Communication & Dementia Meaningful Activities PDF

Communication & Dementia Meaningful Activities Communication & Dementia Part 1  Quick Review  Dementia is an overall term for a set of symptoms that is caused by disorders affecting the brain. Symptoms may include memory loss and difficulties with thinking,...

Communication & Dementia Meaningful Activities Communication & Dementia Part 1  Quick Review  Dementia is an overall term for a set of symptoms that is caused by disorders affecting the brain. Symptoms may include memory loss and difficulties with thinking, problem-solving or language, severe enough to reduce a person’s ability to perform everyday activities. A person with dementia may also experience changes in mood or behaviour. These dementia symptoms are irreversible, which means that any loss of abilities cannot come back.  Dementia is not a specific disease. Many diseases can cause dementia, including Alzheimer’s disease, vascular dementia, Lewy Body disease, frontotemporal dementia and Creutzfeldt-Jakob disease. These conditions can have similar and overlapping symptoms.  There is currently no cure for dementia. However, there are treatment options and lifestyle choices that may slow it down. Researchers continue to look for ways to prevent or stop dementia and to improve care and quality of life for those living with dementia.   Dementia can have a profound effect on communication abilities, which can be upsetting and frustrating for the person with dementia and those around them.  This language deterioration is known as aphasia. Individuals with aphasia experience difficulty:  Expressing themselves  Finding the right words  Understanding spoken language  Reading and writing Communication  As a result, people with dementia need assistance to communicate. & Dementia  Deterioration in communication (which may be gradual or sudden) is a significant fact in many types of dementia.  People with dementia will lose specific communication abilities during the early, middle, and late stages of the disease.  As the disease progresses, non-verbal communication will become increasingly important.  Despite the changes in communication abilities, it is important to remember that communication remains possible at every stage of the disease.  Speech and Language Challenges Communication Loss of Understanding Challenges for Clients with Non-Verbal Communication and Dementia Behaviour Advanced Stage Difficulties 1. Speech and Language Challenges Word-finding issues: Reduced Difficulty Repetition: vocabulary: Speech remembering or Repeating words, becomes simpler or replacing words (may phrases, or thoughts. more limited. create new ones). Loss of Speech Lack of coherence: conversational abnormalities: Speech may lack skills: Interruptions, Hesitant speech, logical flow or ignoring others, or stuttering, or clarity. failing to respond. incorrect grammar. 2. Loss of Understanding Difficulty following conversations: Losing track of topics or struggling to process fast or complex speech. Abstract concepts: Struggles with idioms, humor, or figurative expressions (e.g., “I feel blue”). Facial expressions and gestures: Difficulty interpreting non-verbal cues like winks or nods. Reduced reasoning skills: Challenges in processing logic or understanding what is being said. 3. Non-Verbal Communication and Behaviour Social norms: Loss of Emotional expression: typical conversational Struggles to express conventions, such as waiting emotions appropriately. for a turn to speak. Speech volume: Speech Distractibility: Difficulty may become softer, slower, staying focused or on topic. or marked with pauses. 4. Advanced Stage Difficulties Mute or minimal speech: Reading and writing: Skills may Inability to recognize words: Speech may reduce significantly deteriorate, making written Loss of familiarity with written or stop altogether. communication challenging. or spoken words. Additional Contributions Causing Communication Difficulties It is very important that people with dementia have annual hearing and vision Sensory impairments such evaluations and that they as hearing and vision loss. use assistive devices, like hearing aids and eyeglasses, as needed.  Behaviours may arise as a result of the individual with dementia not being able to communicate with people around them.  For example, a resident with dementia in a long-term care home hits out at a staff member because they can’t tell the person that they don’t want to get Behaviours as a dressed. Result of These behaviours are often called “challenging”, Communication  “aggressive”, or “manipulative.”  It is important for these “challenging behaviours” to be understood as a means of communication. Difficulties  The person with dementia is transmitting a message/need/problem via their behaviour that something is not right  We can reframe these behaviours as “responsive behaviours”  When behaviours are reframed as responsive, it directs caregivers to search for the meaning of the Responsive behaviour and provide care in a way that is respectful and personcentred. Behaviours  But more on this next week… Importance of Communication for Clients with Dementia People with dementia When they are ignored or who have communication isolated, their needs, difficulties may become abilities and strengths isolated, neglected and are not acknowledged excluded from social and supported activities As a result, the person with dementia does not This leads to a sense of want to engage which helplessness and brings on more disempowerment nonengagement with the caregiver Communication  Communication is an important part of our life  It helps us to express who we are and allows us to relate to one another.  When we communicate, we exchange information about our needs, opinions, ideas, beliefs, feelings, emotions, experiences and values.  Communication is more than talking and listening; it involves understanding and interpreting. How Communication Happens 01 02 03 Verbal Non-verbal Para-verbal communication: communication: communication: words we use (7%) body language tone, pacing and (facial expression, volume of our posture and voice (38%) gesture) (55%)   Given that 93% of how we communicate is non-verbal, Importance of communication is not so much about what you say, but how you say it. When caring for a person who has Non-Verbal dementia and who is having difficulty communicating this is especially true. Communication Person Centered Care Approach to Communication  Person-centred care values people with dementia as individuals with unique histories, values, likes, beliefs and strengths  Care includes a person’s abilities, preferences, and choices  Providing person-centred care moves beyond the physical act of providing care and involves the whole person and their social, cultural and individual identify.  A successful person-centred care approach to communication includes: 1) Believing that communication is possible 2) Focusing on the skills and abilities of the person 3) Reassuring and being positive 4) Meeting people with dementia where they are and accepting their reality 1. Believing Communication is Possible  Communication is possible at all stages of dementia.  What a person says, does and how they behave is a way to communicate and there is meaning behind these things.  Knowing the person you care for will help you interpret the meaning behind the behaviour.  No matter what the person does or says, treat them with respect and dignity. 2. Focusing on the Person’s Abilities and Skills  Although there are cognitive deficits with dementia, the person’s emotions and feelings will remain.  Focusing on their remaining skills and abilities will increase their quality of life.  If speech is lost or you are having a difficult time understanding the person with dementia, consider using alternative ways to help them express themselves (i.e. through art, gardening, and touch).  3. Reassuring and Being Positive  Encourage the person when they are having trouble expressing themselves.  Move away from criticizing, correcting, ignoring and be supportive and positive.  Laughter and humour go a long way in diffusing a challenging situation.  “Be a guide, not a parent” – never start a sentence with the words “no” or “don’t” 4. Meeting the Person Where They are and Accepting Their Reality  The reality of a person with dementia may be very different than our own reality.  Individuals with dementia are not able to enter our world, therefore, caregivers must enter into the world of the person with dementia.  “It is easier to change the environment than to expect the person with dementia to change.”  Try to meet the person where they are. Leave your agenda at the door.  Avoid confronting/convincing the person with dementia that what they are experiencing is untrue.  Trying to bring them back into our reality (reality orientation) or disagreeing with the person with dementia will cause them to become even more confused or upset.  If the person says something that you know is untrue, try to find ways around the situation instead of reacting negatively  Utilize Validation Therapy instead of Reality Orientation. Validation Therapy  Validation Therapy helps the caregiver understand the meaning behind the message from the person with dementia.  The caregiver enters the person with dementia’s world and validates their emotions/thoughts/feelings in whatever time or place that is real to that person.  The caregiver listens to the emotional message behind the person’s behaviour and validates how they are feeling.  Redirection might be helpful   Do not argue with a person if they are insisting something is true that you know is not.  Example: A person with dementia says, "The dog is in the backyard," even though there is no dog and they haven't owned one for years.  Response: Instead of arguing, say, "Oh, you loved having your dog in the backyard! Tell me more about your dog." This redirects the conversation without causing frustration.  Listen to the message and try to find the meaning behind what they are saying.  Example: A person with dementia keeps saying, "I need to go home," Points to  even though they are already at home. Response: Instead of focusing on the literal words, recognize they may feel unsafe or disoriented. Say, "It sounds like you're feeling uneasy. Can Remember with  I sit with you and help you feel more comfortable?" Allow the person with dementia to express themselves. Validation  Example: A person with dementia is having difficulty finding the right words and is pausing frequently. Therapy  Response: Instead of interrupting or finishing their sentences, wait patiently and provide a calm, encouraging smile. After they finish, you can summarize or clarify gently if needed.  “Remember to Connect and not to Correct” Always respond to repetitive questions with patience, in a caring, reassuring manner. No matter how many times the person asks the question – to them, it is the first time they have asked it.  Example: A person with dementia repeatedly asks, "When is dinner?" even though you've answered multiple times that it’s at 6 p.m.  Response: Each time, respond with patience: "Dinner will be ready at 6 p.m., but I can get you a little snack now if you're feeling hungry." Use a soothing tone to reassure them. Verbal Redirection  Redirection may also be used as a way to help communicate with a person with dementia.  Redirection can be position or negative.  Negative redirection happens when you dismiss someone or ignore what they are trying to tell you. For example, “You don’t need your purse” or “Don’t worry about it.”  Positive redirection validates and joins in on what a person is thinking and feeling.   Validate the person’s reality, or what they are feeling or thinking.  Example: A person says, “Someone took my jacket, and now I can’t go outside.”  Response: “You’re worried because you think your jacket is missing. I can see why that would upset you.”  Join the person where they are and listen to their point of view. Successful Verbal  Example: A person says, “I need my jacket because it’s cold outside, and I have to go to work.” Redirection can  You’re right, jackets are important when it’s cold. Let’s see what we can find together. be Done in Four  Distract the person by pointing their attention to something else. Steps  Example: A person keeps searching for their missing jacket.  Response: “Why don’t we check near the window? Maybe it’s there, and we can see what’s happening outside.”  Redirect them by engaging them in an enjoyable activity.  Example: The person continues to worry about the jacket.  “You know what? Before we look, I’d love to hear the story about how you got this jacket. It’s so fashionable and I could do with buying a new one for myself.” Communication  There are some very simple communication strategies that you can use when caring for individuals with Techniques for dementia. They fall under the following areas: the HCA in 1) Caring Approach Talking clearly Supporting 2) 3) Body Language Clients with 4) Setting up the right environment Dementia 5) Using the most appropriate words 1. Caring Approach  People with dementia are very sensitive to how we look, act, the tone of our voice, our body position, etc. How we present will affect our relationship with the person that we are caring for.  Using a friendly, calm, relaxed approach will put the individual at ease even if they do not understand what you are saying.  Additional Tips  Addressing the person by their preferred name  Be flexible  Never use a controlling manner or an authoritarian tone.  Do not argue  Remain calm – ask for help if you are frustrated  Be patient  Listen carefully and do not interrupt  Make communication a two way street  Encourage humour and laughter  Respect sadness  Avoid literal phrases (i.e.. I am going to put the person in room 306 down) which may confuse the person with dementia.  Avoid using modern slang.  Avoid using generic terms like “love”, “dear”, “papa”  Avoid abstract language  2. Talking Clearly  Residents with dementia have difficulty in remembering and interpreting information. As the disease progresses, the ability to manage complex information declines.  To make communication successful, the message that you send needs to be short and simple.  Additional Tips  Use simple, short sentences.  Speak at an appropriate volume. Do not yell.  Give one direction/piece of information at a time.  Give enough time for the person with dementia to process information (10-20 seconds minimum).  Speak slowly and clearly – gage your pace by the reaction of the person with dementia.  Use words that the person with dementia understands, knows or is familiar with.  Never speak “over” the person as you care for them.  Do not speak to the resident with your back turned or from a different room.  Always introduce what you are doing prior to completing a task. 3. Body Language  Given that people with dementia receive over 93% of their information about their world through non-verbal communication, it is important that care givers understand how strongly that these individuals rely on non-verbal communication to interpret the world around them.  Caregivers need to be observant of the body language they present.  You may be saying one thing, but body language could suggest another  Body Language is always present. It can either be positive or negative.  Additional Tips  Ensure that the person with dementia realizes that you are there. Make eye contact before saying anything (where culturally appropriate).  Smile.  Do not stand directly over top of the person with dementia.  Crouch down to their level so that they don’t have to look up at you.  Use hand gestures and other visual cues to communicate.  Provide touch and contact (as appropriate).  Be aware of the personal space of the person you are caring for. They may not be comfortable with you in their “whisper zone.”  Try to avoid body language that conveys that you are frustrated, angry and in a hurry (even if you are!). Examples include: sighing, shaking fists, rolling eyes. 4. Setting Up the Right Envrionment  Often times, the person with dementia is overstimulated in an environment that has “too much going on.”  For example: Too many people talking at the same time or radio and the television playing in the background.  Additional Tips  Turning off the TV, Radio, CD Player.  Taking the person to a quiet area if you are not able to minimize the background noise to have a conversation.  Stay still while you are talking; the more the person can focus on you the better.  Ensure hearing aids are on or they have batteries in them.  Ensure that the person with dementia is wearing their glasses  5. Using the Most Appropriate Words  It is essential for the care giver to use words that the resident is able to understand.  Additional Tips  Talk to the person as an adult.  Use words that the person knows.  Use close ended questions when trying to do tasks.  Use open ended questions when you want to open up conversation.  Watch for signs of frustration.  Use words that are positive, encouraging and reassuring.  Use visual cues and pictures if you are struggling to get a message across. Other Communication Tips ALLOW PEOPLE FROM OTHER LEARN A FEW WORDS IN THE CULTURES/BACKGROUNDS TIME TO LANGUAGES OF THE PEOPLE THAT YOU EXPLAIN. CHECK WITH THAT PERSON TO CARE FOR TO NOT ONLY CONNECT WITH BE SURE THAT YOU GOT THE THEM, BUT TO GIVE THEM INFORMATION INFORMATION CORRECT. YOU CAN FORM ABOUT WHAT YOU NEED THEM TO DO IT AS A QUESTION. (I.E. MR. SMITH, DO (I.E. LEARN THE WORDS BATH AND YOU WANT ME TO GO AND GET YOUR DINNER IN FRENCH). GLASSES?”).  Communication is a vital part of who we are as human beings.  People with dementia can communicate at every stage of their disease.  Behaviour is a means of communication.  Sometimes “responsive behaviours” occur as a result of communication difficulties.  Communication is not so much about what you say, but how you say it.  To enhance communication, a person-centred care approach is recommended. Takeaway Message  Early Stages of Dementia & Communication Communication Challenge Tips for HCAs Additional Tips for Successful Communication Be patient; give the individual time to find Difficulty finding the right word the word. Use visual aids or gestures to Recognize that Alzheimer's affects each person support understanding. Don’t make assumptions differently. Avoid assuming their abilities based Repeat key information as needed. Use solely on their diagnosis. Forgetfulness and confusion simple, clear sentences and reinforce messages with visual or written cues. Always involve the individual in discussions and Keep communication brief and to the point. Include the person in conversations decision-making. Speak directly to them, not just Short attention span Use short, simple sentences and avoid to their caregiver. complex instructions. Break down tasks into small, manageable Allow the person to express their thoughts and Misunderstanding directions or tasks steps. Demonstrate tasks if necessary. Take time to listen feelings without interruption. Respect their need Speak slowly and clearly. Allow extra time for for time to respond. Difficulty following conversations the individual to process information and respond. Ask which methods they prefer (e.g., face-to-face, Introduce yourself at the start of interactions. Tailor communication methods email, or phone calls) and adapt to their comfort Trouble remembering names or events Use reminders or memory aids, like photos or level. name tags. Maintain a calm and reassuring tone. Avoid Laughter can ease tension and encourage Mood shifts or defensiveness Use humor when appropriate connection. Be lighthearted if it feels appropriate arguing or correcting unnecessarily. for the moment. Engage the individual in meaningful Restlessness or inability to stay focused conversation related to their interests or memories. Offer friendship and reassurance. Show that their Provide support through honesty Observe body language and facial expressions opinions and emotions are valued and respected. Communication through non-verbal gestures to understand needs or emotions. Respond with supportive gestures. Reduce excessive stimuli to prevent the person Provide gentle orientation cues, such as Manage overstimulation from feeling overwhelmed. Focus on one Disorientation to time or place mentioning the day, date, or location when conversation at a time. appropriate.  Middle Stages of Dementia & Communication Communication Challenge Tips for HCAs Engage in one-on-one conversation in a quiet, distraction-free space to help Increased difficulty communicating focus their attention. Speak slowly and clearly. Maintain eye contact to show you care and to help Additional Tips for Successful Slower processing and responding them stay engaged in the conversation. Communication Be patient and offer reassurance. Encourage them gently to express their Struggling to express thoughts or needs thoughts and listen carefully to understand the meaning behind their words. Choose quiet environments to Avoid distractions communicate effectively. Ask one question at a time and keep it simple. Use yes-or-no questions when Overwhelm from complex questions possible, such as, “Would you like some tea?” Offer reassurance and praise to Be encouraging Offer clear, step-by-step instructions for tasks. Avoid lengthy or complex build confidence in their abilities. Increased need for step-by-step guidance requests that could overwhelm them. Use visual cues or demonstrate tasks to encourage understanding and Adapt your approach based on Misunderstanding spoken instructions participation. Stay flexible their mood and behavior. Provide written notes or reminders if spoken communication becomes Confusion with spoken words challenging or unclear. Allow extra time for them to Maintain patience respond or complete tasks Avoid criticizing, correcting, or arguing. Instead, listen empathetically and Emotional distress or frustration without feeling rushed. validate their emotions, even if their words seem confusing. Redirect gently if the person becomes stuck on a topic. Use calm and positive Focus on what they can do rather Repetition or fixation on a single topic Use positive reinforcement language to shift focus. than their limitations. Be direct and kind in your expressions. Use clear and simple gestures or facial Difficulty interpreting social cues expressions to communicate your intent. Limit options to avoid confusion. For example, instead of asking, “What would Overwhelm from choices you like to eat?” say, “Would you like soup or salad?” Use activities or conversation topics that align with their interests or past Restlessness or disengagement experiences to keep them engaged.  Late Stages of Dementia & Communication Communication Challenge Tips for HCAs Encourage nonverbal communication through gestures, pointing, or facial Additional Tips for Loss of ability to communicate verbally expressions. Use visual aids to support Successful Communication understanding. Always approach the person from the front and Focus on the feelings behind vocal Approach from the front identify yourself to prevent startling or sounds or words. Emotions are often Severe speaking difficulties confusing them. more important than precise meanings in this stage. Encourage nonverbal If you don’t understand, gently ask the person Use touch, sights, sounds, smells, and communication to point or gesture to communicate their needs. Inability to process verbal tastes as alternative forms of communication Incorporate touch, sights, sounds, smells, and communication. Use sensory-based tastes to engage the person and communicate Approach from the front and identify communication effectively. Dependence on others for all needs yourself to build trust and minimize Consider the feelings being expressed behind confusion. Focus on emotions over sounds or actions rather than focusing strictly on Engage the person by using calming words words. sensory stimulation, such as familiar Withdrawal from interactions Avoid talking down to the person or ignoring smells, soothing music, or gentle Show respect and dignity them. Treat them as an individual with value physical touch. and worth. Use familiar items, photos, and Difficulty recognizing people or meaningful objects to create a sense of Your presence is more important than finding surroundings comfort and familiarity. Be present the perfect words. Show friendship and comfort Pay attention to facial expressions, through simple acts of care. Reliance on nonverbal cues vocalizations, and body language to interpret needs or emotions. Provide a calm and quiet environment to Risk of overstimulation avoid overwhelming the person. Meaningful Activities Part 2 Meaningful Activities  Meaningful activities refer to tasks or engagements that bring purpose, joy, or a sense of accomplishment to individuals.  For people with dementia, meaningful activities are tailored to their interests, abilities, and stage of the disease, helping them maintain a sense of identity and connection with their environment. These activities stimulate physical, emotional, social, and cognitive well-being while reducing agitation, boredom, and anxiety. Characteristics of Meaningful Activities Person-Centered: Activities align with the person’s interests, history, and preferences (e.g., hobbies they once enjoyed or skills they excelled at). Engaging: They provide stimulation without overwhelming the individual, offering a sense of accomplishment or joy. Adaptable: Activities are modified based on the person's abilities, considering the progression of their dementia. Purposeful: They help the person feel productive or connected, even if the task itself is simple.  Emotional Well-Being: Reduces feelings of loneliness, anxiety, or depression. Behavioral Management: Helps reduce agitation, aggression, and restlessness. Benefits of Cognitive Stimulation: Encourages memory recall, Meaningful focus, and problem-solving within their capacity. Activities Physical Health: Promotes mobility, motor skills, and overall physical health. Social Connection: Strengthens relationships and reduces isolation. Key Consideration Before you Initiate a Meaningful Activity  Safety First: Ensure the activity is safe and appropriate for the individual’s physical and cognitive abilities.  Timing: Patients with dementia can be unpredictable, so pay attention times when the person seems, happy, content, distracted, anxious or irritable.  Be Flexible: Be prepared to adapt or switch activities based on their mood or energy level.  Failure Free Activity: Pick projects that will be frustration and failure-free. Find activities for your patient that match their ability level, are low-maintenance with simple easy-to-follow steps, and are something they can complete without experiencing a sense of frustration.  Simplify Tasks: Break activities into manageable steps and avoid overly complex tasks. Assisting with parts of the activity that they may seem to be struggling with.  Focus on the Process, Not the Outcome: The goal is engagement and enjoyment, not perfection  Activities Must Be Stimulating: It’s important that dementia patients stay active physically and mentally as much as they are able. This is why you’ll want to choose activities that stimulate your patients mind and senses. A great way to do this is to keep an eye out for things that your loved one loves to do or things that they enjoyed in the past. Engage your loved one in conversation. If they’re unable to respond, you can give them a play-by-play account of what you are doing. Even if the person is unable to respond, they will benefit from hearing your voice.  1. Sensory 2. 3. Social 4. Physical 5. Creative 6. Cognitive 7. Activities of Stimulation: Reminiscence Interaction: Engagement: Expression: Stimulation: Daily Living and Memory: (ADLs): For Early Stage: Participating in For Early Stage: Painting (finger Solving simple Folding laundry, Activities that Looking through group activities like Light exercise like painting), drawing, puzzles or setting the table, or involve touch, smell, photo albums. card games, book yoga, walking, or or coloring. crosswords. simple cooking tasks. or sound, such as clubs, or dancing. Balloon Playing simple Sorting or organizing Watering plants or baking, gardening, or Talking about past singing/karaoke. volleyball. events, hobbies, or musical instruments. objects (e.g., feeding a pet. crafting. Explore the Spending quality For Middle and Late matching colors or fish tank. places they loved. Building simple Engaging in self-care time with family Stage: Chair crafts, such as shapes). activities with For Middle and Late Playing music from members or pets. exercises, gardening their youth or using creating greeting Playing easy board assistance, like Stage: Hand Joining dementia- assistance, or simple cards or decorating games or bingo. brushing hair. massages, memory boxes filled hand movements like with personal friendly community objects. Jigsaw puzzles aromatherapy, or events. folding towels. listening to calming mementos. Knitting or familiar music. Beading Experience textures. Snoezelen therapy cart. Examples of Meaningful Activities In Class Activity Part 3 Case Study #1  You are assigned to work with Mrs. Helen Adams, a 72-year-old retired teacher who has been recently diagnosed with early-stage Alzheimer’s disease. Mrs. Adams lives with her husband, who is her primary caregiver, and they are very close to their adult children who visit regularly. Despite her diagnosis, she is still very independent and enjoys gardening, reading, and attending her weekly book club. However, her family has noticed changes in her behavior and communication that are beginning to cause frustration and worry.  Case Study Details:  Mrs. Adams forgets recent conversations, including plans she has made with her family or book club members. This often causes confusion and frustration during interactions.  She often tells the same stories multiple times in one conversation without realizing it.  Difficulty finding words: Mrs. Adams struggles to find the right words, which makes her feel embarrassed and withdraw from conversations.  Overwhelmed in noisy environments: She becomes distracted and disoriented when multiple conversations are happening around her, such as during family dinners.  She frequently loses items like her keys or glasses, leading to frustration for herself and her husband.  Mrs. Adams has difficulty following long or fast-paced conversations, particularly when the topic changes frequently.  Your task as HCAs:  Label/Identify 6 communication challenges Mrs. Adams is experiencing, based on the above case study details.  For each communication challenge:  Describe the impact this challenge has on Mrs. Adams or her family.  Propose effective HCA strategies to address the challenge.  Identify 3 tools, resources, or meaningful activities that could help Mrs. Adams stay engaged and maintain her quality of life. Example Communication Challenge Impact on Client or Family HCA Strategies 1. Forgetfulness 1. Mrs. Adams feels 1. Use memory aids like a 2. embarrassed, causing her to calendar or sticky notes for 3. withdraw; family feels reminders. 4. frustrated and worried. 2. 5. 2. 3. 6. 3. 4. 4. 5. 5. 6. 6. Suggested Tools, Resource, 1. Memory aids: A large-print calendar, labeled drawers, or a daily Meaningful Activity planner to help Mrs. Adams stay organized. 2. 3. Case Study #2  You are assigned to care for Mr. Robert Johnson, a 75-year-old retired engineer who is in the middle stage of Alzheimer’s disease. Mr. Johnson lives in a care facility, but his family visits him regularly. He enjoys walking in the garden, listening to classical music, and looking through photo albums. However, as his dementia progresses, he is experiencing more significant communication challenges, which are causing frustration for both him and his family.  Case Study Details:  Mr. Johnson often becomes confused when given multi-step directions.  He frequently asks the same questions, which frustrates his family during visits.  He occasionally forgets the names of his children and becomes visibly upset.  Mr. Johnson becomes irritable or withdrawn when he struggles to communicate.  During conversations, he often starts a sentence but cannot finish it, leading to frustration.  He paces around the facility when he is unable to express his needs, such as hunger or discomfort.  Your task as HCAs:  Label/Identify 6 communication challenges Mr. Johnson is experiencing, based on the above case study details.  For each communication challenge:  Describe the impact this challenge has on Mr. Johnson or his family.  Propose effective HCA strategies to address the challenge.  Identify 3 tools, resources, or meaningful activities that could help Mr. Johnson stay engaged and maintain his quality of life. Case Study #3  You are assigned to care for Mrs. Evelyn Brooks, an 82-year-old former artist who is in the late stage of Alzheimer’s disease. Mrs. Brooks lives in a long-term care facility and requires 24-hour assistance. She is nonverbal but communicates through facial expressions, gestures, and occasional vocal sounds. Mrs. Brooks enjoys being read to, listening to soft music, and holding familiar objects, such as a paintbrush or a scarf she used to wear often.  Case Study Details:  Mrs. Brooks is unable to speak but uses facial expressions and gestures to express herself.  She struggles to process verbal instructions or conversations.  Mrs. Brooks does not recognize her surroundings or familiar faces, leading to distress.  She often appears anxious, crying or groaning, but cannot explain the cause of her discomfort.  She frequently fidgets or shifts in her chair, which may indicate discomfort or unmet needs.  Mrs. Brooks has a short attention span and becomes disengaged easily.  Your task as HCAs:  Label/Identify 6 communication challenges Mrs. Brooks is experiencing, based on the above case study details.  For each communication challenge:  Describe the impact this challenge has on Mrs. Brooks or her family.  Propose effective HCA strategies to address the challenge.  Identify 3 tools, resources, or meaningful activities that could help Mrs. Brooks stay engaged and maintain her quality of life.