____ Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded ACCOMMODATIONS FOR SAFE DISEASE PROGRESSION ACTIVITIES FOR THE PATIENT WITH AD OR OTHER DEMENTIA
As AD progresses, people may require oversight provided by a residential community. Most people intend to age in place at their homes, but disease progression may present limitations for safety, mobility, and socialization. Ideally, a person would determine a plan of care in the early stages of AD, but this does not typically happen. Limitations of caregiving combined with an increased need for care prompt loved ones to explore day care options and/or residential options with 24-hour care. Adult Daycare Adult daycare programs are located throughout the U.S. They allow the person to remain in the home with supervision but have a full structured day in a safe environment. These programs may be run by nonprofits with a sliding fee scale, or the cost can be covered in part by Medicaid. These programs include meals, activities, toileting support, rest, and sometimes transportation. Assisted Living Facilities (ALF) ALF may be appropriate for earlier stages of dementia, as they adjust the level of care to accommodate the disease. And they often have separate memory units to provide higher levels of care. These facilities can be paid for by long-term care insur- ance, private pay, or Medicaid. Memory Units These units are designed specifically for the patient with dementia. Buildings are often structured to safely accom- modate wandering and mobility, and they provide structured activities for stimulation and engagement. There is a higher ratio of professional caregivers to patients. These facilities can be paid for with long-term care insurance, private pay, or Medicaid. Skilled Nursing Facilities (SNF) Skilled nursing facilities (SNF) are long-term living facilities for people who require extensive 24-hour care. Patients experienc- ing end-stage AD may move to a SNF for care. These facilities are the most expensive of the residential options and while a short period of time is covered by Medicare (up to 100 days), there can still be a copayment, followed by the full rate once the Medicare benefit has expired. This can also be private pay or covered by Medicaid. Hospice Hospice services can be appropriate for end-stage AD. Hospice treatment can be brought to the home, the community, or a unit that provides accommodations for overnight care. Addi- tionally, hospice provides respite care for the caregivers for a set amount of time during the service. The hospice benefit is typically fully covered and offers many value-added services. However, the person may have to pay for caregiving assistance if it is needed.
Activities should be adaptable mental and physical options that are integrated into the daily schedule. Physical activity can slow cognitive decline and provide the strength that is neces- sary to perform ADL.THE FOLLOWING ACTIVITIES CAN HELP ENCOURAGE INDEPENDENCE AND IMPROVED QUALITY OF LIFE • Physical activity—walking, light weights, and dancing/moving to music • Sit to stand exercise—practice sitting in a chair and getting up; create a game to encourage participation • Chair-based exercises—this type of exercise accommodates all levels of ability • Engage in activities that are done standing to promote balance (dish washing, meal prep) • Stretching exercises—can be done in bed or on a chair or sofa, and can help with mobility • Tai chi—can be done sitting or standing • Guided meditations—find YouTube videos that are short and engaging • Gardening—this type of activity is often found in communities serving people with dementia, as the process of planting, watering, and cultivating seeds is physical activity that is also engaging and fulfilling • Interactive games and puzzles • Music—this may impact brain plasticity, improving cognition and mood (Flo et al., 2022) ‒ Adjust type of music to person’s taste and response—they may prefer music from their childhood
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Use quiet music as background for a calming effect
Healthcare Consideration: A person’s living environment should be empowering and encourage positive risk-taking, meaningful activities, and a sense of self (Mmako et al., 2020). Ensuring that these concepts are integrated into daily life, in any living environment, can lead to improved quality of life for the patient. Self-Assessment Quiz Question 16. Music therapy is thought to do which of the following? A) Improve cognition and positively impact mood.
B) Cause depression. C) Increase anxiety. D) Encourage music as a second career.
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