Encore Communities® & the Best Friends™ Approach

On March 22, David Troxel, MPH, led a webinar on a variety of therapeutic activities for people living with Alzheimer’s and dementia. A key component of Troxel’s Best Friends Approach, these activities can help build self-esteem, preserve cognitive function and create joy – both for people with dementia and those who care for them.

The following post contains a summation of the topics and strategies discussed in this session.
Dementia and Active Participation
While many of us are familiar with the broad range of dementia symptoms – disruptive memory loss, difficulty completing familiar tasks, confusion, and problems with communication – we sometimes overlook how these symptoms coalesce into an inability to partake in social and recreational activities.

For example, an avid walker might hang up his sneakers after getting lost in his own neighborhood. An expert cook may stop preparing meals after finding it difficult to follow recipes, or a seamstress might stop mending garments when her needle and thread become difficult to maneuver.

For a variety of reasons, the cognitive and motor difficulties of dementia often lead people to withdraw from activities that once gave them pleasure, and this type of withdrawal can often lead to social isolation – a state that could potentially accelerate dementia’s symptoms.

Preventing Apathy

When a person is apathetic about taking part in activities – particularly those that once brought them joy – it can be deeply disconcerting. For family members and primary caregivers, a loved one refraining from taking part in tasks may even prevent you from doing so, as well. After all, going for a walk or watching a movie is often much more fun when done with a pal.

One way to address this sort of apathetic behavior is to frame “non-essential” activities as essential. For example, instead of asking your mother if she’d like to go for a walk – to which she could easily say, no – you might say: Mom, I want to go for a walk. Would you mind coming to keep me company?

It’s a basic human desire to be needed and feel useful, and people with dementia are no exception to this common trait. By framing activities in this manner, your mother now feels needed, as though she’s doing you a favor. In many cases, this type of framing can lead to an increased likelihood of participation.

Dementia Care vs. Treatment

While everyone longs for the day when we have veritable cures for dementia and Alzheimer’s, there currently exist only five FDA-approved medications to treat these conditions, and their respective efficacies are highly variable.

Until newer, more effective drugs emerge, we must put much of our focus on the actual practice of caring for loved ones with dementia and Alzheimer’s. By filling a loved one’s day with engagement, activities and social interactions, you can help them find meaning, fulfillment and happiness in their lives.

Providing a Great Day for a Loved One with Dementia

The ideal day for a person with dementia is filled with art, conversation, exercise, animals, spirituality and reminiscing fondly on days past. Essentially, anything that keeps the mind and body active is a worthwhile alternative to sitting on the couch and watching TV for hours on end.

As you might have noticed, people without cognitive impairment would also benefit from all of these activities, and this is a core tenant of a successful approach to dementia care – treating people like people.

Naturally, dementia makes it more difficult to partake in these relatively routine activities; however, with proper planning and support, it can be done!

Take Things Slowly, as Needed

With dementia care, David Troxel notes that it’s about the journey, not the destination. With this in mind, caregivers should feel free to approach an activity or a task in a relaxed fashion, helping their loved one to enjoy, observe and be stimulated by the experience of an activity rather than focusing on completing it.

Troxel goes on to recall one of his favorite activities for people with dementia – building birdhouses from kits. In most cases, the average person could complete this project in under an hour; however, when working with dementia patients, Troxel prefers to let everyone go at their own pace. Rather than focusing on the goal, he stimulates conversation with everyone involved, asking questions about birds, making observations about the wood, contemplating where to place the finished product.

In some cases, the project might end up taking nearly a month to complete; however, along the way, everyone engaged in stimulating conversation and shared memories and thoughts about birds. The project is less about a result and more about creating discussion, learning and the sharing of experiences.

Dining

For many, dining is the biggest activity of the day. As such, you’ll want to brainstorm ways to bring back sociable elements of dining like music, conversation, sharing favorite dishes, serving meals with enthusiasm, and debating the best desserts.

For example, if you’re eating ice cream with your loved one, you might consider asking them what their favorite flavor of ice cream is. You might also consider expanding the conversation to their favorite flavors, styles and types of food.

In a community setting, you can take a poll with several residents – and even have everyone set and decorate the tables together.

Food is an inherent link to culture and history, and by sharing one’s interests in food, you can help unlock the person within.

A Summer Project: Touring Local Ice Cream Shops

While there are few universal truths in life, we can safely say that everybody loves ice cream. One idea that’s effective – particularly for multigenerational participation – is to visit all the different ice cream shops in your area. At each shop, take a selfie, take a menu, and write up your own Yelp-style guide to the best local ice cream shops and put it all in a scrapbook.

When completed over the course of a month, this activity provides a constant source of excitement, and it also allows a group – perhaps a family – to build weeks of memories together preserved in the form of photos.

Classes and Adult Learning

As humans, we never stop learning, and while dementia may make the formal instruction of a topic more difficult, this does not mean we can’t learn by discussing various topics with each other.

Troxel provides an autumn example of leading a discussion on apples. During this discussion, he brought out several topics with his group:

● Old sayings about apples
○ An apple a day keeps the doctor away.
● Trivia about apple varieties
○ Which apples are native to America?
● Recipes and foods used to make apples
○ Almost everyone has a favorite way to make apple pie.
● History of Johnny Appleseed
○ Widely known tales like those of Appleseed often have far more interesting (and lesser known) histories.
● Discussion and debate
○ Which kind of apple makes the best apple pie: Granny Smith or Honeycrisp?

The goal is to generate stimulating and welcoming discussion. If people are talking, thinking, and engaging with one another, then this should be viewed as a success.

Volunteerism

Many senior care communities encourage the purposeful engagement of residents within their communities. For memory care residents and those with dementia, activities that help out other members of the community are often a great idea.

We’ve previously mentioned how turning activities into tasks can spur participation, and the same applies to doing good deeds that help others. A person might have no desire to bake cookies for themselves, but when asked to bake cookies for the local women’s shelter, you might find a spike in enthusiasm.

Some ideas:
● Baking dog biscuits for a local dog shelter
● Assembling care packages for local houseless populations
● Baking for local police and fire departments

Music

Noted neurologist Oliver Sacks has written extensively about the ways in which music impacts the brain, particularly as it relates to those with dementia. He writes:

Music can lift us out of depression or move us to tears…But for many of my neurological patients, music…can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury but a necessity.
-Oliver Sacks, MD

Regardless of our cognitive state, we’re all familiar with the ways in which music can connect us to emotions, both from the past and our present. As such, music should become a regular part of your loved one’s day.

Consider using a Bluetooth speaker that allows you to move music around the house. In particular, smart speakers connected to the internet make this incredibly easy, allowing your loved one to queue up their favorite songs by using their voice.

Art

Dr. Bruce Miller of UCSF Alzheimer’s Center claims that some people with dementia may experience greater creativity and artistic ability, most notably in persons with frontotemporal dementia, wherein he’s witnessed activity spikes in the creative brain areas.

This can be facilitated in a variety of ways:
● Visiting local museums or art galleries
● Touring street art and murals in your city
● Painting or drawing in the home
● Creating greeting cards for friends and family
● Making collages with paper, fabrics, buttons, bows and magazines
○ Collages, in particular, offer a highly tactile experience.
● Show and tell with famous paintings

Due to the pandemic, many of the most renowned art galleries in the world now have virtual tours available for free on their websites. While you may not be able to take your loved one all the way to Paris, you can certainly utilize a free virtual tour from The Louvre.

Some other virtual tours include;
● The British Museum
● Detroit Institute of Arts
● Georgia O’Keeffe Museum
● The Getty
● The Metropolitan Museum of Art
● National Museum of the United States Air Force
● The Smithsonian
● Van Gogh Museum
● The Vatican Museum

Life Story and Social Histories

A tenant of Troxel’s Best Friends Approach is to know your loved ones well in terms of their identities and life experiences. This allows you to celebrate all that goes into making a person who they are. When you learn about the activities that a person enjoys or used to partake in, you can more effectively use those activities to engage with them.

If a person used to grow grapes and create their own wine, then you might consider having a wine tasting or gardening session. If a person worked for decades as a carpenter, you can call on this experience and ask them to help you build something.

This type of personalization helps a person feel known, understood and connected. It’s also life-affirming for a human being to resume participating in an activity that was once central to their identity.

Getting to Know Your Loved Ones

One effective way to begin building relationships with the people you care for is to engage in a memoir creation activity. This type of activity can take many different forms.

For example, some people might want to create a month-long process of creating a miniaturized memoir in the traditional sense. Others may elect to complete notecards that correspond to various memories.

Some ideas to begin memoir writing:
● Where did you grow up?
● What was your first job?
● Where is your favorite city in the world?
● How did your parents meet?
● What is your greatest skill?

Exercise

Regardless of age or health, we all know how important it is to exercise, and this is no different for those with dementia or Alzheimer’s; however, these conditions, coupled with age, can make it unfeasible to go for a run, swim, or bike ride.

Still, all people should engage in physical activity twice per day. Some accessible options include:

● Dancing
○ A great way to tie in both music and movement
● Therabands/resistance bands
○ These provide a low-impact way to work on muscles
● Daily stretching and breathing
○ Stretching can help maintain mobility
● Chair yoga
○ Less complex than traditional yoga, chair yoga offers a simplified way to obtain the mental and physical benefits of this practice.
● Indoor and outdoor walks

As caregivers, one of our goals should be to get our loved ones outside as much as possible. Not only is being in nature relaxing, but it also helps stimulate vitamin D production. You might also consider partaking in some outdoor chores like gardening or other light yard work.

Technology

The internet opens doors that we could not have imagined only a decade ago. Family Zoom calls, in particular, can help deepen social bonds. While Zooming can often be awkward, especially for those unfamiliar with the technology, there are plenty of fun, lightly structured activities you can partake in over a Zoom call. Consider:

● Making collaborative lists
○ For example, cities you’ve visited, concerts you’ve attended. Naturally, recalling all this will bring up fond memories.
● Showing and telling about clothing
○ Asking for advice on your wardrobe or a new purchase
● Menu planning
○ Sharing favorite recipes and planning for an upcoming in-person meal
● Reminiscing
○ Asking about how a parent met their partner or about their first job

The Best Friends Approach at Encore Communities

In addition to planning a robust calendar of larger activities, we pride ourselves on never losing sight of the seemingly smaller interactions we have with your loved ones. Talking to a resident about their day, asking them to share their memories, and complimenting them genuinely are all ways we work to create engagement in ways that are meaningful to them. Smiles, hugs, handshakes, and other friendly gestures can all work to build and preserve a person’s self-esteem.

For many people with dementia, it becomes difficult or seemingly impossible to partake in the activities that once brought them joy. However, with the help of an empathetic and loving caregiver, they can find new meaning in their day-to-day lives.