Dementia and the Meaning of Meaning

What Makes an Activity Meaningful, Anyway?  

Image by Alex Green at Pexels


*Resident names and any identifying details have been changed for privacy.

June 02, 2021

Asking “What’s a meaningful activity for someone with dementia?” is a lot like asking “What’s a meaningful activity for someone with cancer?” There may be some common ground, but by and large, the answer will depend on the individual – not on the disease they happen to have.


That being said, let’s explore what makes an activity meaningful, as well as what makes an activity successful for someone with dementia.


What Makes an Activity Meaningful?


Some people prefer to spend the majority of their time being “productive”, “useful” or doing “important” things. Others may be more content – and find more meaning in – relaxing, playing games and pursuing leisurely activities.

Many people enjoy a robust selection of worthwhile ways to spend their time. Most appreciate a balance of hard work, responsibility and relaxation – although the exact balance and assortment of activities varies a lot from person to person (and throughout the phases of a person’s life).  

What Gives Life Meaning?

We don’t all find the same things to be meaningful, important or worthwhile, but there are several types of activities that tend to give life meaning for most.

- Connecting with others
- Helping others
- Personal growth
- Solving problems
- Making the world a better place
- Contributing to the community
- Fostering relationships
- Connecting with or feeling part of something bigger than ourselves (family, community, nature, God, the Mystery, the Universe)

Supporting the types of activities that people enjoy – and that help them feel connected, productive or valuable– is a wonderful way to foster a sense of meaning in their life. 

Mac was a fastidious jeweler who had spent his career repairing the tiny gears inside of watches. He was introverted, quiet and quite lonely since his beloved bride of 72 years had passed away. None of the activities in the memory care program seemed to feel meaningful to him for a long time. One day he tried his hand at a jigsaw puzzle, and from that moment forward he had Purpose! He spent large parts of his days piecing them together, and was very proud of his accomplishments. His confidence grew and he found his voice. “I work all day and all night... working on them puzzles,” he explained one day. “That's why they hired me!”


Behavioral Signs that a Person May Need More Meaningful Activity

Behavioral signs we may notice in a person with dementia who is lacking meaningful activity may include:

- Withdrawal
- Depression
- Sleepiness
- Apathy
- Fatigue
- Tearfulness
- Negativity
- Hostility
- Irritability
- Frustration
- Angry outbursts
- Headaches
- Stomachaches
- Changes in appetite

Once we’ve ruled out potential medical causes for these symptoms, it’s time to consider whether they are engaged in activities that they find personally meaningful, fulfilling and satisfying.

If they aren't engaged in meaningful activity, think about what they would be doing if they could. How can we support a greater sense of meaning in their lives?

Give it a try. If lack of meaning is the cause – and the new activity is indeed meaningful to them – the behavioral symptoms will resolve, and a renewed spark and zeal will be revealed! 

Creating Meaning



Some activities may not be meaningful in and of themselves, but we can often infuse them with purpose. One of the easiest ways to make an activity meaningful is to simply ask for the person’s help to complete it.

“I have to fold all these napkins before dinner, and I don’t know if I can do it on my own! I’m worried I won’t get them done in time! Do you think you might be able to help me out?”

Helping others is one of the most meaningful activities for many people. People with dementia tend to have far too few opportunities to be helpful – and a very real need to be needed.

Many people will be willing to do things they normally wouldn’t, if it means that they’re helping someone out.  

“I have to fold all these napkins before dinner, and I don’t know if I can do it on my own! I’m worried I won’t get them done in time! Do you think you might be able to help me out?”

Meaningful Activities Versus Busywork 


Dementia or not, nobody wants to waste time on busy work. David Graber, Anthropologist and Professor at the London School of Economics until his recent passing, spent quite a bit of his life studying people who work in jobs they feel are pointless.

Graber found that when people are engaged in meaningless work, the result is often depression and lack of motivation. He also referenced research showing that toddlers are thrilled when they first discover their ability to influence the world around them (even in a manner as simple as pushing a pencil off a table). On the other hand, when that ability to impact their world is nullified, they grow confused and very upset.

The ability to meaningfully impact the world around us is regarded by many as very important to our psychological health and well-being as human beings.

Meaningful activity is just as important to those of us with dementia as it is to those of us without it. Remember, though, that our perception of reality can vary quite a bit, so whether the activity is “actually” important is less relevant than whether the person believes it is. 

Mary Ellen took great satisfaction in ironing her husband's dress shirts, as she had done for decades. Her husband hadn't worn his dress shirts for many years, but when she was ironing she felt useful, peaceful and at home – a stark contrast from her frequently discontented, restless state of being. While ironing may not be an appropriate activity for many seniors with dementia, in Mary Ellen’s case, supervised ironing was safe and profoundly meaningful to her. 

Examples of Meaningful Activities for People with Dementia


Because what is meaningful varies from person to person, there are no one-size-fits-all "meaningful" activities.

A person who places a lot of importance on looking nice may find meaning in manicures, “spa days”, and sorting through costume jewelry. Another person may find far more satisfaction in watering the plants, feeding the cat or walking the dog. Of course, a third person could consider all of those activities meaningful, while a fourth might find meaning in none of them. 

Activities for Dementia

Aside from being meaningful on a personal level, activities for someone with dementia should be safe, and set up for success.

A WORD ON SAFETY
Obviously, there are plenty of things that those with dementia can no longer do safely – although exactly what that entails varies from person to person, depending on their unique situation. The types and stage of their impairment play a part, as do any other challenges that may be at play (visual impairment, arthritis, etc.)

However, just having dementia doesn't automatically mean the person can't use knives, scissors or other potentially dangerous items. In many cases, someone who has used these tools throughout their life can still do so quite adeptly!

Provide supervision – we know things can change quickly and unpredictably – and use good judgement in each situation. Be careful with anything that might be toxic, sharp or otherwise dangerous. Just don't keep something important, meaningful and therapeutic out of someone’s life just because of their diagnosis.

SETTING AN ACTIVITY UP FOR SUCCESS
Set the person up to succeed by breaking tasks down into manageable steps consistent with their current abilities – which, of course, can change throughout the day, or even from moment to moment.

If the activity will be demanding on a social, cognitive or other level, it may help to schedule it for the part of the day the person is at their best. Pay attention that needs are met, keeping a special eye on fatigue levels. Cut out background noise and other distractions, if possible. 

Sorting Activities


Sorting activities are popular for people with dementia for good reason. They can be simple and easy to set the person up for success. They have potential to offer many therapeutic benefits, such as reminiscence or sensory stimulation. However, sorting activities aren’t necessarily meaningful on their own accord.

In general, sorting items that don’t resonate with the individual won’t be meaningful for most people unless there’s a particular reason for it. Perhaps they are helping a friend, preparing for a group activity, or doing something else they feel is a worthwhile pursuit.

Whenever possible, sorting activities should have the person handling something that resonates with them. Extra points if it stimulates senses or memories!

- Flies for the fisherman
- Fabric samples for the seamstress
- Paperwork for the office manager (sort by form type, color, etc)
- Crayons for the kindergarten teacher
- Fruit, veggies, or other foods
- Baseball cards 

Household Chores


Contributing to a clean house can be very helpful and valuable! Some people have an ingrained sense of its importance, while others may not necessarily agree. Many household chores rely on implicit memory, which is repetitive and doesn’t require much thought. This type of memory tends to be less affected by dementia than other types, so it’s easier for them to be and feel successful.

Furthermore, research shows that repetitive movements tend to evoke feelings of comfort and reduce anxiety. Many household chores are repetitive in nature, so they can be very soothing to the soul.

Household chores can also provide fertile ground to grow positive feelings such as confidence, competence and pride. They can provide an outlet for feeling helpful, and to a sense of contribution and belonging to the household community. On top of that, many household chores are a good form of physical activity!

Washing or drying dishes
Wiping down countertops or tables with a damp cloth (avoid chemicals)
Setting the table (break it down into manageable steps)
Sweeping the floor or patio
Using a carpet sweeper
Pairing socks or folding laundry (folding washcloths or hand towels is easiest, other clothing may be too challenging, depending on their abilities)  

Caring for Others

Caring for others tends to be one of the most meaningful pursuits for many people. Helping others, or caring for children, pets or plants can be enormously satisfying. It can be especially nice to interact with those we’re helping, but it’s not always necessary. Just the knowledge that we’re making a difference can be meaningful in many cases.

- Taking care of a pet
- Baking dog biscuits
- Gardening, weeding, watering or deadheading plants
- Rocking a realistic baby doll or cuddling a stuffed animal
- Reading or singing to another resident
- Sitting with a resident on hospice (for certain individuals) 

Sherry was a vivacious mother of six and a psychologist. She had worked hard all her life, and she was ready to enjoy her retirement! She would become upset when asked if she wanted to help set the table or do other household chores. She was much more interested in socializing and setting up for parties. It also turned out that with her psychology background she made a wonderful companion for other residents who may be feeling down or upset!

Reminiscing


Research shows that reminiscence therapy can help improve quality of life, cognition, communication and mood for people living with dementia. It can help them remember their own identity, feel more connected to others, and relieve symptoms of depression in some cases.

Asking people with dementia a bunch of questions about whether they remember this or that is usually not a very effective approach to reminiscing. In fact, it can be stressful, frustrating or embarrassing.

Sharing your own memories can be a less stressful and demanding way to start a conversation on a topic than asking them questions directly.

Conversations about childhood or days of yore can be a simple way to evoke self-affirming memories in some individuals. In others, it may be more effective to evoke memories by stimulating their senses.

- Favorite music
- Old TV or films they enjoyed in their earlier years
- Photographs or pictures of people or places that have been important in their life
- Food or drink that brings them back to childhood, or with cultural significance
- Equipment for past interests (old baseball glove, fishing tackle box with bait, gardening tools, typewriter, adding machine, etc)

Keep in mind that reminiscing may bring up memories that are sad, painful or difficult. If so, it may be helpful to simply sit with the person and listen to their thoughts, help them name emotions, or offer a hug or other support as they work through old wounds. It may feel awkward to us, but holding space like this can be powerfully healing for them on a spiritual level.

Other times, if we sense that they are “stuck” in a painful place or loop that isn’t progressing or healing, distraction or redirection may be helpful.  

Cooking 


Cooking and food preparation activities have it all: they’re meaningful, stimulate senses, and have a good potential for reminscise value. Many cooking tasks draw on ingrained implicit memories, so they tend to be successful in that regard as well.

Try asking residents’ loved ones for traditional family recipes, perhaps for Christmas or other holidays throughout the year. Helping to make the dish certainly will bring back memories for the resident. Sharing it with others can spark great conversations and contribute to a sense of community and belonging.

Of course, we know that following a recipe is too complex in many circumstances, but when broken down into appropriate steps, cooking can be a very satisfying and purposeful pursuit.

- Cutting veggies
- Peeling potatoes
- Adding ingredients into a bowl
- Stirring soup
- Kneading dough
- Spooning batter into muffin tins

Obviously, it’s important to be careful to avoid burns, cuts or other accidents in the kitchen.  

Other Purposeful Activities

Again, the purpose in most activities comes, to a large extent, from the presentation of the idea. If something is inherently important to someone – great, go with that! If you’re not sure what they find meaningful, think about how you present the idea and convey why it’s important, useful, helpful or valuable.

- Cutting coupons to donate to the less fortunate
- Wrapping presents
- Wrapping yarn into a ball (especially for someone who used to knit or crochet)
- Correcting “the children’s homework” (especially for someone with good math skills that may have deteriorated. This can provide some individuals a way to utilize these skills at their current level within a context of being helpful and respected, and not embarrassed about their decline)
- Organizing a tool box or tackle box (sharp hooks or dangerous items removed)
- Placing pieces back into a ratchet set 

Look to the Wellness Wheel for Inspiration


Holistic health requires attention to multiple aspects of wellness. Each has the potential for meaningful activity, and each needs some attention. The balance is different in every person, but everyone should have at least some activity in each of these areas for optimal wellbeing. 

Physical 


When most people think of health, it’s physical health that comes to mind. This includes the food we eat, our physical exercise and medical conditions.

- Walks
- Dancing / chair dancing
- Swimming, aerobics, stretching or other exercise classes 

Intellectual

Many people with dementia still enjoy the process and feeling of learning, especially if they have valued education throughout their life. Whether or not they retain the new information is secondary. Creativity is often included in intellectual health.

- Educational programs or lectures on topics of interest
- Reading
- Scrabble or certain other board games
- Painting, adult coloring books, or crafts that provide outlets for creativity. 

TRIVIA
Using information that they may have memorized in school can work well. Giving them the first part of a phrase for them to complete can be a good way to set them up for success. It’s important to find a good balance to where they feel a little challenged, but not too much. Have a variety of material ready that you can go up or down in level depending on how they’re doing.


- State or world capitals (You tell them the city name to make it easier, or increase the difficulty a bit by stating the state or country and having them provide the city)
- Multiplication facts
- Spelling
- Finish the line! Use famous sayings, songs, poems or advertising slogans they would find familiar. You can also use celebrity names, film names or song names. Use nursery rhymes sparingly or with caution. A little bit sprinkled in can be fun, and can bring back memories of childhood or young parenthood – but don’t overdo it! It can easily cross the line into feeling infantile and demeaning.

Occupational / Vocational 


Occupational or vocational health refers to a person’s “calling” in the world. Many times it aligns with their chosen career, and other times it doesn’t. This aspect of health also refers to how productive and useful we feel we are.

- Volunteering or helping others
- Performing household chores
- Utilizing skills from past hobbies or careers (taking notes on a clipboard, tinkering with tools or gadgets) 

Emotional


Emotionally healthy people can connect with their emotions, and express them appropriately. They can laugh and have fun.

- Sharing jokes or funny programs
- Listening to sad songs or watching emotional movies
- Rousing music
- Discussing difficult topics
- Being there, and simply holding space for sadness, grief and other hard feelings 

Social 


Social health, of course, has to do with our relationships and ability to relate and connect with others.


- Feeling included in group activities
- Connecting with others over a shared meal or snack
- Card games, board games or dominoes 
- Connection and meaningful interaction with animals 

Spiritual

Spiritual health refers to how “at peace” we feel in the universe. What guides our sense of morality? This may be tied to religion, or it may not. Read more about supporting people with dementia on their path of spiritual growth and healing at ABC Dementia’s post on Supporting Spiritual Wellness in Dementia.

- Prayers
- Reading passages of faith
- Gratitude journal
- Religious or spiritual rituals
- Attending services or watching or listening to spiritual programs
- Connecting with nature (Awe-inspiring natural scenes can be especially powerful)
- Looking up at the stars (or, perhaps, at a star projector indoors), wondering where we fit into the universe 

Age Appropriate Crafts and Activities


It’s really important that crafts and other activities are appropriate for the person’s age and are not childish in nature. It’s an issue of dignity, and can be a sensitive area for many residents and their families. We want them to feel proud of what they have done, not embarrassed by it.

Admittedly, this can be a challenge at times because many crafts or activities geared for adults may be too challenging for some people with dementia. However, the internet is full of amazing, creative ideas for crafts that end up looking amazing with very little skill required, and it’s worth taking the time to find them.

A couple of my favorite go-tos were pressed flower or leaf greeting cards or bookmarks, and flower arrangements. These are both great outlets for creative expression that are virtually failure-free. Flowers and leaves can be collected on walks (providing more “purpose” for the walks!), or local vendors are sometimes willing to donate flowers that they can’t sell for residents to use.

The supplies we use also convey a message. Cheap children’s crayons or paints will generally evoke much different emotions in our residents than watercolor pencils or a nice, inexpensive set of paint with a pallet. Tasteful adult coloring books should be used over those made for youngsters.

Occasionally, we can get away with more childish activities with the story that we are making these for the “children”. 

Meaning is Personal


Again, any activity can be meaningful on a number of levels to each individual. Our job is to do our best to uncover which activities hold meaning for each individual in our care.

Good intake material, including detailed life story forms, can be a good first step. However, keep in mind that people with dementia – like anyone else – grow, evolve and change over time, and as they encounter and adapt to new situations.

We should stay curious, observant, and communicative with teammates about what our people find interesting and engaging. If we're creative and keep trying new things, even as we rely on the old standbys, we can afford those we support the best chance at a fulfilling and meaningful life. 


How have you discovered or supported meaningful activity for those in your care?

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