Engaging residents with apathy

A person who is withdrawn or apathetic is someone who is socially withdrawn and is experiencing a loss of interest and motivation. Behaviors that reflect being withdrawn or apathetic might include:

  • sitting alone in one’s room
  • avoiding contact with others
  • making limited eye contact with others.

It’s important to note that these behaviors are not often considered problematic because they don’t call attention to themselves like screaming does. They can, however, lead to rapid loss of cognitive and physical function.

How to approach the person who is withdrawn or apathetic:
  • Try to engage the person in creative activities.
  • Give instructions slowly and break tasks down into manageable portions for the person.
  • Remain positive and calm with the person.
  • Encourage the person to do what they can for themselves and provide praise often.
  • Avoid excess stimulation such as large crowds or loud noises.

Things to try:

  • Sensory stimulation may be helpful. Some ways to do this might include playing music, looking through visually stimulating thing such as pictures from old calendars or holiday cards, and touching or holding a stuffed animal.
  • Involving the person in cooking or baking activities can help stimulate the sense of smell and be a good time to talk and reminisce with the person as their memory allows.
  • Consider the persons’ preferences. For example, if the person is fond of animals, bring in a therapy dog as a way to spark interest and movement (reaching, petting).
  • A visit from young children can be a wonderful, heartwarming way to engage a withdrawn older adult.
  • For many, a short walk or simply sitting outdoors for a short period of time can offer valuable sensory stimulation.
  • Try to engage the person in a 1:1 or small group social activity.  Try to individualize social contact, which can include casual conversations or “small talk.” Adapt the conversation based on how advanced the person’s dementia is. For someone with very advance dementia try to focus mostly on questions involving “here and now” discussion such as comments about music playing, food being served or the weather. For an individual with mild to moderate dementia, small talk can be facilitated by asking the person simple questions, such as: “did you ever play football in school?” or “have you always lived in Wisconsin?”
  • Talk to family members to learn more about the person’s history and use this information to plan activities. For example, a painter could help make posters for events; a policeman could “walk the beat”; a homemaker could help knead dough, dust or sweep the floors.
  • Another simple strategy for facilitating social contact is to share information about your life or plans for the day and ask the person with dementia for their input about things you share using straightforward questions.

Increasing resident engagement in activities

We’ve talked about how encouraging residents to participate as much as possible in their own care can help maintain or even increase function and decrease negative behaviors. Let’s remember that residents with moderate to severe dementia can have fun too!

How often do we see a group of residents participating in a recreational activity, but notice that at least a few of them are left out? Sitting in the corner looking on? Often, these more “challenging” residents are the people who most need to be active and engaged in activity so they avoid feelings of frustration, agitation, and boredom.

To help with this, here are some activity ideas that your nurses, nursing assistants and recreation staff can use to get residents with cognitive decline in on the fun:

  • Flyswatter volleyball: Give residents plastic flyswatters have them hit a balloon back and forth to each other
  • Dance, dance, dance! Turn off those televisions and turn on some music and dance. Have staff members take turns playing music from their iPods through a speaker. Fast or slow, old or new, music has the power to move everyone.
  • Horseshoes: Now that summer is here, horseshoe games are everywhere. Look for the foam kind and play inside or outside on a patio. Residents can play while standing or sitting.
  • Foam swim noodles: Get a bunch of these, cut them in half, and start bending. These make for great resistance exercises! Leave them out in common areas for a safe, easy way to start spontaneous exercise.
  • Movement scarves: These can be found on enasco.com, or you can make your own with a lightweight material. Toss these colorful scarves in the air and have residents try to catch them. These scarves can be better than throwing a ball back and forth since people with slower reflexes and limited hand flexibility can catch them more easily.
  • Chores! Yes, chores. Your kids might not agree, but for older adults with dementia, doing familiar household chores can be calming and comforting. Grab a basket of cloth napkins and ask them to help you by folding them. Give them a broom and ask them to help you sweep the floor since company will be coming. Get some pillowcases or old clothes, hang a clothesline between a few walls, and give them some clothespins. They can hang the laundry.
  • Don’t forget to go outside! Warmer days are here now, so in the morning or early evenings when it’s a bit cooler, go outside. The sunshine, change of scenery and fresh air is something we all need. Look at the flowers, look for birds, and have some lemonade.

Function focused care exemplars

As you continue to work with the “Champions” at your nursing homes, we encourage you to show them these brief videos from our website: http://www.functionfocusedcare.org/videocoaching

The six videos offer great tips on how to engage residents with cognitive impairment and help them perform activities of daily living such as dressing, oral care and toileting, and reinforce the information we presented during the training sessions. You can even show the videos on a mobile device to GNA’s and other busy staff, as each video is only about 3 minutes long. Consider showing a different video at each of your next staff meetings, and discussing the ideas presented. Could some of the approaches from the video work with one of your more challenging residents?