Canadian Association of Occupational Therapists

Using the senses to connect with someone who has Alzheimer's

The primary sensory areas of the brain remain relatively untouched by the processes of Alzheimer's disease (Aronson, 1988; Zgola, 1987). Experiencing the touches, smells, movement, sights, sounds and tastes of everyday life can serve as an ongoing source of pleasure, stimulation and method of communication.

Please meet Mr. D., a distinguished, balding elderly man with an engaging smile. Trouble is, neither his wife of more than 50 years, nor his children, nor the staff in the institution where he lived saw it much any more. What they saw was a severely disabled man, who apparently recognized none of his loved ones or caregivers, and out of the grey confusion which made up his world, forcefully resisted the full care he so much needed. He no longer fed himself and spent most of his day sleeping or staring off into space. On rare occasions he might utter a solitary, unconnected word. Mr. D. was severely impaired due to Alzheimer's disease.

It was almost Halloween the first time Mr. D. came to the sensory stimulation group. When his chair was wheeled to a place at the table, he didn't even open his eyes. Our department garden had produced a fine, brilliant orange pumpkin which I had brought to group that day. I placed the pumpkin in front of Mr. D. without getting a response. While verbally introducing myself, and mentioning the day and the season, I gently guided Mr. D.'s hands to the cool, ridged surface of the pumpkin. Suddenly, his eyes were open, sparkling with life. This man, who hadn't spoken a sentence in weeks, hefted the pumpkin, eyed it approvingly and said, "Well, now, isn't that a dandy. Where ever did you get that?" That day, after the other sensory experiences of the group and almost every day thereafter, Mr. D. put in the milk and sugar and stirred his own tea.

This account may seem trivial, but underlying it is the fact that unless one steps into the world and hearts of people severely disabled by Alzheimer's disease and related dementias (ADRD), it is impossible to imagine the significance of being able to perceive, appreciate and respond to an ordinary item in the environment, like the lowly pumpkin, or the immense satisfaction of being able to prepare your own tea. These simple acts of daily life become rare gifts; gifts that enable someone with ADRD to be competent once again and feel affirmed as a person. Caregivers who are able to appreciate these occasions as gifts also share in them. Mrs. D. once said, "If only I could see him smile once again, it would do my heart such good." In fact, she saw this and much more.

A few months later, Mr. D. joined a group engaged in a variation of sensory stimulation - eating stimulation (Bowlby, 1993). Prompted by physical and verbal cues, the home-like environment and the enhanced sensory cues of the tastes and smells of pre-meal activities in this group, Mr. D. began to feed himself for the first time in seven months.

Such progress is not possible for everyone who is severely disabled by ADRD. However, with enhanced and guided sensory stimulation, it is possible for everyone to appreciate and respond to the rich sensory world of smells, movement, touch, sights, sounds and tastes, which they are often isolated from by their disease.

Using Sensory Stimulation in everyday activities

In order to make use of the senses for stimulation it is important to:

a. Use familiar, everyday objects (for example, fresh flowers or an orange).

b. Focus on only one sense at a time (for example, the smell of the flowers or the feel of the orange skin).

c. Draw the person's attention to the item (for example, by placing the flowers under her/his nose or gently placing hands on the stems).

d. Encourage the person to make an adult, functional response (for example, putting the flowers in the vase or peel and eat the orange).

Everyday activities provide thousands of opportunities for sensory stimulation. Using steps (b), (c), and (d), above, caregivers can enable the person to be more responsive and involved in life, as well as provide pleasurable sensory experiences.

Characteristics of Useful Sensory Cues

  • Familiar (e.g. foods, clothing articles)
  • Adult (e.g. pen & paper)
  • Natural materials (e.g. flowers, pine cones)
  • Every day, sensory rich materials (e.g. pieces of wood, grooming articles)
  • Obvious functional response (e.g. snack to eat)
  • Not dangerous, toxic or likely to cause allergic reactions.

Using Sensory Stimulation During ADL

Everyday activities present endless opportunities to use sensory stimulation techniques, which always provides pleasure, and often facilitates "occupation", or interaction with the environment.

  • Introduce the activity using the person's proper or preferred name. As you speak to the individual, provide reassuring orienting information, such as, "Good morning, Mrs. MacDonald. I have brought you some toast for breakfast on this sunny Wednesday in June."
  • Use a verbal approach which encourages a positive response, and nonverbal cues which communicate warmth and reassurance.
  • Target one particular sense at a time, such as the delicious smell of the morning toast.
  • Reduce confusion and competing stimuli. Place only the toast in front of the person, not the whole meal.
  • Provide verbal and nonverbal prompts to encourage a related functional response. For example, provide hand-over-hand guidance to bring the toast to the persons' mouth.
  • Make connections with personal interests or habits. "here is some delicious strawberry jam to put on your toast. What is you favourite kind of jam?" Or, "Did you make strawberry jam?"
  • Give ample, but not excessive positive feedback, using caring personal touch. Squeeze the person's hand or put your arm around her/his shoulder. Give verbal praise: "Great! You have eaten the whole piece of toast. That will give you energy for the day."

Structured sensory stimulation groups are a skilled and specialized intervention but every caregiver can enhance both the pleasure and responsiveness of the person with ADRD by using some of these basics of sensory stimulation.

References/readings

Aronson, M. (Ed.) (1988). Understanding Alzheimer's disease. New York: Charles Scribners and Sons.

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.

Excerpt from
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:

Related consumer tip sheet: Reducing Caregiver Stress 


Articles

Bowlby-Sifton, C. (1997). The dementia story: Challenging the art of occupational therapy. Canadian Journal of Occupational Therapy, 64, 3-6.

Abstract
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  


Book Reviews

Keeping busy: A Handbook of Activities for Persons with Dementia. (1995)

James R. Dowling

The Johns Hopkins University Press
2715 N. Charles St.
Baltimore, Maryland,
USA, 21218-4319
178 pages

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.