Connecting People, Connecting Support was designed to help you embed health promoting activities into your daily routine. Whether you are visiting this website because you have been told that you have mild-cognitive impairment, have been given a diagnosis of dementia, or want to keep well by taking steps to maintain good brain health, there is something here for everyone.
Connecting People Connecting Support on-line shares 32 topics full of information and resources supporting health promoting activities into a person’s daily routine using film, illustration and photography. The resources and activities have been tried, tested and recommended by people living with dementia and those who support them while also being informed by the developing evidence base on brain health, occupational therapy and dementia rehabilitation.
Allied health professionals have an important role in supporting brain health, by sharing our expertise and public health messages. Allied health professionals can support people to eat well, take part in physical exercise, offer ideas on how to improve sleep, support people to engage in mindfulness and support people to try something new.
In our interactive website at www.CPCS.online we have called our contribution to brain health “Lifestyle Matters”. Everything is connected. How we feel, what we think and our physical health are all linked and evidence shows that the activities and occupations we engage with on a day to day all impact on our health and wellbeing.
Many factors can affect our brain health and by making tiny adjustments to our lifestyle we can make a difference: maximising how we function and potentially preventing or delaying the development of some types of dementia. When you click on the lifestyle matter folder, you will find things to Chat about, Try, Play and with additional resources in More.
CHAT. We offer ideas to start the conversation about lifestyle including
What do you do on a day-to-day basis to relax? What activities do you find particularly restorative? (having a bath, going for a long walk, spending time with family) How often are you able to these?
What activities give you a sense of purpose?
What motivates you to get out of bed on a morning?
How much of a balance do you think you have between the things you have to do and the things you want to do?
When did you last try something new? What helps or hinders trying new things?
How do you connect with others?
TRY. Lifestyle matters and making tiny adjustments and embedding health promoting activities into routines can make a huge difference. This includes taking steps to eat and sleep well, taking time to connect with friends and family, challenging ourselves to learn new things and building in some physical activity throughout the day. Examples and ways of doing this can be found across this website and this theme offers a short introduction that will hopefully help you to begin to think about small changes you can make to keep well by taking steps to maintain good brain health. Try this lifestyle challenge. See how many elements you can achieve in the next few weeks?
PLAY. As more and more connections are made between brain health and dementia we are seeing an increasing number of online tools and quizzes to help check out your wellbeing. You will find some here
MORE. In this section you can read about ways to keep your brain healthy including the work of colleagues at Brain Health Scotland. To further your support your brain health, why not try the brain health quiz https://brainhealthplan.brainhealth.scot/start
Related topics:
Have a look at our other topics that support good brain health.
Many of the activities we take part in are shared with others. It is through friendships that we give and receive support, share these meaningful activities and develop valued roles. Activities in this topic help you to identify some of the friendships and broader support mechanisms you currently draw on and explore ways to maintain existing friendships as well as develop new ones.
There is a close relationship between physical health and emotional and brain health. Building in some form of physical activity in our everyday routines can support wellbeing, offering a good source of exercise and a way to channel energy in a positive way.
Maintaining some kind of balance and finding time to relax is important. Stress not only impacts on emotional wellbeing it can also affect memory and physical health. These activities promote relaxation.
A balanced healthy diet is important to keeping mentally and physically well. In this topic we think about the importance of establishing mealtime routines and ways of making dining into a meaningful activity.
A good night’s sleep is important for physical and emotional wellbeing. Over a lifetime our sleep patterns and the amount of sleep we need will change. However dementia can also significantly impact on these patterns. These activities invite you to think about sleep and offer some suggestions of how to get a good night’s rest.
Occupational therapists work to enable people and communities to live their best lives. They work with people of all ages, focusing on the ways in which time spent influences health and well-being, this could be playing sport, through going to work and or a caring for others. But perhaps most importantly, occupational therapists focus on the areas which are identified by people as most important to them, working further to support and enable the person to lead a purposeful, fulfilling life. Irrespective of practice setting, occupational therapists have a vital role to play in public health promotion, including dementia risk reduction across the life span. More widely the profession are experts in advocating the right to occupation (what we want, need, and must do as part of our everyday lives) to empower people living with dementia, and those who support them, to maintain and sustain a positive life for longer.
This framed our ambition to come together as co-editors of a new publication “Occupational therapy and dementia: promoting inclusion and opportunities for people living with dementia”. Over forty co-authors have contributed to this book and their generosity and willingness to share their expertise from both within and beyond the profession of occupational therapy has been overwhelming.
Book content aims to share our ambition to inspire occupational therapists of today and tomorrow, to be future leaders, innovators, researchers, and rights-based practitioners in dementia. It does so by highlighting examples of ground-breaking work by occupational therapists and inter-professional colleagues, that we hope will inspire, challenge and encourage readers to be a rights-based practitioner. Each chapter in the textbook offers examples of how and in what way occupational therapists (potentially others also), can respond to and reflect on, a human rights-based approach to dementia practice. To highlight ideas and examples of content included in the book, we have organised three free webinars, which follow the structure of the text; person, environment and occupation.
At our third webinar you will meet all four editors and hear from authors who contributed to:
Chapter 13. The Pool Activity Level (PAL) Instrument (Jackie Pool, Lix Copley and Sophie Dickinson)
Chapter 14. Occupational Therapy Home Based Memory Rehabilitation (OTHBMR) (Alison McKean, Mary McGrath and Gillian Gowran)
Chapter 16. Working with People with Dementia and their Caregivers (Caroline Kate Keefe, Alison McKean, Jill Cigliana, Kari Burch and Catherine Verrier Piersol)
Chapter 17. Challenges and Opportunities in Occupational Therapy Research (Jennifer Wenborn and Alison Warren)
Keep in Touch
Fiona, Alison, Elaine, and Lyn can be found through Twitter, now known as X. If interested in further supporting our conversation with occupational therapists, consider using the #ROARdementia acronym to reach out via X/twitter or Instagram.
As I come to the end of my journey as an art therapist trainee, I have learned various skills and techniques that shaped my understanding and practice when working with people with dementia. Here are the top five lessons gained from my placement experience.
First and foremost, I understand the significance of building and warming up the therapeutic relationship. Creating a safe space for clients extends beyond the physical surroundings, it involves establishing clear time boundaries. To enhance this, I make it a practice to gently remind the client when there are only 5 minutes remaining in our session. Trusting the process is vital; change may unfold gradually when you consistently maintain the same time and space within the therapeutic setting. Besides, each session begins with a transitional period, allowing clients to shift from being alone to connection. It is a crucial foundation for the therapeutic work that lies ahead.
Another lesson I have gained is the importance of fostering a client-led environment, where we respond to what the clients bring into a supported setting. Some individuals with dementia express a desire for sensory experiences therefore, I introduced food ingredients as a creative medium. This adjustment not only catered to their sensory needs but also reinforced the idea that the art therapy space is one where their individual need is acknowledged and embraced. Importantly, it ensures they can express themselves in a secure environment.
Moreover, I’ve come to appreciate the profound impact of attachment in therapy. Attachment is one of the psychological needs of people with dementia in Tom Kitwood’s framework. When working with people with dementia, physical touch plays a crucial role in fostering a sense of bonding. A shared dance during the music therapy group or a handshake at the end of therapy session served as bridges, allowing the clients to feel a connection that transcended the boundaries of verbal communication. At the same time, it is essential to attune with the client, respecting their preferences regarding physical touch and acknowledging their choice to engage in such connections.
Utilizing music to art therapy emerged as my fourth valuable lesson. As I learned in university, the way the brain changes in Alzheimer’s disease does not seem to match up much with the part of the brain responsible for remembering music. Therefore, people who are living with dementia frequently maintain the capacity to recall and remember music. Using music that resonates with the client during art therapy sessions is crucial to motivate their active participation. Moreover, I found that music is a powerful tool to soothe anxieties or frustration, allowing clients to delve deeper into the creative process. Therefore, the intertwining of art and music can motivate clients, making them more willing to participate in the therapy session. I have experimented with integrating visual art and music by synchronizing the drawings with the rhythm of a song. This approach enhances the client’s willingness to participate with the art materials.
Lastly, I have found that individuals with advanced dementia possess the capacity to form new and positive relationships. Despite the challenges that advanced dementia may post across various aspects of their lives, the potential for cultivating positive connections remains. They can convey their feelings through non-verbal means, such as smiling joyfully or seeking connection through gestures. Being present and connecting with the client is crucial, and they can sense it. In my perspective, when engaging in art therapy with people with dementia, the objective is not to provide training, but rather to enrich their overall quality of life.
Discussion questions:
Have you ever participated in any art therapy session or witnessed its impact on someone you know? Share your experience and thoughts on how creative expression can contribute to well-being.
Before reading this blog, what was your perception of individuals with dementia? How does the blog challenge or reshape your understanding of the potential for positive experiences through art therapy?
Contributor
I’m Kwan Yiu Wong (Kylie) who previously worked as a social worker in Hong Kong at an elderly centre serving individuals with dementia. Currently, I am enrolled in the MSc Art Psychotherapy program at Queen Margaret University, and I am undergoing my placement in an NHS ward dedicated to people with dementia.
Disclaimer: The view expressed in the above blog are solely my own opinions and do not represent the stance of QMU, NHS or any of my academic work. However my placement provider was aware and supported me writing this blog.
Little things which can enhance the quality of person-centred communication
By Frank O’Hagan
“Everything starts and ends with successful communication.” (Anonymous)
Introduction
Carers always need to be mindful that, as far as dementia is concerned, communication can be both complex and tricky. It calls for careful consideration being given to aspects of talking, listening, reading, writing, and technological usage. Each of these forms of communication are multi-faceted and overlap to some extent. Thoughtfulness and sensitivity are required in the use of both verbal features such as speaking, writing messages, labelling, singing, and non-verbal aspects for instance pointing, signaling, touching, and so forth. All have a role to play in ensuring that clear-cut messages are conveyed meaningfully and efficiently.
The effectiveness of exchanges is dependent on the quality of a person’s physical wellbeing (such as hearing and sight), mental health (for example, awareness and comprehension), interpersonal skills (abilities in relating to others), and context (whether at home or in an unfamiliar place, levels of noise, and interruptions, etc.) Caregivers have the task of taking full account of these variables every day and sometimes even on a moment-to-moment basis in a period of crisis.
Although this post is focused mainly on communicating with persons experiencing dementia, the ideas presented may also be supportive for others with hearing loss, people with trauma-induced problems, or having significant learning impediments. The good news is that it is amazing how dedicated carers can intuitively acquire appropriate competences to communicate capably in a variety of situations. Key skills include being a patient and expert listener, keeping questions straightforward, and never causing any feelings of humiliation or embarrassment.
Strategic approaches to think through
When trying to understand the nature of communication difficulties, attention to changes concerning the symptoms of dementia, making the most of existing circumstances, asking appropriate questions, and having the ability to cope with ‘outsiders’ are of importance (Volkmer, 2023). In practice, there is a wide range of beneficial interactions to employ during everyday pursuits. Depending on the needs of people with dementia and the setting, some methods will prove to be more successful than others. Routines to bear in mind might include the following.
When addressing persons, face them directly and state their names at the beginning of the conversation to gain attention and to show a genuine interest in their opinions.
Be on the outlook for confused or puzzled expressions which indicate that you are not being understood.
Avoid statements or requests which are too intricate for the listener. Now and then, Joseph Priestley’s warning is pertinent – “The more elaborate our means of communication, the less we communicate.”
Re-phrase or repeat succinctly if a suggestion is not being conveyed adequately. Give the listener sufficient time to reply to comments and questions.
Try your best to prevent anyone from ‘talking over’ or ignoring a person experiencing difficulties and only conversing with you.
To ensure that the topic or object which is being discussed is clearly comprehended, it is often helpful to explain and to point simultaneously. (Illustrations: (1) When going out for a walk to say “Let’s go now”, point to the door, and then open it. (2) When planning to take a drive in the family car, drawing attention to the passenger seat and inviting your companion to get in.)
Good use can be made of photographs, keepsakes, poetry, and music to recall pleasant memories. This approach – which gradually might become a shared ‘life story’ – could be particularly constructive when individuals are unsettled or distressed. If asked to switch on a playlist of favourite songs, do not be surprised if they join in singing and know all the words, even if at an advanced stage of dementia. Words which you may have forgotten!
Additionally, if you have the opportunity, please consult the ‘Footnotes’ towards the end of this article for hints which may be of value when communicating with someone who has dementia.
Addressing challenges which caregivers may encounter
Carers can enhance the quality of their own lifestyles, and those of persons for whom they care, by way of their well-judged management of practices and resources which help to administer and structure busy schedules (NHS Health Scotland, 2013). Communication, in a wide-ranging and all-embracing perception of the term, can encompass some or all of the undermentioned procedures.
Devising comprehensive checklists to cover all essential aspects of maintenance and safety in the home such as locking the main doors particularly at night-time, closing windows, how to control the central heating system, etc.
Sticking notices or ‘post-its’ in prominent places as reminders of when to engage in pastimes or recreational interests, have meals, and carry out household chores.
Placing labels – maybe combined with colour-coding – on drawers, wardrobes, and cupboards to make it easy to find clothing, shoes, and utensils (Scottish Dementia Working Group, 2017).
Making use of a traceable security wallet to safeguard items which might frequently be misplaced or lost such as keys and tickets.
In addition, utilising technological appliances can be of great value in the forward planning of weekly duties and responsibilities. In the case of those facing difficult circumstances, programs can be devised to remind or alert carers about their timetable for tasks concerning dressing, toileting, medication, meals, outings, and so forth. Technologies also are supportive in: sending out up-to-date information on local events; providing friendship toys, games, quizzes, and other forms of entertainment; tracing someone who is missing; and directly contacting friends, neighbours, or social services when emergencies arise.
“Communication is one of the most important skills you require for a successful life.”
(Catherine Pulsifer)
Some further comments regarding non-verbal communication
Various forms of non-verbal communication, usually together with speech, are advantageous in the course of transmitting and reinforcing advice and guidance. These include:
Gestures – perhaps raising a thumb or clapping to communicate approval for an achievement. Likewise, ‘body language’, for example facial expressions such as smiling will show happiness and pleasure whereas grimacing will convey disapproval.
Modelling techniques – to demonstrate how to carry out specific practical activities (e.g. carefully showing someone how to use a remote control; or to stand in the correct space for taking a shower, and then asking for your actions to be copied).
Mirroring (occasionally referred to as adaptive interventions) – to follow or adjust to the same or similar styles, signs, sayings, and habits of persons who are being helped. In this way, a carer can learn how best to simulate and employ an individual’s preferred processes of communicating.
Showing love and affection – to send very positive and uplifting messages. For instance, when someone living with dementia is having a bad day, a gentle hug may be sufficient to bring solace. Similarly, it is no surprise when a kiss from a partner, a child, or grandchild turns out to be a powerful means of restoring self-confidence and assurance.
A cautionary note: “Not all tools and techniques will be suitable for every individual or every time, and so a modifiable suite is recommended to allow adaptation, for example, as dementia further progresses.”(Collins, 2022)
Supporting carers
All carers require social meetings during which they can share their lived experiences with others in order to evaluate their own inputs, learn about best communicative practices, and gain added knowledge of ‘what works’ when challenging occasions occur. Effective forms of collaboration are essential in ensuring that ‘living well with dementia’ becomes the norm within modern society.
Carers deserve and will profit from expert professional advice and assistance to enable them to extend their interpersonal skills including those pertaining to consultation, communication, and the exchange of ideas. Nationally, they will benefit from more breaks to learn about current developments, hone their strategic competences, and evaluate which technological inputs would be most appropriate to meet their requisites.
A consistent message to carers must be to remember that they always should take good care of their own health and wellbeing. Importantly, they require to have opportunities in ascertaining on how best to relax, particularly after stressful incidents, perhaps by way of engaging in artistic activities, listening to music, watching a comedy series on television, or taking a mindful walk.
As a carer, you are an indispensable agent in safeguarding and maintaining high quality support. Your compassion and expertise matter. You matter!
Footnotes
An information sheet of Alzheimer Scotland provides the following ‘12 helpful hints’ when communicating with someone who has dementia. (1) Be calm and patient; (2) Face the person, speak clearly and slowly; (3) Make sure that you have their attention by gently touching their arm and saying their name; (4) Use short, simple sentences and say exactly what you mean; (5) Try to get one idea across at a time; (6) Allow plenty of time for the person to take in what you say and to reply; (7) Try not to confuse or embarrass the person by correcting them bluntly; (8) Use questions which ask for a simple answer; (9) Don’t ask questions which test their memory. e.g. ‘Who am I?’ or ‘What did you do yesterday?’; (10) Talk about familiar people, places and ideas; (11) Use the names of the people you are talking about instead of ‘he’ or ‘she’. It will remind the person of who you are talking about; (12) Use facial expressions and hand gestures to make yourself understood. (Alzheimer Scotland, 2023)
Also available are Tips for Talking developed by our speech and language therapy colleagues that you can find here.
Additionally, other suggestions regarding communication and dementia are available on the Better Health Channel and, for good mental health, in an article entitled ‘Good Practices: Good Mental Health among Carers’. (See links in References below).
References
1. Volkmer, A. and others (2023) – Giving Voice to People with Dementia and Their Carers: The Impact of Communication Difficulties on Everyday Conversations. International Journal of Qualitative Methods, Volume 22.
2. NHS Health Scotland (2013) – Younger people with dementia. Living well with your diagnosis.
3. Scottish Dementia Working Group (2017) – Our “Top Tips” for living well with dementia. Alzheimer Scotland – Action on Dementia.
4. Collins, R. and others (2022) – Methods and approaches for enhancing communication with people with moderate-to-severe dementia that can facilitate their inclusion in research and service evaluation: Findings from the IDEAL programme. Dementia, Volume 21, Issue 4.
8. A related animation entitled “Communication Matters: The Little Things Which Can Enhance the Quality of Person-Centred Communication” has been designed and produced by Caitlin Quinn and Lucy Beckett.
Acknowledgements
My thanks are due to Elaine Hunter, National AHP Consultant, Alzheimer Scotland/Visiting Professor, School of Health and Social Care, Edinburgh Napier University, and to Caitlin Quinn and Lucy Beckett, students of speech and language therapy, University of Strathclyde, for their very helpful support and for providing splendid company during the writing of this paper.
COMING SOON. A co-designed animation in partnership with Frank and the Caitlin and Lucy as part of their impact project internship with Alzheimer Scotland. Follow @NDCAN_Scotland and @AHPDementia to find out more.
Frank has shared this post already at his own blog site here and gave us permission to repost.
The Technology Wall at the Alzheimer Scotland Brain Health and Dementia Resource Centre, Kirkcaldy, Fife.
Hello! My name is Eva O’Callaghan and I’m an MSc in Occupational Therapy student at Edinburgh Napier University. I completed an eight-week placement between NHS Fife and Alzheimer Scotland at the end of last year, where I spent two days of each week at the Alzheimer Scotland Brain Health and Dementia Resource Centre in Kirkcaldy. I am keen to share my learning with you from my time with Alzheimer Scotland as it relates to the Person Environment Occupation Model of Occupational Therapy (Law, 1996).
Person
Dementia is not part of the normal aging process. It is a neurocognitive disorder, meaning it affects the brain in how a person remembers and thinks.
Most people diagnosed with dementia are over the age of 65. However, some people can be in their 50s or early 60’s when they receive a diagnosis.
Women tend to be more likely to develop dementia than men.
Some conditions may increase a person’s risk of developing dementia, such as Down Syndrome, some Cardiovascular Conditions, Traumatic Brain Injury, some Mental Illnesses, and some Sleep Disorders.
A person’s lifestyle choices such as smoking, excessive alcohol consumption, a sedentary lifestyle or poor diet may also increase their risk of developing dementia.
Dementia will present differently from person to person. A person with dementia may present with Memory loss, Disorientation and/or Confusion, Personality and/or Behavior Changes, Impaired Judgement/Decision-Making and Initiative, Mood Swings, Language/Communication Problems…
The person living with dementia is not defined by their diagnosis. Each person living with or who has lived with dementia possesses distinctive qualities. That is, their own personality, skills, interests, and beliefs, amongst others.
Environment
The physical environment at the Alzheimer Scotland Brain Health and Dementia Resource Centre in Kirkcaldy follows the Alzheimer Scotland’s Environmental Audit Tool.
Alzheimer Scotland works in conjunction with the Health and Social Care Standards ‘My Support My Life’. The Resource Centre visibly demonstrates their meeting of these standards through the framing of specific standards and placing of them next to relevant features of the space.
Technology also plays an important role in creating a dementia-friendly environment at the Resource Centre (See Image). I had the opportunity to attend a training session for the use of Virtual Reality Headsets in Dementia Care during my placement.
The social environment of the Resource Centre incorporates service users, and sometimes their loved ones, staff and volunteers.
Other environmental factors for consideration include cultural and socioeconomic. For example, what kind of funding is available in Fife for these resources, and what impact could this have on the physical environment available to service users? Or, what are the cultural beliefs in the surrounding areas regarding Dementia, and how could this affect Dementia Care?
Occupation
In Occupational Therapy, occupations refer to anything a person does to occupy themselves. Occupations can be categorised into self-care, productivity and/or leisure.
Someone living with Dementia may experience difficulties with, what we call in healthcare, ‘Activities of Daily Living’ or ‘ADLs’. These include mobilising, transferring, toileting, bathing, dressing, managing medication(s), preparing food and drink, feeding and drinking, shopping, and so on.
Occupational Therapists work to enable people with a variety of difficulties to participate in their necessary ADLs and in occupations that are meaningful to them.
During my time at Alzheimer Scotland, I attended a number of groups centred around meaningful occupation – a snooker club, a baking group, social groups, a seated exercise group, and daycare – which was made up of meaningful activities. Toward the end of my placement, I had the opportunity to lead a group activity focused on reminiscence during daycare.
Overall, this was a highly valuable placement for a Pre-Reg. Occupational Therapy student. I am now far more comfortable talking about dementia and going on to provide care and support for those living with dementia and their loved ones.
Reference: Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63 (1).
Let's Talk about Dementia 