On Oct. 27, I attended a conference hosted by the Alzheimer’s Association here in the bay area. There were about 400-500 people in attendance many of which were family caregivers looking for advice for their loved ones. The workshops covered topics such as moving a relative, home safety, and Alzheimer’s research.

The most compelling workshop was given by Bonnie Bollwinkel. There is a fairly new program available in a variety of regions called “The Savvy Caregiver.” Bonnie shared a module of this program with the audience. She introduced the concept of “Contented Involvement” - where the person with dementia is performs appropriate activities in a state of calmness and comfort.

She began by leading the audience in a guided imagery exercise. We all closed our eyes and imagined we were driving on a busy highway, in snow, with wipers not working very well, and the radio at full blast. I could feel the tension in my body as I imagined this. I began to feel stressed, scared and confused. This is what people with dementia feel frequently because their perception of their environment is confused causing these emotions. I suddenly had a new appreciation of what dementia is like.

Bollwinkel then lead us through a much more pleasant and relaxing guided imagery exercise where we all felt positive, in control, and relaxed. Her point - the antidote for confusion is contentment. Finding and guiding your loved one through activities that result in contented involvement are really important but require some changes in thinking.

Individuals with memory-loss problems first forget the purpose (why am I doing this?), next the order or sequence of activities, and finally what things are for. Familiar objects no longer are familiar - for example, a spoon becomes a foreign object. By assigning or having loved ones participate in daily tasks, we can draw them into life and avoid distress and conflict.

The caregiver should focus on the process of the activity - not the result. Many of us are worried about things not “turning out” perfectly so this represents a big shift in thinking. We guide our loved one through an activity, focusing on the steps themselves, not the end product.

To get started, the caregiver learns how to assess their loved one’s level of functioning. What stage is he/she at? What can he/she realistically do? There’s a balance between keeping him/her safe and maintaining self-esteem by letting the loved one keep activities. A patient in early stage of dementia still can do quite a bit on their own - complex parts of a task should be removed though. He/she can probably manage about 4-5 steps. Suggestions for tasks to assign to the loved one include getting things from another area or measuring and mixing things together in the kitchen. Bollwinkel cautioned that the caregiver needs to be careful with his/her emotions keeping him/her from recognizing what the loved one can do. Emotions can really get in the way of this process.

The caregiver should then identify what makes the person with dementia content. What makes the loved one happy and peaceful?

Finally create or match a task to the person. Breaks down the task into steps. The caregiver should be proactive and in control throughout the process providing structure and support. As the loved one proceeds the caregiver should be ready with the next step (what’s the next step? What’s the missing word?). The type of communication varies depending upon the stage of dementia but regardless, the caregiver should remain positive and supportive.

This tool can help people with dementia feel involved and content while avoiding distress and difficult behaviors. This introduction to contented involvement and its valuable potential made me curious about what else I might learn in the Savvy Caregiver course.

Additional Resources:
Alzheimer’s Association - Northern California and Nevada Chapter Website
The Savvy Caregiver - a evidence-based training program for those caregiveing for a relative or friend with Alzheimer’s disease or another dementia.

Filed under: Caregiving