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Caren Silverlieb MMHS
SilverLiving Consulting and Training
Joyful Connections!A Structured Social Club
for People with Dementia
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Heading
Joyful Connections!
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What’s Happening in the BrainPlaques
✓ Beta amyloid protein
accumulates forming dark
clumps outside neurons
✓ These cells are most involved
with thinking, sensing,
perceiving, feeling, planning,
language, movement…
✓ These clumps cause brain
cells to die
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What’s Happening in the Brain
Tangles
Tau protein erodes the
walls of the neurons and
cause neurofibrillary
tangles
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✓ Healthy brain weighs 3 lbs.
✓ Diseased brain weighs 1 lb.
✓ Length of decline 3-18 yrs.
✓ Neuropathology begins
10-15 years prior to
noticeable changes
What’s Happening in the Brain
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Hippocampus
✓The disease starts in the
area of the brain just
above the ears on both
sides of the brain, called
the Hippocampus.
What’s Happening in the Brain
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Hippo… Campus
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✓ Takes in new information through the senses
✓ Puts that information in a form that the brain can use
✓ Compares new information to old
✓ Labels and files information
With Alzheimer’s, the Hippocampus is broken
Hippocampus
What’s Happening in the Brain
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Amygdala
✓ Almond-shaped groups of
nuclei located deep and
medially within the temporal
lobes of the brain
✓ Remains pretty much intact
long into the progression of
the disease
What’s Happening in the Brain
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Amygdala
✓ Involved with emotions:
• the ability to feel emotions
• the ability to hold an emotion
• the ability to perceive emotions
• the need to evoke and receive
emotions in others
What’s Happening in the Brain
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Habilitation - not Rehabilitation!
✓ Rehabilitation Therapy helps a person to re-learn abilities
they’ve lost
✓ Habilitation Therapy creates an environment around the
person:
• To promote positive emotion
• To compensate for sensory losses
• To make the most of remaining skills and abilities
• For staff to speak the same language of Habilitation
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Behavior as the Resident’s
Communication with Us
The Habilitation Model
Our Communication
with the Resident
Physical EnvironmentPurposeful Engagement
Knowing and Understanding the Individual
Our Approach to Personal Care
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Joyful Connections!
• A structured, afternoon social club for people with or without memory loss and with or without their care partners
• Operates 3 p.m.-5 p.m. five days per week
• Most daily sessions include three distinct parts
• Exercise
• Refreshments
• Therapeutic activity
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Rationale for Joyful Connections!
✓Alzheimer’s prevalence by age:• 3% of ages 65-74
• 17% of people age 75-84
• 32% of ages 85+
✓Returning from Adult Day Health
✓Sundowning – late afternoon confusion
✓Difficultly making new friends
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Intent of Joyful Connections!
• Demand less attention from RSC
• Promote social connections
• Inspire creativity
• Improve mood
• Foster a sense of belonging
• Cultivate a sense of purpose
• Create a safe space for those who might otherwise suffer from social isolation and its negative physical and mental health effects
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Three Components1. Exercise - get the:
• body moving
• blood flowing
• mind focused in the moment
2. Refreshments - encourage:
• participation
• conversation
• engagement to the extent possible
3. Therapeutic Activity
• Art, Dance/Movement, Music Therapy
• Entertainment, Games
• Other
Use it or
lose it!
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Exercise
✓Imaginative – A trip to the supermarket or mall; play a baseball or basketball game; set sail and go fishing
✓Hidden exercise – Balloon volleyball, Octaband
✓Discussion:
• What exercise did you do as a child
and/or as an adult?
• Do these movements feel familiar?
• Does anything hurt?
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Exercise
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RefreshmentsProvide a variety of fruits, vegetables, lean protein, dairy
products, and whole grains foods, and some other stuff…
Fruits Vegetables Proteins Carbohydrates +
Applesauce Dried sweet potato Cheese sticks Crackers
Orange slices Cherry tomatoes Yogurt Rice cakes
Pitted prunes Tomato juice Cottage cheese Pretzels
Fruit smoothies Cucumber slices Hummus Oatmeal
Fresh juice Beet slices Milk shakes Cookies
Raisins Fresh peas Custard Chocolate
Fruit juices String beans Deviled eggs Salad dressing
Hot/cold apple cider Sliced peppers Ice cream Potato salad
Banana Edamame Nut Butters Ice cream
Berries Fruit-sweetened veggie juices Pudding Jello
Apple slices Turkey peperoni
Melons
Grapes
*Be mindful of allergies
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Refreshments
Limit:
• Fats that are highly saturated, partially hydrogenated, trans, and cholesterol - such as butter, solid shortening, lard and fatty cuts of meats
• Refined sugars and offer fruit-sweetened or sugar free choices
• Foods with high sodium
*Note: in the later-stages of Alzheimer's, if loss of appetite is a problem, adding sugar to foods may encourage eating
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Expressive Arts Therapy
Expressive Arts Therapy combines the visual arts, dance/movement, drama, music, writing and other creative processes to foster deep personal growth and community development.
- International Expressive Arts Therapy Association
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Art TherapyCreative process of visual art making has many therapeutic benefits:
• improves/enhances physical, mental and emotional well-being • increase functionality • develop interpersonal skills • manage behavior • reduce stress• handle life adjustments• achieve insight• resolve conflicts and problems
– American Art Therapy Association
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Art Therapy
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Art Therapy
PROPS!
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Dance/Movement Therapy✓DMT is especially vital for people with memory loss
because it allows them to live in the moment, be present, and feel alive in their bodies/minds/spirits.
✓ When a person is fully involved in an experience that is engaging on all levels, a sense of self and purpose can be restored.
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Audrey and the Octaband
https://youtu.be/P4sRfOrkroE
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Movement Therapy
✓Be seen and heard - to be met where they are in the moment (ever-present in an ever-changing world)
✓Movement stimulates memory• body memory• motor memory• sensory memory
✓Trust (the therapeutic relationship)
✓Safety – emotionally/physically
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Music Therapy✓ Sessions may be facilitated by credentialed music therapist
✓ Nonverbal Communication – crucial when words may not be available
✓ Group cohesion, belonging, connection, building community
✓ Creative self/group expression
✓ Rhythm is organizing
✓ Group energy is contagious
✓ Decreases anxiety (staying present)
✓ Calm, peace, revitalization, joy, and fun
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Music Therapy
Following an African drumming activity:
“I’m not trying to change the world. I’m just trying to change myself. But you never know, I could change the world” Peg, 82
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Purposeful Engagement
✓ Makes us feel a sense of purpose
✓ Keeps us engaged and active
✓ Physically and mentally maintains our
remaining skills and abilities
✓ Promotes a positive emotion
✓ Reduces withdrawal and depression
✓ Keeps them active in the day for a
better night’s sleep
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Purposeful Engagement - Alice
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Purposeful Engagement - Josephine
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Purposeful Engagement - Claire
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Other Activities✓ Entertainment
• Cultural movies• Performers• Theatre• Bands• Dancers• Children• Animals
✓ Games• Tic Tac Toe• Ring toss• Bingo
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Scheduling Activities
✓Topic lists
• Nature• Animals• Travel• Food• Sports• Art• Music• Memories• Five senses• Other topics
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List Activities for Each TopicNature Animals Travel Food Sports Art Music
Walks Farm Stories
Invite Guest for
Slideshow
Bake Corn Hole View One Artist’s Work
Make an Instrument
Plant flowers
Fish/Birds Travel Magazine
Collage
GuestFoodie
Watch Finals
Paint Listen to Music and
Discuss
Pictures of flowers
Visiting Dog
Favorite Trips
Make Pasta
Invite local team
Create a Project
Sing
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Build a Monthly Calendar
Sample MonthTIME
29 MONDAY 1 TUESDAY 2 WEDNESDAY 3 THURSDAY 4 FRIDAY
3:00
3:20
3:45
VISUALIZATION EXERCISES - To paint a fence + knee lifts, heel
raises, neck stretch, ball taps
SNACKS (yogurt, cookies, tomato juice
TRAVEL AROUND THE WORLD - JAPAN (Video and discussion )
EXERCISES– Balloon volleyball
+ knee extension, wide leg squat, side hip raise, ball taps,
squeeze ball
SNACKS (rice cakes, berries, tea )
DANCE THERAPY WITH AUDREY
VISUALIZATION EXERCISES - To paint a fence + knee
lifts, heel raises, neck stretch, ball taps
SNACKS (yogurt, cookies, tomato juice
TRAVEL AROUND THE WORLD - JAPAN (Video and
discussion )
VISUALIZATION EXERCISES
Flight to your favorite city + toe stand, chest and arm stretch,
upper back stretch, elbow to knee
SNACKS (plums, cakes, tea)
ART THERAPY (ORIGAMI)
7 MONDAY 8 TUESDAY 9 WEDNESDAY 8 TUESDAY 11 FRIDAY
3:00
3:20
3:45
VISUALIZATION EXERCISES - Shopping at the grocery store
+shoulder blade squeeze, ankle rotations, shifting weight,
squeeze ball
SNACKS (cookies, cherry tomatoes, apple juice)
BINGO ( GIFTS AFTER GAME)
VISUALIZATION EXERCISES–
Take care of your farm +toe and chair stands, knee marching, eye
tracking, squeeze ball
SNACKS ( yogurt , oatmeal cookies, tea)
COUPON GAME (SORT COUPONS BY CATEGORY FOR YOUR
FRIENDS)
EXERCISES – Balloon volleyball
+ knee extension, wide leg squat, side hip raise, ball taps,
squeeze ball
SNACKS (prunes, cookies, black currant grape juice )
MAKE A FRESH JUICE FOR YOUR FRIENDS
VISUALIZATION EXERCISES–
Take care of your farm +toe and chair stands, knee
marching, eye tracking, squeeze ball
SNACKS ( yogurt , oatmeal cookies, tea)
COUPON GAME (SORT COUPONS BY CATEGORY FOR
YOUR FRIENDS)
VISUALIZATION EXERCISES –
Ride your bicycle to the park +toe and chair stands, knee marching,
eye tracking, squeeze ball
SNACKS ( chocolate, cookies, tea)
DANCE THERAPY WITH AUDREY
14 MONDAY 15 TUESDAY 16 WEDNESDAY 15 TUESDAY 18 FRIDAY
3:00
3:20
3:45
VISUALIZATION EXERCISES –
Leaf peeping trip +standing leg curl, toe stand, chest and
arm stretch up, ball taps
SNACKS (apple sauce , cookies, tea)
SPRING DECORATIONS FOR JCHE HALLWAY
VISUALIZATION EXERCISES –
Camping +toe and chair stands, knee marching, eye tracking
SNACKS (prunes, fruits, orange Juice)
DANCE THERAPY WITH AUDREY
EXERCISES – Balloon soccer
+knee lifts, heel raises, neck stretch, ball taps
SNACKS (nuts, blueberries, prunes, apple juice)
MAKE A FRESH FRUIT SALAD FOR YOU AND YOUR
FRIENDS
VISUALIZATION EXERCISES –
Camping +toe and chair stands, knee marching, eye
tracking
SNACKS (prunes, fruits, orange Juice)
DANCE THERAPY WITH AUDREY
VISUALIZATION EXERCISES –
Dancing competition + shoulder blade squeeze, ankle rotations,
overhead arm extensions
SNACKS (apple, cookies, tomato juice)
DANCE THERAPY WITH JULIA
21 MONDAY 22 TUESDAY 23 WEDNESDAY 22 TUESDAY 25 FRIDAY
3:00
3:20
3:45
VISUALIZATION EXERCISES –
Harvest gathering +knee extension, wide leg squat, side
hip raise, hold a ball with both hands at your stomach
SNACKS (prunes, fruits, orange Juice)
LARGE TIC TAC TOE GAME (WIN THE GIFT)
VISUALIZATION EXERCISES –
Fishing +knee lifts, heel raises, neck stretch, ball chest press
SNACKKS (rice cakes, berries, orange juice)
DANCE THERAPY WITH AUDREY
EXERCISES – Balloon volleyball
+toe and chair stands, knee marching, eye tracking
SNACKS (yogurt, oatmeal cookies, apple juice)
SNACKS (yogurt, oatmeal cookies, apple juice)
PLANTING BULBS IN THE JCHE GARDEN
VISUALIZATION EXERCISES –
Fishing +knee lifts, heel raises, neck stretch, ball chest
press
SNACKKS (rice cakes, berries, orange juice)
DANCE THERAPY WITH AUDREY
VISUALIZATION EXERCISES –
Trip to the zoo +toe stand, chest and arm stretch, upper back
stretch, balancing toe taps
SNACKS (dark chocolate, bananas, tea)
DANCE THERAPY WITH JULIA
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Staffing
• Knowledge, understanding, expertise in some model of working with people with memory loss
• Innate and learned responses
• Appropriate activity planning for level(s) of memory loss
• If possible, have a certified personal care assistant
• Develop a relationship with expressive arts therapy school, internship, volunteers, individual therapists
• Staff to participant ratio dependent on levels of memory loss (2 minimum, 1 staff/volunteer per five participants)
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Tips for Success✓ Be mindful of what you call the program
✓ Use the right term for dementia for your group (forgetfulness, memory loss, brain disease, Alzheimer’s, memory impairment, cognitive issues…)
✓ Have the program at the same time each time ( 10 a.m., 2 p.m., 3 p.m., daily, weekly, monthly)
✓ Have the program in the same location each time (procedural memory)
✓ Create special invitations for residents with memory loss
✓ Have memory impaired residents help plan the program
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Tips for Success
✓ Get families involved
✓ Get community volunteers
✓ Post flyers (be mindful of the information on the flyer)
✓ Call residents to remind them to come (reverse 911)
✓ Provide an escort for those who need it
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Resident Participation
✓ Set a goal for the number of residents. Small is fine.
✓ Be mindful of the size of the space and limitations
✓ Don’t be discouraged if it takes a while to catch on
✓ If people are having fun, word will spread
“I’ve lived here almost 30 years and I’m the happiest now because of this program” Han, 93 (Chinese former surgeon responsible for separating co-joined twins in China)
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What Doesn’t Work
✓ Anything too complicated (e.g. learning a dance)
✓ Projects with many steps unless they are explained slowly and each person gets to finish each step before moving on to the next
✓ Refreshments that require more prep unless that is the activity
✓ Language groups with no interpreter
✓ Singing with multiple language groups
✓ Changing the day, time, or location
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Evaluation
How Do You Feel Right Now?
In the first few months, we saw an overall improvement in mood of 26%, and individual improvement as much as 94%.
After a few months, even those with memory loss are coming in happier because they associate the space, the staff, and the activities with a positive emotion.
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Thank You!
Caren Silverlieb, MMHSSilverLiving Consulting and [email protected](617) 407-3663
Guides are available free of charge at:www.2lifecommunities.org/resources-guides
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