This article, the third in a series of four, explores how carers and activity providers can achieve and maintain a sense of wellbeing for individuals living with moderate dementia.
In the previous article, we focused on individuals with moderate to severe dementia, defined as the Sensory level by the QCS PAL instrument. People at this level are mainly acting in response to sensations such as taste and touch, as well as movements in the body.
Individuals living with dementia at the Exploratory level can carry out simple activities, in addition to being responsive to these sensations. They won’t have a pre-planned idea about what they are going to do, nor have an end-goal in mind. Instead, their approach is much more spontaneous and creative. At an exploratory level, they interact with objects and people when they come across them.
To create a supportive environment, care givers should understand and appreciate the individual’s behaviour, which can often be quite joyful. The person might, for example, walk into a room and start interacting with the curtains, stroking the material, or moving them backwards and forwards. Rather than asking them to stop, the carer should encourage the playful and explorative behaviour and even join in.
Similarly, dressing is not just about putting on clothes, about having the right attire for the weather. It’s about carers being present and relishing the activity alongside the individual. Care givers can help the person enjoy and have fun with the process, rather than just seeing it as a task to complete as part of the day’s ‘to do list’.
As part of the process, an individual might ask to wear bright colours or dress in an unusual way. One experienced care giver cites the example of an individual who wanted to wear her Dior dress. When the item was given to her, she decided to put it around her shoulders like a shawl. Rather than correcting the individual, the carer was encouraging, saying: “That’s great. You look beautiful.”
When assessing and working alongside a person, it is crucial to remember that those operating at an Exploratory level can undertake most activities if they are broken down into two or three steps. Carers should provide simple directions, and not put any pressure on the individual. What’s most important is to help the person get the most out of what they are doing.
Another key point to stress is that individuals can more easily complete activities they are accustomed to, especially if they are in familiar surroundings. For example, when getting dressed in a room with a wardrobe, or preparing food in a kitchen with culinary appliances, they will receive visual cues from their environment.
That’s why it’s important that they surround themselves with objects they are used to, and that these are always on view. If the carer is helping them get dressed, for instance, they can lay out the clothes in the order the person would typically put them in. For example – from glasses and hearing aids, to pants, socks, jumpers and jackets.
There are many suitable leisure activities for the person at the Exploratory level outlined in the PAL guide, including flower arranging, woodworking and DIY projects such as building a bird box, and initiating and engaging in discussions about newspaper and magazine stories.
When it comes to discussing newspaper or magazine articles, focus on headlines and photos with the goal of drawing on memories and prompting reminiscences. There might be images of the seaside in a magazine feature. The carer can ask questions such as: “When you were young, did you ever go on a beach holiday? Where did you go? What did you do?”
For the more hands-on activities, the carer can support the individual by breaking down the activity into several simple steps. Flower arranging promotes creativity, while building a bird box includes sanding wood and hammering nails into the item – all contributing to a sense of wellbeing.
It’s important to remember too that the individual at the Exploratory level may not be mindful of the impact they have on others. They might behave in a way that doesn’t fit with social norms, and this behaviour can be inappropriate and therefore quite challenging. They might, for example, approach complete strangers and interact with them in an over familiar manner.
People usually understand the situation and react with good humour. But that isn’t always the case. Don’t correct the person with dementia or tell them off – just move them on gently. It’s important to be aware that how people respond can have a powerful impact on the person, that can be positive or negative depending on the skills of the care giver.
Reassurance is therefore key in dementia care. Carers should reassure the person that what they are feeling is valid and never dismiss their feelings. They can also take responsibility by saying things such as “I’m sorry I upset you” to show they understand.
To ensure the wellbeing of individuals at this level, carers should ensure they know the person well and tailor activities to their level of ability and their interests. It’s not just about helping people get washed and dressed, it’s about promoting a sense of achievement and happiness.
By engaging with individuals and sharing in their enthusiasm for different activities, carers feel a sense of reward and wellbeing too. For them, caring is about making a difference to the lives of those they support. The PAL instrument can aid carers to achieve their goals by providing them with a platform to better engage with individuals and support them to achieve better outcomes. This contributes hugely to job satisfaction — which is, after all, why many carers do the job.