Activities as Pathways to Meaning
Bingo is not inherently evil. I know many people, of varying ages, who find it enjoyable. Still, Bingo can strike fear in the hearts of people who associate it with what they imagine to be a wasteland of mindless activities in senior centers, or assisted living and nursing home activity rooms. But Bingo in and of itself is not to be feared. If Bingo is the only activity, or if it is part of a day’s line up of activities in which an older adult is primarily passive— then, people are right to be afraid. The key to structuring activities for older adults, be they at home or in a communal living arrangement, is to build a schedule of meaningful activities that include a range of restful and more active or “up” activities. (Kovach).
How can we determine what constitutes a “meaningful” activity? What is “meaningful” to someone really depends on that person’s life experiences. If I, for example, rode horses in my childhood and have fond memories of that experience, I might enjoy visiting a horse farm, reading about horses, looking at art depicting horses, or actually going for a ride.
The first step is to get to know the person for whom you are designing activities - both their past and their present. What careers did they have? What hobbies? What made their lives meaningful? What are their current abilities and disabilities? What level of stimulation can they tolerate?
While what is considered “meaningful” will depend on each person, there are also some consistent characteristics to such activities. Meaningful activities create opportunities for people (of any age) to express their thoughts and feelings, develop self-esteem, build skills, and build social networks by connecting with others. In the case of older adults, a meaningful activity is primarily initiated by the older adult, possibly with a caregiver/friend/teacher as facilitator. These activities can include creating or discussing music, journaling, creating collage, writing or discussing poetry, creating or discussing art, dancing, gardening, cooking, or participating in discussion groups on current and/or life events. Again, the type of activity will depend on what an individual found meaningful in the past, and their physical/psychological condition in the present.
There are two types of meaningful activities: restful and active. Restful activities involve low levels of stimulation, while active or “up” activities involve high levels of stimulation. Restful activities include quiet, more solitary activities such as watching television or movies, watching birds or fish, listening to people read, looking at photographs or drawings, or listening to music. Because passive activities take less thought and initiative, they can be relaxing. In order to keep our sense of self vibrant and growing, restful or passive activities should not dominate a person’s day.
Active or “up” activities include things like walking, animated group discussion, or music making. These activities stimulate the body and the mind, often simultaneously. It is important that all activities be meaningful, and that one strives for a balance between restful and “up” activities over the course of any given day.
Older adults who attend senior centers or are in assisted living, are free to pick and choose activities that interest them and should try to attain this balance on their own. Those with cognitive disabilities who attend adult day programs, live in skilled nursing facilities, or live at home with a care companion, will need help in balancing their days.
What makes an activity meaningful will depend on two factors, 1) who the person is, and 2) the stage of their dementia. For example, if a person was an extrovert, and is in the early stages, they will likely respond to group activities like storytelling, song-making, or discussion circles. If the person was shy, and is in the later stages of the disease, she might respond to a caregiver who softly touches her hand and makes eye contact. In this case, meaningful activity is simply a clear and comforting connection with another person. For a person who had been an accountant, and who is in later stages of the disease when verbal communication is nearly impossible, a meaningful, “up” activity might be sorting papers. A meaningful, restful activity might be to watch an evening business report on television. A person who was deeply religious might find certain ritualized prayers to be a restful, meaningful activity.
It can be overwhelming sometimes to find meaningful activities for loved ones with dementia – particularly if you are caring for someone at home by yourself. Many activities are designed for groups and will need to be adapted for one-on-one participation. Some books that provide ideas for activities do not identify “meaningful” activities, or differentiate between restful or “up” activities. It is possible to make an activity meaningful by framing it in a way that encourages self-expression and building social connections. For example, a sorting activity, where a person with dementia sorts different color clothes, can be turned into a discussion about family chores. What chores did you do? Do you think chores have changed? It can also be turned into a dance by waving the clothes in various patterns and asking the person with dementia to create their own pattern.
It is important not to underestimate what a person with dementia can do. If a meaningful activity is set into clear, ritualized steps, it is quite possible for a person with dementia – even middle to late stages – to learn a new activity or skill. Be sure that steps are clear, simple, and repeated the same each time the activity is repeated. Also be sure not to lose patience. A person’s ability to concentrate might change day to day.
Activity books can be helpful in coming up with ideas, but I find the best inspiration is to come up with an inventory of all the things that you do to express who you are. These might include things like dressing with style, whistling or humming, telling jokes, cooking, gardening, drawing, commenting on political events. The list can grow quite long. These are also ways that a person with cognitive challenges might also find to express who they are. Don’t be afraid to be silly. Don’t be afraid of serious or scary thoughts. Activities that provide opportunities for meaning making are designed to release thoughts and feelings. All thoughts and feelings are important to hear and acknowledge.
Kovach, C.R., Taneli, Y., Dohearty, P., Schlidt, A.M., Cashin, S., & Silva-Smith, A. (2004). Effect of the BACE (Balancing Activity Controls Excesses) Intervention on Agitation of People with Dementia. The Gerontologist.,44(6), 797-806.
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