Recreational

Therapies in Dementia
Care
Tonya R. Hensley

Recreational Therapies 1

Recreational Therapies in Dementia Care

Interview:
My patron is an in-home care giver for her elderly mother who has been diagnosed with
vascular dementia. During the interview process my patron began inquiring as to the
information available on dementia. In an attempt to narrow down her topic, during the reference
interview I asked specific questions about the kinds of information she wanted. As I advised her,
any inquiry concerning medial issues can be very broad with many resources available especially
on all of the varied aspects of the disease management, diagnosis and treatment. As our
conversation progressed her responses became on techniques that would improve the quality of
life for her mother which would enable her mother to remain at home for a longer period of time
without having to be placed in a long term care facility. Her main objective was to discover
therapies that would be easily implemented in a home care environment.
Introduction:
For my research studies I accessed the electronic resources through the Jackson Library
at UNC-Greensboro, the C.G. OKelly Library at Winston-Salem State University and NCLIVE
through the Davidson County Public Library System. The major platforms used in my search
were EBSCO and Worldcat. As I found, the topic of dementia is extremely broad, so narrowing
down the information was essential. For this reason, I began by using dementia therapies and
in-home care of dementia patients as my search prompts. At first the results yielded articles
on drug interventions. As I adjusted my search terms to include: non-pharmaceutical therapies
of dementia patients and alternative therapies and dementia produced better results.
My first discovery was a book entitled, Creative approaches in dementia care by edited
by Hilary Lee and Trevor Adams1 located at the Jackson Library at UNCG. While not an
electronic resource, I found it necessary to include this work in the bibliography because it
1 Lee, H. & Adams, T. (2011). Creative approaches in dementia care. New York:
Palgrave MacMillan.

Recreational Therapies 2

provided substantial information on the topic. Moreover, the information served as a starting
point in my research. In the forward, I was able to unearth key points as it relates to patient care
and the need to adjust perceptions of thought concerning the effects of dementia. Emphasis was
placed on the mental denigration through progression and the tendency of care givers to attribute
mental acuity that has been filtered through the lens of healthy brains. This is not necessarily the
case when dealing with dementia. The family must realize the world in which the patient finds
themselves is real to that patient.
Throughout the text, chapters are devoted to the different therapies used in improving the
quality of care for patients with this disease. Case studies are provided with each chapter as well
which serve to strengthen the research points. The following therapies were highlighted: music,
humor, dance, exercise, art, animal, doll, aromatherapy, religion, storytelling, photography and
reminiscing. From there I was able to narrow my research by searching for electronic source
information on each of the therapies listed above. Because of the invaluable information as well
as the writing style which was written for any laymen to understand, I felt it was important to
include this printed source in my bibliography.
As I moved away from the book, Creative approaches in dementia care, I further
searched the electronic resources available to me. With more search terms to use like,
recreational therapies for dementia care and occupational therapies for dementia care,
combined with music, art, religion, et. El listed above, I was able to find material needed to
address my patrons question.
Summary:
While conducting this research for my patron, I was able to find a wealth of information that I
believe will provide her with therapy options which will allow her to extend the amount of time
her mother will be able to remain at home. The majority of approaches were focused on reducing
anxiety and calming moods. I provided a list of resources that include all aspects of recreational

Recreational Therapies 3

therapies. The most popular of these treatments are centered on music or creative avenues such

Music and religion have been an important

part of Ruths life. Here she is singing
using shaped note music in her home
around 1965 with three of her five sisters.

as art, drama or role-playing.

L-R: Rema Monteith Sisk, Ruth Monteith

Musgrave, Thama Monteith and Gleta
Monteith Cook.

After providing my patron with her list of resources and following up with her, I have discovered
that therapies such as music have greatly improved the quality of life for Mrs. Musgrave. Her
church has also provided recordings of its services which include singing and preaching. Both
mediums have been shown to reduce her anxiety levels. She is less agitated and cooperative
after hearing the gospel songs of her childhood. As part of her physical therapy which she
received several times per week, her therapist is employing techniques such as exercise,

Recreational Therapies 4

remembrance and music therapy. Her daughter has been able to see the benefits of these
activities and is pleased with its use. This opportunity was personally gratifying to me because
being able to assist patrons in this capacity is one of my favorite aspects of being a reference
librarian in a public library. The patron came in with a problem I was able to help her solve
which will make the lives of her and her family more enjoyable.

Four generations front (L-R): Della Hensley, Racelynn Hensley, Ruth Musgrave
Back row: Tonya Hensley
Lighthouse Baptist Church 2011
Annotated Bibliography:
Altshul, S. (2003). Ease Alzheimer's Agitation. Prevention, 55(5), 57. Retrieved from
http://ehis.ebscohost.com/ehost/detail?vid=10&sid=52969440-70c4-4e08-adb947fde3065ea8%40sessionmgr114&hid=102&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#db=a9h&AN=9451493.
The article Ease Alzheimers Agitation found in Prevention Magazine highlighted the
importance aromatherapy can have as an addition to the overall health care of patients suffering
from dementia and its related diseases. Althshul contends that research published in British
Medical Journal reveals a correlation between specific smells and a decreased level of anxiety in
dementia patients. The author further points out that it is not the fragrance in such things as
lavender and lemon balm, but the terpenese which are components of many oils. Even

Recreational Therapies 5

spritzing in a room of someone can have a positive effect. The medical community believes that
the rapid absorption into the body that can quickly calm patients. The theory that some aromas
may trigger happy or safe memories is also included as possible benefits to using this type of
therapy.
Alzheimers Foundation of America (2013). About dementia. Retrieved from
http://www.alzfdn.org/AboutDementia/definition.html.
This website is a valuable resource as it helps to explain all aspects of dementia. While not
specifically targeting recreational therapies, this site can provide alternative solutions along with
information and referral for topics associated with this disease. I always include the national
organization of any illness because of the types of information found on the website as it usually
includes medical experts and research specifics to the disease.
Arts project offers trip down memory lane. (2012). Nursing Older People, 24(6), 4. Retrieved
from http://ehis.ebscohost.com/ehost/detail?vid=14&sid=52969440-70c4-4e08-adb947fde3065ea8%40sessionmgr114&hid=102&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#db=a9h&AN=77713500.
This article although short in length provides an excellent point about using the arts as a way to
enhance the overall quality of life in patients who suffer from dementia. By using songs, sounds,
textures, and items from school, childhood or even family gatherings, studies have shown
success with these techniques. Residents are paired with professional artists to assist with the
projects. The interactions with the artists assist patients by improving communication skills as
well as providing a sense of belonging to a community.
Bennett, S., Shand, S., & Liddle, J. (2011). Occupational therapy practice in Australia with
people with dementia: A profile in need of change. Australian Occupational Therapy
Journal, 58(3), 155-163. doi:10.1111/j.1440-1630.2011.00930.x
This authoritative study in the Austrian Occupational Therapy Journal uses action research to
highlight the difficulties associated with the care and treatment of people suffering from
dementia as well as the techniques that have a general influence on the health and well-being of
said patients. While providing a list of therapies, this report gives insight into the successful

Recreational Therapies 6

integration of in-home therapies, the importance of training caregivers and traditional ideas can
be beneficial to the patients overall health. This study also illustrates the struggle patients and
caregivers face such as access to adequate medical facilities in addition to the total cost of care.
Bible therapy may be effective treatment for agitation in Alzheimers. (1995). Brown
Universitys Long-Term Care Quality Letter, 7(5), 5. Retrieved from
https://libproxy.uncg.edu/login?url=http://search.ebscohost.com/login/aspx?
direct=true&db=f6h&AN=9503240603&site=ehost-live. 13 Apr. 2013.
This case study in this article demonstrates the role spiritual beliefs have in treating patients.
Two elderly men showed visible signs of aggression during their hospital stay. Drug therapies
were not effective in reducing the aggression; it was only after one patients son began reading
scripture that the behaviors changed. Following the visit as the patients would normally become
aggressive during the medical procedures, they began reciting the passage from the Holy Bible
which seemed to curb the aggressive tendencies. This technique was instituted in other cases
within the hospital and the same results occurred.
Dementia clowns-no laughing matter: past studies have revealed the great benefits that humor
and laughter deliver to other health populations. (2008, Dec.). Australian Nursing
Journal, 16(6), 27. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE
%CA190379446&v=2.1&u=gree35277&it=ITOF&sw=w.
This study from the National Health and Medical Research Council in Australia found that when
humor techniques, in this case dementia clowns, are implemented, the ability for staff to tame
aggressive increases. This has a beneficial effect on the quality of care patients received.
Gustafson, M. (2011, Nov.). Humor therapy may reduce agitation levels for residents.
McKnights Long-Term Care News, 32(11), 6. Retrieved from http://go.galegroup/ps/i.do?
=GALE%CA273715697&v=2.1&u=gree35277&it=r&p=ITOF&sw=w 13 Apr. 2013.
Research from the SMILE study in Australia contends that humor therapy can be as beneficial
to patients with dementia as anti-psychotic drugs. Decreases in agitation, violence, wandering,
anxiety and other effects of the advancement of this disease can be seen with the implementation

Recreational Therapies 7

of this therapy. Humor practitioners visited care facilities using techniques such as comedy,
improvisation and other forms of laughter to create fun, comfortable environments.
Learner, S. (2010). Striking a positive note. Nursing Standard, 25(2), 24-25. Retrieved from
http://ehis.ebscohost.com/ehost/detail?vid=7&sid=10cf7e50-1092-46b6-b942f8fbe64364e0%40sessionmgr4&hid=5&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#
db=a9h&AN=54413337.
This article from Scotland states that 1/5 of all people suffering from dementia are using
at least one psychotic drug as part of their care. Striking a positive note highlights the
Adamwood Nursing Home which makes it a priority to wean patents off drugs and to implement
therapies that improve the overall quality of life. By introducing such activities as art, music,
drama, dance, poetry and storytelling, patients along with visiting artists work together to keep
minds active and working. By creating individualized schedules tailored to each patient and
introducing less structured environments residents are able to reclaim independence and be
allowed more authority over the types of activities they wish to participate in. This creative
approach is yielding great results such as an overall change in mood and decreased anxieties.
Merkel, R.B. (1993, Sept. 15). Self-esteem more important than completion for dementia
activities. The Brown University Long-Term Care Quality Letter, 5(17), 1+.Retrieved
from http://go.galegroup.com/ps/i.do?id=GALE
%7CA14235413&v=2.1&u=gree35277&it=r&pITOF&sw=w.
This article is included in the list because it presents a thoughtful step-by-step list of ways to
facilitate a successful home therapy environment. Other techniques presented include how to
integrate meals, with a warm safe dialog, and the use of music therapy as much as possible into
the structure of complete care.
Nonpharmacologic Interventions for the Alzheimer's Resident. (2000). Nursing Homes: Long
Term Care Management, 49(8), 51. Retrieved from
http://ehis.ebscohost.com.proxy050.nclive.org/ehost/pdfviewer/pdfviewer?
vid=18&sid=5903ff82-70df-4b9b-9f3e-00610360e1ad%40sessionmgr13&hid=115.

Recreational Therapies 8

Although this resource is centered on the nursing home environment with reasoning for special
units specifically for the care of Alzheimers patients, there are some important ideas that can
transition to in-home care situations. It is suggested that private areas for patients be constructed
to provide freedom of movement in a safe way. This is important as it affords feelings of
independence to dementia sufferers. This article also supports the idea of love, feelings of being
useful and the ability of expression as important in the lives of these patients.
Creation of a home unit can included such therapies as cooking, music, gardening,
rummaging through old clothes/photographs and aromatherapy. In addition using items found in
nature, fish aquariums, dolls and bath babies provide benefits to patients as well. Each of these
avenues can yield feelings of calm and security which are vitally important to people with this
disease.
Rabins, P. V., & Margolis, S. (2003). Alzheimer Disease. Memory (Medletter), 19. Retrieved
from http://ehis.ebscohost.com/ehost/detail?vid=27&sid=52969440-70c4-4e08-adb947fde3065ea8%40sessionmgr114&hid=5&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#db=hxh&AN=10047456.
This work is an excellent source of information on Alzheimers disease, dementia and related
illnesses. It is a combination of data concerning the illness as whole as well as specific facts. To
begin, this article defines A.D. including its causes, treatment options and its progression. The
approach is given in laymens terms especially medical topics which make it easier to
comprehend. Smaller blurbs are embedded which highlight new research findings, treatments,
medical studies and drug therapies.
In addition to the medical aspects of A.D and dementia found in this article, Rabin and
Margolis have included care options, referrals for services, and the transition from living alone to
moving in with loved ones/nursing homes. Furthermore great information is provided on
choosing quality nursing homes which comprise the types of services to look for, the costs
associated with care. Tips on preventing wandering patients and depression are also provided.

Recreational Therapies 9

Two therapies mentioned in this article are worth noting for the assignment. The authors
included, Reality Orientation Therapy (ROT) and Exercise Therapy as alternatives to traditional
treatment options. ROT works to assist patients on reclaiming information such as dates, times
and locations. Therapists use crossword puzzles, board games, maps, clocks, and calendars as
well as newspapers or magazines. Current event and sport topics are also integrated into this
program which helps patients retain a sense of place and time. However, caregivers are advised
to discontinue if patients develop depression or a change in overall mood.
Another therapy mentioned is exercise. This type of treatment has been proven to
enhance moods with patients becoming less anxious, as well as having the ability to remain
flexible, balanced and mobile. The medical benefits of exercise include increased social
interaction, improved sleep patterns and the regularity of bowel movements. As with ROT, there
are some cautions that must be addressed such as the likelihood of decreased ability as the
disease progresses. Oftentimes, sessions must be adjusted, delayed or eventually discontinued.
Shub, D., Darvishi, R., & Kunik, M. E. (2009). Non-pharmacologic treatment of insomnia in
persons with dementia. Geriatrics, 64(2), 22-26 Retrieved from
http://ehis.ebscohost.com/ehost/detail?vid=27&sid=52969440-70c4-4e08-adb947fde3065ea8%40sessionmgr114&hid=5&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#db=hxh&AN=11653396.
This article focuses on insomnia in dementia patients with medical causes and treatment options.
Shub and Kunik advocate the use of light therapy to alter the moods of sufferers. This uses the
theory of winter mood disorders in which people experience bouts of depression during the dark,
cold months of the season. Discussion on limitations of care specifically cost and availability of
equipment is included as well as the acuity of patients, their awareness of their environment or
the level of comprehension is included in the conversation. This study also stresses exercise
therapy and the establishment of sleep hygiene which is nothing more than set protocols at

Recreational Therapies 10

bedtime like bathing, brushing hair or teeth for example. As with all medical treatments, this
option is individualized to each patient but has had a significant effect on sleep patterns.
Additional information can be found through a listing of websites that are included in this work.
Silvers, A., Wilson, A., & Westgate, G. (2010). Developing a therapeutic recreation dementia
program. Long-Term Living: For The Continuing Care Professional, 59(6), 42-45.
Retrieved from:
http://ehis.ebscohost.com.proxy050.nclive.org/ehost/pdfviewer/pdfviewer?
vid=13&sid=5903ff82-70df-4b9b-9f3e-00610360e1ad%40sessionmgr13&hid=115
This article highlights the project called Pieces of the Puzzle. It is centered on the training of
certified nursing assistants (CNAs) and other nursing home staff to adequately care for
Alzheimers patients using person-centered care. Personalized activities with each patient
need to be diverse and match the level of patient ability. Some suggestions may comprise role
playing, incorporating office tools familiar to patients, doll therapy or even household chores
such as folding laundry. This initiative has seen the quality of care improved with reduction in
stress for caretakers, patients and others involved in treatment. These therapies have reduced
anxiety, depression or reports of falls while increasing alertness and mobility.
Sung, H., Change, S, Lee, W., &Lee, M. (2006). The effects of group music with movement
Intervention on agitated behaviors of institutionalized elders with dementia in Taiwan.
Complementary Therapies in Medicine, 14(2), 113-9, doi:
http://dx.doi.org/10.1016/j.ctim.2006.03.002.
This resource is an action plan that measures the effect music and dance can have on
patients with dementia. This is a scientific study supported through active research and includes
the notion that anti-psychotic medication and restraining patients are not the appropriate course
of treatment. The research advocates exercise in the form of dance combined with music as
recreational therapy to be implemented into an overall health care regimen. Movements such as
toe tapping, clapping and others are seen as added benefits. The benefits of this therapy include
dispelling negative thoughts, improving both body and spirit. The author further state that music

Recreational Therapies 11

is used not only as a primary treatment but reiterates the thoughts that this therapy release
stress chemicals in the brain and can improve well-being.
Thompson, J. (2011). Engaged and transformed: St. Leonard finds success with Alzheimer's
Therapy program. Long-Term Living: For The Continuing Care Professional, 60(3), 4951. Retrieved from:
http://ehis.ebscohost.com.proxy050.nclive.org/ehost/pdfviewer/pdfviewer?
vid=16&sid=5903ff82-70df-4b9b-9f3e-00610360e1ad%40sessionmgr13&hid=115 .
This work illustrates the isolation Alzheimers disease and how these feelings directly affect
patient comfort, care and anxiety levels. This lack of motivation can led to injuries such as falls
or wanderings. Dr. Govind Bharwani a professor at Wright State University and his daughter,
Meena have produced this study on the correlation between ergonomic sand healthcare, Their
work, entitled, Behavior-Based Ergonomic Therapy relates to dementia sufferers while trying
to lessen feelings of disengagement and boredom in patients. This research was implemented at
St Leonard Franciscan Living Community in Dayton, Ohio. Less than a year following the
initial phase of this study, officials saw a 35% decrease in falls, 70% decrease in the need for
anti-anxiety medication and an increase in the quality of individual care. This custom care
approach using techniques designed to comfort patients using music, games, puzzles and
memory boxes filled with family photographs.
Trueland, J. (2013). Bringing back memories. (Cover story). Nursing Standard, 27(26), 16-18.
Retrieved from http://ehis.ebscohost.com/ehost/detail?vid=27&sid=52969440-70c44e08adb947fde3065ea8%40sessionmgr114&hid=5&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ
%3d%3d#db=a9h&AN=85845835.
This article is from a UK study at the Age Exchange Reminiscence Center which uses vintage
items such as toys, candy, tools and cooking implements to provoke happy memories of the past.
Residents are able to exchange ideas and stories with each other as well as family, friends and
nursing home staff to create a calmer environment. This social exchange helps to facilitate

Recreational Therapies 12

independence and the idea that patient minds are working. It is believed that these types of
therapies are best suited at bath time which makes such activities less stressful and the use of
vintage soaps can bring back smells from childhood. These types of treatments can result in less
anxiety and better frames of mind for patients.
Yamagami, T., Oosawa, M., Ito, S., & Yamaguch, H. (2007). Effect of activity
Reminiscence therapy as brain-activating rehabilitation for elderly people with and
without dementia. Psychogeriatrics, 7(2), 69-75. doi:10.1111/j.1479-8301.2007.00189.x
Another action research study which delves into the affects Activity Reminiscing Therapy (ART)
has on patients suffering from dementia like illnesses. The study showed improvements in areas
of social interaction and behavior modifications in these people. It was stressed that a safe
comfortable environment helps to exercise the brain through this type of therapy. The use of
such objects as old books, tools and vintage items help to facilitate memories. The importance of
caregiver training as it relates a to communication exchanges with patients was vital in the
therapy process.