Have you ever been startled by the sound of a smoke detector, fire truck siren, or your morning alarm clock? Was there a highway accident during your commute that caused a major delay? Do you feel nervous when trying a new food or doing an unfamiliar activity? Humans thrive and feel safer with a certain level of structure, order, familiarity, and predictability. Taking the time to create routines for dementia care is one way to increase predictability and improve quality of life, not only for the adult with dementia but also for their care partner(s).

When a person experiences sensory sensitivities (also known as sensory over-responsivity or avoiding), they feel startled more often by sensations or unexpected changes in their environment. If always anticipating “what type of uncomfortable sensory input might I experience next?!”, the nervous system is on high alert. The environment feels less safe because there could be a painful or uncomfortable sensation at any moment.

How do routines help?

There is power in routines for individuals with sensory differences, including adults with dementia. Here are 5 reasons why:

1. A familiar routine provides structure and predictable experiences. Ultimately, this can make the environment feel safer.
   
2. Predictability helps the nervous system regulate. It feels comforting to know what is coming next and to be as prepared as possible.
   
3. If there is a task that is notoriously challenging, routines can be designed to include calming sensory input before and after that task.
   
4. Structure helps decrease the reactivity of the brain’s fight/flight/freeze stress response. Hence, less agitation and aggressive behavioral expressions.
   
5. Repetitive routines tap into procedural memory. Procedural memory appears to remain intact longer than other types of memory (1).

Tips for creating routines for dementia care

• Consider past routines and roles.
  How did they structure their day? Did they prefer to bathe/shower in the morning or evening? Was a cup of tea or coffee their morning drink of choice? Did they go for an evening stroll after dinner? Did they attend church every Sunday morning? Ask the adult with dementia for their input and offer choices when possible.

• Identify the types of prompts or cues the adult with dementia can cognitively and functionally understand.
  Some adults with dementia know what they want to do, but their brain is not telling them how to start. They may need a verbal reminder, visual cues, touch cues, and/or physical assistance.
  
  Note: If the adult cannot cognitively understand/process visual cues, then it is unfair to expect them to follow a written schedule. Do you need support figuring out what prompts or cues are most appropriate? You can ask your physician for a referral for an occupational therapy evaluation. Find an occupational therapist who specializes in dementia care and evaluating functional cognition. Please contact me if you need additional support with this!
  
• Use familiar music to help with transitions.
  Try upbeat music in the mornings and before mealtimes to support alertness. Use slower, relaxing music in the evenings to support calming before bedtime.

• Be flexible.
  A helpful routine does not need to be too rigid. This can create frustration for everyone involved, especially when things do not go as planned. For example, if it is shower time and the adult with dementia is not ready to shower, it is okay to try again at a different time. That might be 10-15 minutes from now…that might be tomorrow morning instead.

How to follow through with new routines

1. Make a routine that is realistic and achievable. On a scale of 1-10, how likely are you to follow through with the routine? If your self-rating is lower than a 7, the routine is likely too complicated.
   
2. Write it down. This significantly increases the chance that you will meet your goals!
   
3. Find an accountability partner. Check-in with one another, support and encourage one another.
   
4. Use tools and technology for reminders. Create a checklist, set customized alarms on your cell phone, add recurring appointments with reminders to your phone calendar, use a paper calendar/planner, or use a habit tracking app.

What works best to help you stick to a routine? Share in the comments below!

Reference:

1. De Wit, L., Marsiske, M., O’Shea, D., Kessels, R.P.C., Kurasz, & A.M., DeFeis, B. (2020). Procedural Learning in Individuals with Amnestic Mild Cognitive Impairment and Alzheimer’s Dementia: A systematic review and meta-analysis. Neuropsychology Review, 31, 103-114. https://doi.org/10.1007/s11065-020-09449-1

Disclaimer: Although I am an occupational therapist and the information compiled is based on years of training and clinical experience, this is NOT a place for skilled therapeutic intervention.  The ideas presented on this website and in products are for informational/educational purposes only and are not medical advice.

A website does not replace an individualized plan of care developed as the result of assessment, clinical observation, and collaboration between therapist, client, and care partner(s). If you are concerned about the cognitive, sensory, or functional abilities of yourself or someone you know, then you should talk with your physician or your therapist.