Dementia and Alzheimers

Materials Used to Enhance Orientation-Alzheimers

Materials for encouraging reorientation and relearning are easy to find and need not be expensive. Of basic importance is the structuring of the patient’s primary living space (e.g., the bedroom or the sitting room). Furniture and accessories should be kept neat and tidy, and in the same basic order. Ideally, the room should have a window, whereby the patient can tell the time of day and the weather. A large clock (preferably with a lighted dial) and a calendar should be visible. The patient should be encouraged to wear and use a watch that contains a date feature. Stimulating materials should be readily available for the patient, such as current newspapers, magazines, a radio, and a television. A daily schedule of the patient’s hourly activities should be posted. Familiar accessories should surround the patient (e.g., family photos, mementos, favorite pieces of furniture, knickknacks, and the like), and around major holidays the room may be decorated. To help keep the patient oriented to place, signs, directional arrows, night lights, or color-coding of doors may be helpful.

In addition to the ongoing orienting that should occur in every inter­action with the patient, the family member may wish to have more structured periods of reality training. These times should be kept relaxed and informal so that they prove to be pleasant experiences for both you and the patient. These sessions should occur in the same setting, be kept short (about 10-15 minutes), and occur several times a week.

A standard prop employed in reality orientation classes is the reality orientation board. The type of board used can be cork bulletin board, peg­board, a felt board, a blackboard, or any surface that allows for an easy changing of information on a daily basis. A typical format for the reality board is the family member and the patient fill in the current responses to these sentence stems together. It is imperative that the reality board be kept current and correct. Other reality materials can include – a toy clock with moveable hands, photo albums and scrapbooks, flash cards with words and pictures; large-print books, magnetic alphabet boards, scrabble sets with large letters, county, state, and world maps, well-known landmarks or a United States map, a globe; large-piece jigsaw puzzle of animals, food, and common object, plastic fruit and food, and large-print, illustrated dictionaries.

The family member must remember that every Alzheimer patient has different strengths and weaknesses that change over time, and even vary somewhat from day to day. As such, it is up to the family member to decide which orienting and training techniques will be more suitable. For higher functioning patients in the early stages of the disease, discussion of current events and newspaper headlines, working on a simple crossword puzzle, or fill-in-the-blank statements may be appropriate. A moderately affected Alzheimer patient may be able to discuss such topics as recipes, television shows, short stories, or sports, and still be able to participate in simple card games or checkers. With the very demented and confused patient, the family member may do best to focus on constant repetition of personal information, such as name, address, telephone number, and the name of the important person in the patient’s life (e.g., spouse, family member, or guardian). Such personal information should be typed on a permanent card that the patient carries at all times. The very confused and demented patient may also derive some benefit from the review of colors, names of objects, and the use of eating utensils or grooming objects.

In some cases the patient will be able to progress to somewhat higher levels of materials. Just remember not to set your expectations too high, and avoid abstract discussion or materials that can confuse and frustrate the patient. On the other hand, the patient should be stimulated and not bored. The key to reality orientation is that repetition and reminders should be offered in a positive, noncritical, and nonthreatening way. One of the primary goals of this technique is to rebuild the patient’s self-confidence and restore personal dignity.

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