When you present an activity to someone with Alzheimer's or dementia, it doesn't always work out exactly as expected. Sometimes that doesn't matter. You may have expected the person to sort the red cards to the left and the black cards to the right but they did it the other way around. That's not a problem. They are still handling the cards which helps with dexterity and they are sorting the cards which helps with cognitive skills. Over time you can coach them to do it the "correct" way, but it really doesn't matter.

On the other hand, if instead of sorting the cards the person with dementia just sits there not engaged, looking around, picking at their clothes, not paying attention, then it is time to look past the activity and try to identify what's going on.

Maybe there was a sudden distraction - a loud truck outside, a clock chiming, people talking loudly in the next room. If that's the case, talk about it with them. "Boy that's a loud truck", "Wow, that person sure is talking loud". This focuses attention on the distraction and conversation about it. When the distraction has passed, encourage them to turn their attention back to the activity.

If they still aren't engaged, just relax and sit with them, observe them and try to figure out what their issue is. Maybe they have to go the bathroom. Maybe they are in pain or simply tired. Maybe it's just the wrong time in the person's day. Don't be negative, don't be disappointed just do what you can for them and leave the activity for another time.

Things to Watch For:
  • Was there sudden distraction?
  • Is it just the wrong time in their day?
  • Was the activity presented properly?
  • Did you misjudge their abilities?
  • Did you misjudge their interests?
  • Are you looking for too much?

If the person is interested in the activity but not really "getting it", just moving the cards around on the table for example, then you should take a further look into exactly what is happening. Don't abandon the activity, it's time to do some detective work.

Go back to the basics of presenting the activity as described in "Presenting an Activity to Someone with Dementia, Start to Finish". Did you present it properly? Did you ensure that there are no distractions? Did you demonstrate the activity slowly so that the person understood what was expected?

Look at the activity itself. Did you misjudge their abilities? Is the activity too difficult for them? Maybe it needs to be broken down differently. Maybe you need to use less abstract materials - a real banana instead of a picture of a banana. Do they have color blindness issues? Are they able to manipulate the materials? Examine all aspects and make any changes necessary to ensure that the activity matches the person with dementia's abilities in all ways.

Did you consider the person's interests? The activity is much more likely to be successful if it appeals to them. For example, if you are asking trivia questions make them about a subject that they enjoy talking about. If you are doing a puzzle, make sure that the picture is something interesting to them.

After you've considered all of these issues and you're still not seeing the results that you expect, it's time to rethink what we consider to be a success.

Just introducing the activity and letting them get a little bit familiar with it, even for just a few minutes, is a success. It helps set the basis for future use. It's not necessary to go from start to finish every time. With every exposure they get more familiar and can do more. It establishes a foundation that can be built on.

For example, if your activity is to work with the tangram puzzle and the person picked up the pieces, felt them, turned them over, looked at them but didn't even attempt to put them on the template, that's a success. They were engaged and interested. Next time, maybe they'll put a piece on the template, maybe they won't. It's still a good activity for them. Be positive, and show it genuinely by your facial expression and relaxed posture. Treat it as a success. Encourage them to be happy about what they accomplished. They will associate this positive emotion with the activity which means that they will feel good about it the next time you present the activity.

Sometimes it's our expectations that are the problem. Maybe it's "you" who didn't get it. If the person didn't do what you expected, rather than treat that as "wrong" instead try to look at through their eyes. Try to understand what they were thinking and why they did what they did. Use it as an opportunity to learn about them and marvel at how they interpret things differently than you. Adapt your expectations to allow them to be successful. Go with the flow. Take your direction from them.