Abstract
People with dementia and their family members cite engagement in meaningful activity as one of their most persistent and critical unmet needs (Miranda-Castillo et al., 2013). Engaging older persons with dementia in appropriate activities has been shown to yield beneficial effects such as reducing behavioral disturbances, increasing positive emotions, improving activities of daily living, improving the quality of life, increasing sense of purpose and routine, and developing constructive attitudes toward dementia among nursing staff members (Cohen-Mansfield et al., 2009; Dementia Australia, 2019; Trahan et al., 2014). In addition, governments worldwide have recognized the importance of meaningful activities in dementia care, with some mandating their use as part of standard treatment (National Collaborating Centre for Mental Health [UK], 2007]. Despite such promise, activity engagement for people with dementia is still in a formative stage (Trahan et al., 2014). The book Creative Engagement: A Handbook of Activities for People with Dementia by Rachael Wonderlin with Geri M. Lotze provides a simple-to-follow guide on programming creative activities for this population and is timely in addressing this gap.
The first author of the book, Rachael Wonderlin, is a gerontologist and dementia care advisor who runs the popular blog Dementia by Day. She is also the author of When Someone You Know Is Living in a Dementia Care Community. The second author of the book, Geri M. Lotze, is a teaching associate professor of developmental psychology at Virginia Commonwealth University. In this book, the authors offer very practical instructions for family caregivers at home and professional carers in community settings on developing, implementing, and encouraging engagement in creative activities for people with dementia. These practical strategies are so straightforward that they can be put to immediate use in the home or community by anyone who takes care of adults with dementia.
The 232-page book is organized into 22 chapters in three parts: background, tips, and activities. Part I (background) briefly defines dementia and discusses the importance of building a dementia-friendly environment and activity engagement linked with decreased caregiver stress. After briefly and vividly illustrating dementia as an umbrella term for a group of symptoms caused by different diseases, the authors begin by connecting the activity engagement approach to a dementia-friendly environment, an essential physical space for activity engagement that is more important for people with dementia than for those without dementia. “Environment is the foundation that you build on, and if the foundation isn’t strong, the rest of your activity programming won’t be either” (p. 26). Dementia-friendly interior design features are less like those in skilled nursing facilities (e.g., sterile, “hotel-like”) and instead should be a place or a world where people with dementia can thrive, enjoy their lives, and meet their needs of daily life. Furniture, pictures, workplace, dining space, for example, all need to be designed as a dementia-friendly environment and be suitable and safe for activity engagement. As a researcher on dementia family caregiving, I appreciate that the authors also talk about caregiver stress in Part I. One of the book’s strengths is that the author goes to great lengths to point out that caregiving for an older adult is not the same as caring for a child. The author also suggests that when possible, sole caregivers should seek additional supports and services in an effort to decrease caregiver burden and stress.
Part II covers general tips for designing and leading activities for people with dementia, including (a) creating a calendar, (b) embracing the reality of people living with dementia, (c) using autobiographical memory as a tool in dementia care activities, (d) group dynamics, (e) asking for help, (f) activities of daily living, and (g) tailoring activities. These tips are consistent with the identified 2018 specific recommendations for Person-Centered Care (PCC) by the Alzheimer’s Association which include recognizing and accepting the person’s reality; identifying and supporting ongoing opportunities for meaningful engagement; building and nurturing authentic caring relationships; creating and maintaining a supportive community for individuals, families and staff; and evaluating care practices regularly and making appropriate changes (Fazio et al., 2018). The general tips for programming creative activities and encouraging activity engagement for people with dementia offered in Part II are grounded in these ideas and concepts. These include embracing the reality of people living dementia, utilizing activities of daily living to design these activities, offering activities that rely on long-term memory, and encouraging engagement in what they are already doing in daily life.
Part III includes 12 chapters, each focused on one activity for engagement. These activity ideas include (a) lifelike dolls and pets, (b) exercise, (c) music, (d) technology (i.e., computers and tablets), (e) holidays, (f) hospice activities, (g) meals and baking, (h) brain exercises, (i) artwork and creativity, (j) outings, (k) entertainment and home visitors, and (l) sensory rooms and activity boxes. The description of each activity includes activity calendars and step-by-step instructions for individuals and small groups. The case examples provide real-life pictures that are very helpful in understanding these creative activities. One important issue is how to optimally engage people with dementia in activities. Cognitive impairments including deficits in memory, language, and spatial recognition present unique challenges to effectively engaging this population. For an activity to be a viable therapeutic modality in comprehensive dementia care, identifying strategies that best foster engagement, especially for those living at home, is essential. Part III also discusses several practical and useful strategies to engage persons with dementia, such as asking whether they can help with this or that task by saying “Can you help me?” rather than “Do you want to help?” This strategy allows people with dementia to feel useful and important and provides them with a sense of agency.
Overall, this book supplies well-organized information and provides a good resource for family caregivers and professional carers in designing, programming, and leading creative activities for people with dementia in the home or community setting. The strength of the book is the authors’ forthright approach in describing general tips and detailed activity examples. The authors provide insights into why each activity is important and case studies of each activity’s design and implementation. The authors also illuminate potential barriers to implementation and creative and effective methods for overcoming these barriers.
This book is potentially useful for family caregivers of people with dementia who live at home or for clinical formal professional carers who work in the front lines in community settings. This book would also have widespread utility as a supplementary textbook in an activity therapy degree program, an undergraduate level course in gerontological social work, nursing, or health science disciplines, as well as for training or continuing education for social workers, nurses, and other clinical health professionals. It could also serve as the foundation of a seminar on dementia caregiving. While the book presents practical guidelines for various creative ideas of activities and engagement for people with dementia, it could be improved if the authors had included some research-based, evidence-based literature on the effectiveness of these approaches. In this way, the practices of designing creative activities could integrate the best research evidence with clinical expertise and participants’ values and offer state-of-the-science guidance for clinical practice.