The Positive Interactions Program of Activities for People with Alzheimer's Disease By Sylvia Nissenboim, M.S.W., L.C.S.W., and Christine Vroman, L.P.N.

Excerpted from pages 8, 9, and 108 of The Positive Interactions Program of Activities for People with Alzheimer’s Disease by Sylvia Nissenboim and Christine Vroman.

Copyright © 1998 by Sylvia Nissenboim and Christine Vroman. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

All caregivers of older adults with Alzheimer’s disease or a related dementia must learn how to go on living with or working with their failing, frustrated, frightened, and sometimes frightening parent, spouse, or client/resident. Although the day-to-day frustrations felt by these caregivers are being grappled with invarious venues (e.g., support groups) across the United States, little has been done to help them develop ways to interact positively and successfully with these older adults. The Positive Interactions Program can change that. When professional caregivers take the approach of this program they help their clients’ families take a step back from caregiving, giving them respite from those day-to-day frustrations. Family members and their loved ones with dementia can spend leisure time doing planned tasks together that encourage the person in his sense of success and the family in their ability to create a safe, rewarding environment. The activities can help them enjoy each other,  get excited over the recognition of hidden abilities, and see that there can and will be moments of shared enjoyment and pleasure.

The Positive Interactions Program focuses on giving caregivers the tools to create opportunities for people with cognitive impairment to be successful in activities and their interactions with other people. The program comprises a series of guided creative arts, daily living, physical, and sensory activities, which are broken down into individual, sequential steps. The activities and interactions are based on working within the remaining abilities or strengths of the person with Alzheimer’s disease. Such a foundation helps shift emphasis away from what is too often focused on — the person’s disabilities and impairments. Every individual has different strengths and these strengths change as the  disease progresses. The structure of the activities is flexible so that even if the person’s impairment worsens over time, his ability level can be met by adjusting an activity.

The purpose of the Positive Interactions Program is not rehabilitative — the person will not regain lost skills or learn new skills, and caregivers will not achieve success if they aim beyond the person’s ability level. The purpose of the program is to achieve good quality in personal interactions because the person with cognitive impairment, particularly in later stages, is dependent on successful interactions in order to meet his daily living needs. He must be fed, clothed, and kept clean and comfortable. Meeting these needs is never easy when dealing with people with dementia, and with time and the deterioration of the person’s cognitive abilities, completing these tasks becomes increasingly difficult.

The Positive Interactions Program depends on the caregiver’s interest and desire to create opportunities for successful interactions. As a caregiver you can do much more than simply maintain the person who is cognitively impaired. You can interact with him in a way that is planned and guided and that encourages his participation, inasmuch as he is able to do so. The program rewards his attempts at participating in activities and provides him with a sense of being capable and alive, which is emotionally nourishing.

Because the interactions are planned and guided, the Positive Interactions Program provides structured time in the lives of individuals struggling with endless time in a hazy world. The program also can provide a teaching model of interaction for caregivers that will help them structure their days, enhance the time they spend with their clients with dementia, and decrease their frustration level as well as that of their clients. A wealth of abilities lie beneath the frustrations of the person with Alzheimer’s disease. The interactions suggested in the activities that drive the Positive Interactions Program unearth that wealth.

Some caregivers lose sight of their long-term goal: to supply the person with cognitive impairment with supports so that he may participate in the world around him. Often, this oversight occurs because the short-term goal of completing  tasks is seen as the objective. To encourage the person to participate, the caregiver must focus on the fact that the person is involved and satisfied (long-term goal), not on the task or activity itself (short-term goal). The use of activities should be stressed only inasmuch as these are the tools through which caregivers arrive at the person-focused objectives. The following objectives must be realized in every interaction:

• The person must be provided with opportunities to achieve success.
• The person must be provided with opportunities to experience high-quality interactions.
• The person must be accepted at his present level of function.

Sample Activity
Identifying a Scent

Supplies

Four or five scents that may be familiar to the client or resident
A standard picture that is representative of each scent you select

Suggestions: floral scents — a crushed flower, flower-scented cologne, flower scented potpourri, and a picture of a flower; pine scent — pine-scented air freshener, pine needles, pine cones, and a picture of a pine tree; baby scent — baby powder, baby lotion, and a picture of a baby; apple pie scent — cinnamon, apple-scented potpourri, and a picture of an apple pie.

Conducting the Activity

Place the pictures and the scents on the activity table. Select ascent, smell it, and choose  the picture that represents the scent. Repeat as many times as you feel it is appropriate to do so. Although it may be difficult for the client or resident to identify the particular scent, it may trigger memories that involve the scent. Be willing to follow his lead in reminiscing.

Suggested Approaches

Familiarize your client or resident with the scent and the picture that is representative of that scent, along with two or three other pictures that are not related to the scent.

‘‘Here is a cinnamon candle and some pictures.’’

Name the subject in each picture.

‘‘Here is a picture of a pine tree.’’

‘‘Here is a picture of an apple pie.’’

Demonstrate by smelling the scent and point to the picture that is representative of it. Explain why the scent is related to the picture chosen and not to the others.

‘‘I’m going to smell this cinnamon candle.’’

‘‘The smell of cinnamon doesn’t really go with this picture of the pine tree.’’

‘‘The cinnamon smell does go with the apple pie because you use cinnamon when you make apple pie.’’

Encourage and reward his participation.

‘‘Does this smell remind you of anything?’’

‘‘Yes, you’re right. It is baby powder.’’

‘‘Which picture do you think goes with that smell?’’