The goal of dementia engagement & programming is to achieve the maximum highest quality of life for people living with cognitive impairments. The challenge in dementia care often lies in finding evidence based interventions or programs that target specific and empirical factors of quality of life.
As it has been published, there are four derived components of good quality of life for individuals with dementia. Let us analyze them and discuss corresponding programs for each of them:
1. Depression and positive events – Person centered programming & Behavior management
Mood and positive events for individuals of all ages have been highly correlated. People living with dementia are vulnerable to a loss of pleasant experiences and subsequent mood disturbances. Increasing cognitive impairment causes a loss of ability to engage in rewarding and enjoyable activities, which in turn leads to increased depression and decreased mood. It has been established that person centered programming for individuals with Alzheimer’s provides a sense of efficacy, reduction in depression, and improved relationships with family members.By using behavior management methods, programming has been shown to reduce negative events and improve sense of self in people with dementia. These non-pharmacological interventions should be based on personhood and reflect dimensions of wellness while matching cognitive and physical abilities of the individual.
2. ADLs – Occupation therapy & programming
The ability to perform activities of daily living (ADLs) and keeping one’s own independence has been identified as a core factor to maintain quality of life.
These tasks include eating, bathing, dressing, toileting, walking and continence. Many factors in the progression of dementia contribute to the loss of control over these tasks and directly reduce QOL.
To strengthen and support the highest level of independence, an occupational therapy & programming approach can focus on interventions to maintain functioning in community-residing individuals with dementia. Other benefits of that approach are that it improves caregivers’ affect, decreases burden, and increases feelings of competence and self-efficacy, all of which also result in improved QOL for the person with dementia
3. Physical functioning and mobility – Programming
Beyond performing ADLs, physical activity that maintains or improves physical functioning and mobility has been proven to directly influence quality of life. The importance of maintaining mobility and physical activity in persons with dementia has been recognized in clinical and long-term care settings. Randomized trials have demonstrated that individualized exercise programs are both feasible and beneficial for increasing strength and maintaining mobility for cognitively impaired nursing home residents.
To support this, programming can focus on individualized programs of endurance activities (primarily walking), strength training, balance, and flexibility exercises. By offering physical activities that match the functioning levels of people with cognitive impairments, programming has been shown to have a direct influence on improving mood, independence and social activities and decreasing depression, behavior disturbances and falls.
4. Cognitive functioning – Neuroscience, rehabilitation programs & programming
Cognitive stimulation or brain fitness has been adapted from neuroscience research and rehabilitation programs with individuals with head trauma, stroke, and other neurological disorders for people living with dementia. Its goal is to improve memory, attention, and general cognitive function in individuals with mild to moderate dementia. Programs may include a variety of cognitive training strategies, including specific memory training, general problem solving, use of mnemonic devices, multisensory stimulation, word games and puzzles, social activities, and/or use of external memory aids such as notebooks or calendars. Used as a method for person centered programming, this type of intervention has been shown to improve mood and memory, with the greatest and most lasting improvement in the focused cognitive rehabilitation group.