1. CONNECTIONS:
CONNECTIONS :
Engagement in Life for Persons Diagnosed
with Dementia
Ellen Phipps, CTRS
Alzheimer’s Association Central and Western Virginia Chapter
Barbara Braddock, PhD
University of Virginia
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2. CONNECTIONS: VISION
Families experiencing a diagnosis
of dementia will find satisfaction
and meaning in their daily lives.
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3. The Beginning
 What on earth can we do all day?
 Incidence of dementia increasing
 Good Activities resources but….
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4. Lessons Learned from Home Visitation
Practical
solutions for Caregivers
engagement needed support
were missing
Adult Day
Persons with a
programs, while
diagnosis
an excellent
needed to be
option, are not
engaged in life LESSONS
LEARNED for everyone
FROM HOME
VISITATIONS
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5. Successful Evidenced-Based Programs
2. Montessori-
1. Therapeutic
Based Dementia
Recreation
Programming
3. Cognitive
Intervention
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6. 1. Therapeutic Recreation
The primary purposes of recreation services are to
provide recreation resources and opportunities in
order to improve health, well being, and
independence.
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7. 2. Montessori-based Programming for Persons
with Dementia
 Based on the process developed for disadvantaged
children by Maria Montessori
 Designs a prepared environment
 Breaks activities down into steps
 Esthetically pleasing objects
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8. 3. Cognitive Intervention
Objects are placed in the
environment to facilitate
orientation and memory, as
well as to encourage
engagement in activities.
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9. Phipps Braddock
COGNITIVE
INTERVENTION
MONTESSORI
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10. The Question
How would it be possible to provide the
training and tools necessary to support
and empower caregivers and offer
strength-based meaningful activities at
home?
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11. DEFINITIONS
 Activity
 Meaningful Activity
 Strength-based
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12. CONNECTIONS
WHAT MAKES AN ACTIVITIY
MEANINGFUL?
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13. Meaningful Activity
 Activities are meaningful when they reflect a person’s:
 Interests
 Lifestyle
 Education
 Current level of function
…and are enjoyable to the person!
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14. STAGES OF THE DISEASE –
STRENGTH-BASED PROGRAMMING
7STAGES OF AD divided into 3 categories:
Early Middle Late
Stage Stage Stage
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15. SYMPTOMS AND STRENGTHS CHART
EARLY STAGE
COMMON SYMPTOMS COMMON STRENGTHS
• Problems coming up with right • Able to express oneself verbally
words • Able to converse intellectually
• Trouble remembering names • Understands spoken language
• Trouble with performing tasks • Able to engage in work
• Forgetting material one has just • Able to self advocate
read • Able to write
• Trouble planning and • Able to use memory strategies
organizing
• Long term memory in tact
• Forget recent events
• Able to continue use of
• Mood changes technology
• Sense of smell may be in tact
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16. SYMPTOMS AND STRENGTHS CHART
MIDDLE STAGE
COMMON SYMPTOMS COMMON STRENGTHS
• Problems recalling current • Ability to express some
address, telephone number thoughts, feelings or ideas
• Confusion with date, time • Able to engage in conversation
• Visual awareness
• Difficulty choosing
appropriate clothing • May be able to write
• May be able to read some words
• Loss of recent experiences
• Able to enjoy some physical
and surroundings activity
• Changes in sleep patterns • Able to recall some past
• Wandering or becoming lost memories
• Able to engage in modified work
• Able to recall familiar songs
• Able to gain pleasure from
activity
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17. SYMPTOMS AND STRENGTHS CHART
LATE STAGE
COMMON SYMPTOMS COMMON STRENGTHS
• Trouble with bowl and bladder • May be aware of the presence of
control others
• Significant personality and • May respond to touch
behavior changes • Able to hear
• Decreased ability to respond to • May be communicating through
environment facial expressions
• Need total assistance for ADLs • Able to gain pleasure from
activity
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18. Bringing it all together: Connections
connecting people with
dementia to meaningful
activity
connecting communities
stimulating brain cells for
for intergenerational
neurological connections
experiences
connecting volunteers
connecting principles of
with persons with
3 practice fields
dementia
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19. Bringing it all together: Connections
Empowering to Person and
caregivers and relationship-
persons centered
experiencing
memory loss
Supportive to
caregivers and Home and
persons community-
experiencing based
memory loss
Volunteer and
community
Strength-based
partnership
driven
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20. AIMS OF CONNECTIONS:
Provide the necessary training, tools, and support to enable
caregivers to structure strength-based meaningful programs at
home for persons experiencing a diagnosis of dementia
Optimize the home environment for success
Facilitate intergenerational relationships
Reduce caregiver stress through enhanced interaction
Educate volunteers to the unique needs of families dealing with a
diagnosis of dementia
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21. CONNECTIONS
Unique strategies:
 Home Visitation / Partnered Volunteers
• Make the Connection
• Assess – (LIS; LQ)
• Summarize
• Design – focus on three
• Guidance / support to family
• Implement – Color coding / intervention
strategies
• Evaluate / Assess
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22. MAKING THE CONNECTION
DESIGN
PROGRAM
SUMMARIZE
OBSERVE
ASK
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23. STEPS TO CONNECTING
ASK OBSERVE: SUMMARIZE
• What are the person’s • Cognitive Ability Checklist •Focus on strengths
interests, and lifestyle? (CAC)
• What are the person’s • Leisure Interest Survey (LIS)
CURRENT abilities? • Life Story Conversation
• What is enjoyable to the Starters (LSCS)
person?
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24. TOOLS
Life Story
Leisure Interest Being in the
Conversation
Survey (LIS) moment
Starters (LSCS)
Cognitive
Information Sample Activity
Checklist –
Summary Charts
Color-Coded
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25. DESIGNING THE PROGRAM
 Select 2 – 3 Activities from the “I” Column of the
Leisure Interest Survey (a comprehensive
checklist of activities)
 Determine the Color from the cognitive checklist
(looks at cognition, language, orientation &
memory, attention span)
 Create Activity Stations – our use mobile Activity
Tool Kits
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26. Be Flexible
 Being “in the moment” for persons in later stage
 If the chosen activity does not work, try another
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27. ACTIVITY CENTERS
Example: RED ACTIVITY CENTER
Care for the animals
RED ACTIVITY CENTER
Wash hands and wipe off the
bathroom counter with spray and cloth
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28. CONNECTIONS
BLUE ACTIVITY CENTER
Make a tuna sandwich for lunch
GREEN ACTIVITY CENTER
Indoor herb garden –
smell and touch
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29. 3. Cognitive Intervention
The environment is held
constant by developing
consistency in
•caregivers and volunteers;
•routines and schedules;
•location of activity centers; and
•materials.
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30. CONNECTIONS
Preliminary data shows: Future work:
• 11 of 12 participants successfully • Data analysis
engaged in selected activities • Training / In-services
• Caregivers reported increased • Training Manual
confidence in structuring activities in • Funding Opportunities
the home
• Faith Communities
Evaluate at each step | Adapt as needed
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31. Acknowledgments
 Student visitations funded through the UVA Office of the
Vice Provost of Academic Affairs
 ADRAF GRANT funding from Virginia Center on Aging for
additional research
 Project supported by Sue Friedman, President & CEO of
Alzheimer’s Association, Central and Western Virgnia
Chapter; and Randall Robey, Program Chair
Communication Disorders, University of Virginia
 Participants and their family members
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32. References
 Bayles, K.A. & Tomoeda, C.K. (1997). Improving function in dementia and other cognitive-
linguistic disorders. Austin, TX: Pro-Ed.
 Bourgeois, M.S. (1990). Enhancing conversation skills in patients with Alzheimer’s disease
using a prosthetic memory aid. Journal of Applied Behavior Analysis, 23, 31-64.
 Bourgeois, M.S. (1991). Communication treatment for adults with dementia. Journal of
Speech and Hearing Research, 34, 831-844.
 Bourgeois, M.S., (1992). Evaluating memory wallets in conversations with persons with
dementia. Journal of Speech and Hearing Research, 35, 1344-1357.
 Bourgeois, M.S., Camp, C., Rose, M., White, B., Malone, M., Carr, J., & Rovine, M. (2003).
A comparison of training strategies to enhance use of external aids by persons with
dementia. Journal of Communication Disorders, 36, 361-378.
 Camp, C., Judge, K., Bye, C. Fox, K., Bowden, J., Bell, M., et al. (1997). An
intergenerational program for persons with dementia using Montessori methods.
Gerontologist, 37, 5, 688-692.
 Helstrom, I., Nolan, M., & Lundh, U. (2004). ‘We do things together’: A case study of
couplehood in dementia. Dementia: The International Journal of Social Research and
Practice, 4(1), 7–22.
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33. References
 Judge, K.S., Camp, C.J., & Orsulic-Jeras, S. (2000). Use of Montessori-based activities for
clients with dementia in adult day care: Effects on engagement. American Journal of
Alzheimer’s Disease, 15, 1, 42-46.
 Keady, J., & Nolan, M. (2003). The dynamics of dementia: Working together, working
separately, or working alone. In M. Nolan, U. Lundh, G. Grant, & J. Keady (Eds.), Partnerships
in family care: Understanding the care giving career (pp. 15–32). Maidenhead: Open
University Press.
 Kessels, R.P.C., & De Haan, E.H.F. (2003). The effects of errorless and errorful learning on
age-related memory loss. Journal of the International Neuropsychological Society, 9, 577.
 Mahendra, N., Hopper, T., Bayles, K., Azuma, T., Clearly, S., & Kim, E. (2006). Evidence-
based practice recommendations for working with individuals with dementia: Montessori-
based interventions. Journal of Medical Speech-Language Pathology, 14, 1, 15-25.
 Phipps, E., & Braddock, B.A. (2008, unpublished). Dementia intervention care: A training
program.
 Wilson, B.A., Baddeley, A., Evans. J.J., & Shiel, A. (1994). Errorless learning in the
rehabilitation of memory impaired people. Neuropsychological Rehabilitation, 4, 307-326.
 Vernooij-Dassen, M., & Moniz-Cooke, E.D. (2005). Editorial. Dementia: The International
Journal of Social Research and Practice, 4(2), 163–169.
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34. CONTACT
Ellen Phipps, CTRS
Vice President Programs & Services
Alzheimer's Association Central & Western Virginia
The Jordon Building
1160 Pepsi Place
Charlottesville, VA 22901
Phone: 434-973-6122 Fax: 434-973-4224
ellen.phipps@alz.org
www.alz.org/cwva
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