Activity-Focused Dementia Care

Activity-focused dementia care stresses the importance of activity as personally meaningful occupation in the lives of those with dementia. In this approach to care, caregivers make a commitment to doing activities with care recipients rather than for them, which helps care recipients to maintain and perhaps even improve their skills and capacities. Caregivers recognize and compensate for dementia-related impairments by identifying and encouraging the use of the care recipients’ retained physical and motor, cognitive, emotional, social and communicative capacities.

People with dementia are highly vulnerable to rapid functional decline, because they are dependent on caregivers to help them use their remaining skills and capacities. Without continual use of remaining skills, people may eventually lose those skills and develop excess disability (disability beyond what is expected from the brain damage associated with the dementia). Activity-focused care can help to prevent excess disability and preserve functional capacities
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By using strategies to create a supportive environment and to enable the person with dementia, caregivers can increase the likelihood of successfully completing meaningful activities. Strategies include removing visual and auditory barriers to activity participation and creating individualized occupational spaces that provide access to familiar tasks. Activities can be selected or adapted using Zgola’s hierarchy of grading so that the activities are within the skill level of the care recipients.Caregivers can use practical strategies for selecting, guiding, and terminating activities to increase the likelihood of obtaining the benefits of activity-focused care. By following a hierarchy of task assistance, caregivers can provide the least amount of assistance possible so that the person with dementia independently does as much of an activity as possible. The hierarchy of task assistance includes:

  1. Set-up: Adapt an activity environment to increase the likelihood of successful participation.
  2. Supervision: Supervise rather than do the task for the person.
  3. Verbal and physical prompting: Prompt only as necessary to keep the person engaged.
  4. Direct cueing and initiation: Limit verbal directions to one or two-step commands. Providing brief physical direction may be able to jump-start a movement that the person could not independently initiate.
  5. Assistance with sequencing: Some persons may need help with the order of the steps needed to complete a task.
  6. Direct physical assistance: Provide only the level of physical assistance needed to ensure safety and effectiveness with the task.

Activity-focused care is person- and abilities-focused care that promotes dignity and respect for the individuals. Care is individualized to each individual’s wants and needs based on knowledge of the care recipient’s meaningful life experiences, past roles and accomplishments, cultural background, beliefs, values, preferences, characteristic habits and routines.

Meaningful activity can be incorporated throughout the day to reduce and prevent excess disability and promote the well-being of both the caregiver and care recipient. Studies have shown that activity-focused dementia care can help to reduce distress, agitation and other problematic behaviors and possibly redirect them into positive behaviors. It is the responsibility of all caregivers and anyone involved in the person’s care to provide activity-focused care across the day to make it a reality.

This article is adapted from an original manuscript authored by Wendy Wood, PhD, OTR, FAOTA, with editing and additional material contributed by Mindy Kim-Miller, MD, PhD.

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