behavior:

if a person with dementia rubs his hand on a table, place a cloth in his hand and encourage him to wipe the table. Or if a person is moving his feet on the floor, play some music so he can tap them to the beat.

Simplify instructions and offer support:

you may need to show the person how to perform the activity and to provide simple, step-by-step directions. Too many directions at once can overwhelm a person with dementia.

Relate activity to work life:

A person who once worked in a business office might enjoy putting coins in holders, doing routine mailings, or making lists on a legal pad or in a notebook. Someone who was a farmer or gardener would probably enjoy working in the yard. Activities that relate to a former career are often the most familiar, reassuring and enjoyable for the person.

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Note when the person seems happy, anxious, distracted or irritable . Some people with Alzheimer's may enjoy watching sports, while others may be frightened by the fast pace or noise.

Think about the past week. Make notes about activities and experiences that worked and didn't work. Try keeping a daily journal and record which activities worked best and which didn't.

Determine what time of day is best for an activity . Many caregivers find that they have more success with certain activities, such as bathing and dressing, in the morning.

Be flexible - adjust to the person's level of ability and look for hidden messages. When a person insists that she doesn't want to do something, it might be her way of telling you that she can't do it or fears doing it. You may need to alter what you are doing so that the person does not feel uncomfortable.

Adjust activities to stages of the disease - as the disease progresses, you may want to introduce more simple and repetitive tasks or allow the person to take a less active role in activities.

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When planning the day for the person with Alzheimer's, think about how you organize your own day. It is often helpful to set up a written schedule of the day, which allows you to spend less time and energy trying to figure out what to do from moment to moment. It is best when you allow your self and the person with dementia some flexibility for spontaneous activities. Be realistic and relaxed. Don't be concerned about filling every minute of the day with an activity. The person with Alzheimer's needs a balance of activity and rest, and may need more frequent breaks and varied tasks.

Sample Daily Schedule

Morning Activities:

• Take a bath, brush teeth, get dressed
• Prepare and eat breakfast
• Coffee and conversation
• Discuss newspaper, make a craft or reminisce about old photos
• Take a break or have some quiet time
• Do some chores together
• Take a walk or play an active game

Afternoon Activities:

• Prepare and eat lunch, read mail, clear and wash dishes
• Listen to music, do a crossword puzzle or watch television
• Do some gardening, take a walk or visit a neighbor
• Take a short break or nap

Evening Activities:

• Prepare and eat dinner, and clean up the kitchen
• Reminisce over coffee and dessert
• Play cards, watch a movie or give a massage
• Get ready for bed, read a book or look through a magazine

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• Modify a workshop by removing toxic materials and dangerous tools so an activity such as sanding a piece of wood can be safe and pleasurable.
• Change your surroundings to encourage activities.
• Minimize distractions that can frighten or confuse the person.
• Click here to get more information on Home Safety .

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• Experiment with watching old videos of the 1950s or 1960s or old movies of the 1920s to the '40s. Some people may enjoy watching sporting events.
• Try the following arts/crafts projects – color pictures, sand wood, cut out pictures from magazines, cut up used paper for scratch paper.
• Try making these things in the kitchen – bake cookies, make homemade lemonade, applesauce or bread, make a pie, make a fresh fruit salad, pop popcorn, make sandwiches, bake a birthday cake.
• Have some fun - dress up, fancy or fun, have afternoon tea, play horseshoes, play simple games appropriate to the person's level of function such as dominos, checkers or Pictionary.

For additional information on activities for People with Alzheimer's Disease, click here .

Sources: the Orange County Chapter of the Alzheimer's Association, including the following source material: information from Mary Barringer, RN,C, Director, Clinical Services, Center for Alzheimer's Disease and Related Disorders, Southern Illinois University, School of Medicine, Springfield, IL and Lisa P. Gwyther, ACSW, educational director of the Joseph and Kathleen Bryan Alzheimer's Disease Research Center of Duke University, Durham, NC.; information from the following Chapters of the Alzheimer's Association: Eastern Massachusetts, Cleveland Chapter, South Central Michigan and Greater New Hampshire.; David L. Carroll. WHEN YOUR LOVED ONE HAS ALZHEIMER'S DISEASE. New York: Harper and Row, l989; Howard Gruetzner. ALZHEIMER'S: A CAREGIVER'S GUIDE AND SOURCEBOOK. New York: John Wiley & Sons, Inc., 198; Lisa P. Gwyther. CARE OF ALZHEIMER'S PATIENTS; A MANUAL FOR NURSING HOME STAFF. Washington D.C.; American Health Care Association, Alzheimer's Disease and Related Disorders Association, 1985; Nancy L. Mace and Peter V. Rabins, MD. THE 36-HOUR DAY. Baltimore: The Johns Hopkins University Press, 1991;Carmel B. Sheridan. FAILURE FREE ACTIVITIES FOR THE ALZHEIMER'S PATIENT. Oakland: Cottage Books; Jitka Zgola. DOING THINGS: A GUIDE TO PROGRAMMING ORGANIZED ACTIVITIES FOR PERSONS WITH ALZHEIMER'S DISEASE AND RELATED DISORDERS. Baltimore: Johns Hopkins University Press, 1987.

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