Nov 22 2011
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Time to Get Moving: How a Function-Focused Approach Helps Caregivers and Those They Care For

By Elizabeth Galik, PhD, CRNP, Assistant Professor at the University of Maryland School of Nursing and a Robert Wood Johnson Foundation Nurse Faculty Scholar

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Older adults with dementia are more likely to be physically inactive, require assistance with personal care activities, and have more medical problems than older adults without dementia. There is a tendency to promote sedentary activities rather than exercise among older adults with dementia for fear that they will fall or injure themselves if they are allowed to be mobile and physically active.

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Despite the gradual and progressive cognitive and functional decline associated with dementia, there are benefits to keeping older adults engaged in their own personal care and physical activity. These benefits include slight improvement or maintenance of functional abilities, fewer behavioral and depressive symptoms, better sleep, and fewer falls. A function-focused philosophy of care is designed to prevent or minimize functional decline and optimize the function and physical activity of older adults regardless of their memory impairment. It promotes the belief that all older adults are capable of and benefit from some improvement or maintenance of functional potential, even though the function may not be entirely independent, such as passive range of motion through hand-over-hand feeding, or encouragement of self-propulsion in a wheelchair.

Caregivers also benefit from using a function-focused care approach. Even small improvements in the functional performance of older adults with dementia may decrease the physical requirements of caregiving, such as heavy lifting, and also may result in psychological benefits for the caregiver, such as increased self-confidence and improved satisfaction with his/her caregiving role.

There are a variety of caregiving “tricks of the trade” that are crucial to function-focused care activities with older adults with dementia. These strategies include: (1) adapting communication techniques; (2) care and consistency; (3) enhancing sensory experiences; and (4) incorporating humor and play.

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Adapting Communication Techniques

Communication techniques that are designed to encourage and motivate older adults with dementia to participate in functional activities should include short, simple verbal cues given while directly facing the individual. Because of short term memory impairment, reminders, encouragement, and praise should be utilized. Physical gesturing, demonstrating, and role modeling are effective for those individuals with difficulties understanding speech.

Care and Consistency

Individuals with dementia are more likely to be active in their own care when routines are predictable and caregivers are consistent. A sense of trust and a caring attitude is helpful in eliciting maximum participation in functional activities.

Enhancing Sensory Experiences

Approximately two-thirds of older adults with dementia exhibit apathy and passive behaviors. For these passive individuals, enhanced sensory experiences can be motivating. For example, visual, color contrast between the food and the serving dishes may help with attention to the task of eating. In an exercise class, the use of familiar music can motivate cognitively impaired individuals to dance and move.

Incorporating Humor and Play

Humor and playful activities are often used to prevent catastrophic behavioral outbursts among older adults with dementia. This same strategy can also be utilized to motivate these older adults to be actively involved in their own personal care activities. Some suggested activities that are appropriate for older adults with dementia include: indoor and outdoor hiking programs and parades, balloon toss, beauty makeovers that focus on grooming, movement groups, and dances.

Let’s get moving!

Tags: Health & Health Care Policy, Medical, Nursing & Dental Workforce, Caregiving, Nurse Faculty Scholars, Nursing, Voices from the Field