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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 Trainingcsilverlieb@gmail.com(617) 407-3663

Guides are available free of charge at:www.2lifecommunities.org/resources-guides

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