Encouraging social skills in someone with Alzheimer's
Before bringing her mother to the adult day program, Nancy was invited to spend the morning getting to know the other participants, observing and joining in the activities. As she spent time singing, cooking and reading the newspaper with the participants, she noticed one person who seemed especially skilled at getting everyone involved. Nancy decided she would join this person at coffee break to learn more about this energetic volunteer. She began by complimenting her on her ability to generate enthusiasm and participation. Nancy then said, "I'm sorry, but I didn't catch your name." A look of panic overtook the "volunteer" and she said, "I forget." In fact, this person with the exceptional social skills was herself a program participant, and was so impaired that she couldn't remember her own name.
For this person, and others with Alzheimer's and related dementias, overlearned social skills persist until death (Bowlby, 1993; Mace 1990; Reisburg 1983; Zgola 1987). This is a particular asset in the home setting, where environmental and other familiar cues support social skills. The home caregiver, however, may be so preoccupied with the overwhelming losses and deficits in other skills as to overlook this asset. It may be hard for family members to appreciate that while the person is no longer able to, for example, prepare lunch for a friend, greeting the friend at the door and serving as a hostess at the table is still possible. Such occasions frequently enable the impaired person to demonstrate skills thought long forgotten. It be must remembered, however, that this will require a great deal of energy and the person may need extra rest and quiet afterwards. While social occasions help to support self esteem, there must be a balance. Large and noisy gatherings may overwhelm the person with too much stimulation, and even lead to a catastrophic reaction.
It is important to note that both verbal and non-verbal social skills are a continuing ability which should be supported. The more socially skilled the person has been, the more these skills can be called upon. However, basic adult social greetings, or what might be called cocktail party conversation can be called forth from most. Some sample phrases might be "nice day", "pretty dress", or "delicious coffee".
The handshake is also an excellent example. With proper cuing, even individuals in the advanced stages respond by shaking an outstretched hand, held out in greeting. If the greeter smiles warmly and asks, "How are you?" there is more often than not a smile and a "Fine, thank you" in return.
The simple handshake is a wonderful way to accomplish many ends. Through touch, perhaps clasping the outside of the hand as well, the greeter communicates caring. It serves to bring the individual to attention, initiates eye contact, and increase alertness in an adult, socially appropriate and familiar way. It causes the person to initiate movement and perhaps speech. And above all, it supports self-esteem by acknowledging the person in a familiar, adult way.
By supporting and encouraging sociability this persisting skill can help compensate for losses in memory, reasoning, and language. Returning a standard greeting with a generic social response doesn't require remembering the person's name and, because the phrase is an overlearned one, it doesn't require more complex verbal and reasoning skills.
In a typical scenario, a family member might say, "Mom, this is our old friend, Wayne, visiting from Hamilton, Ontario." The mother could then reply, "I am so glad to see you again, how are you?" The family member provided the cues, so the mother wasn't struggling for the name, and standard social responses were made. The mother was happy to be able to participate in welcoming the old friend and was saved the embarrassment of admitting to not recognizing him. Dignity and adult function were preserved.
While these skills must be encouraged, it is also important that family and professional caregivers not mistake social skills for the persistence of higher skills, such as memory. Many individuals with ADRD, especially in the early and middle stages, cover their losses by relying on these skills. This is an excellent coping mechanism in social situations, but should not be mistaken for actual skill in vital areas of self-maintenance such as nutrition (e.g. "No thank you, I already had a delicious supper.") taking medication, or safety.
In the preceding illustration, the visitor was impressed to have been remembered and thought that the mother's memory must be quite good. After he left the room, she quietly said, "Who is that nice man?"
Bowlby, C. (1993). Therapeutic activities with persons disabled by Alzheimer's disease and related disorders. Gaithersburg, MD: Apsen Publishers.
Mace, N. (Ed.) (1990). Dementia care: Patient, family and community. Baltimore, MD: Johns Hopkins University Press.
Reisburg, B. (Ed.) (1983). Alzheimer's Disease: The standard reference. New York: The Free Press.
Zgola, Y. (1987). Doing things: A guide to programming activities for persons with Alzheimer's Disease and related disorders. Baltimore, MD: Johns Hopkins University Press.
Zgola, Y. (1992). The tea group: A special programme for the "difficult" resident in long term care. Physical and Occupational Therapy in Geriatrics, 104 (4): 1-16.
Canadian Association of Occupational Therapists & Alzheimer Society of Canada. (1998). Living at home with Alzheimer's disease and related dementias: A manual of resources, references and information. Ottawa, ON: CAOT Publications ACE.
Available from CAOT at 1 (800) 434-2268, ext. 263 or by e-mail.
This book was researched and written for CAOT in conjunction with the Alzheimer Society of Canada by Carol Bowlby Sifton. It is a guide for both caregivers and professionals on how to work collaboratively to enable people with Alzheimer's disease and related dementias (ADRD) to live at home for as long as possible.
Other excerpts from the book appear on the following skills for the job of living tip sheets:
- Using the senses to connect with someone who has Alzheimer's
- Emotional awareness and emotional memory
Related consumer tip sheet: Reducing Caregiver Stress
Bowlby-Sifton, C. (1997). The dementia story: Challenging the art of occupational therapy. Canadian Journal of Occupational Therapy, 64, 3-6.
The art of occupational therapy may be understood as getting in touch with the life story of our clients, and the science, finding ways to enable the continuing unfolding of that story. The story of Frank and Emily is an illumination of the ways in which occupational therapy practice can participate in this unfolding, with persons with Alzheimer's Disease and Related Dementias (ADRD).
For the full paper in Acrobat PDF format download ADRDBowlby97.pdf
Keeping busy: A Handbook of Activities for Persons with Dementia. (1995)
James R. Dowling
The Johns Hopkins University Press
2715 N. Charles St.
Keeping Busy is based on the experiences at the Alzheimer's Care Centre in Maine, USA as described by the author, James Dowling. This is a residential care facility for individuals with Alzheimer disease and Related Dementias. The intent of the book is to provide practical ideas and share successes and failures for others to use. It would be of greatest benefit to caregivers in established residential settings looking for new programming ideas, as well as those implementing a new programme.
Dowling is described as an activity specialist, who frequently conducts workshops on behaviour management of persons with dementia. He demonstrates an empathy toward the need of the older adult with cognitive impairment and an obvious enthusiasm for his work, however the ideas presented are not unique. The principles are congruent with the practice of occupational therapy, with an emphasis on purposeful activity and task breakdown to meet individual client needs. Activity is described for a person with dementia as "everything a person does" with the "most valuable dementia activity as work that is tied to the life of the home".
The book is divided into 12 chapters, focusing on different activities such as music, cooking, gardening, art and exercise, all with many practical suggestions, and includes a variety of anecdotal stories about certain residents. Appendices include an overview of Reality Orientation, a daily activity schedule and the five basic steps of Remotivation Therapy. There is a list of (American) resources, a bibliography and a well-organized index.
Although this book reiterates much in the field of programming for the cognitively impaired, it does provide a broad overview in an easy to read format.
— By occupational therapist Catherine Brock
Other sources of information
The Alzheimer Society of Canada has a nation-wide network of provincial and local organizations that provides support, educational resources and programs for people with Alzheimer's Disease and their caregivers. Visit their web site at http://www.alzheimer.ca
For a copy of the brochures "10 Signs of Caregiver Stress" and "Reducing Caregiving Stress" call your local Alzheimer Society or 1 (800) 616-8816.
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