7. Module 6 · Everyday life & daily structure

Everyday life

Security through structure and meaningful activity

Good organisation of everyday life is central to the wellbeing of people with dementia. Two elements are particularly important: a reliable daily structure and meaningful activity/occupation. The daily structure (familiar, regular routines and rituals – fixed times for meals, activities, rest) provides security and orientation: in a world that dementia has made confusing and unpredictable, recurring, familiar routines provide stability and reduce anxiety and restlessness. Rituals (e.g. a particular morning routine, a song before meals, a good-night ritual) have a calming and orienting effect.

Meaningful activity and occupation meet the basic need for occupation/inclusion (Kitwood, Module 5) and give the day meaning and joy. People with dementia – like all people – need activity, participation and the feeling of being needed and being able to do something. Inactivity, on the other hand, leads to boredom, withdrawal, restlessness and decline. Activities are designed to be individual (adapted to life history, preferences and abilities – Module 5), resource-oriented (what the person can still do, not what they can no longer do) and free of overload/pressure to perform.

What this module is about. How a calm, familiar rhythm of the day and small meaningful activities give a person with dementia security, and how you can plan both without overloading anyone.

What you will be able to do afterwards. You can sketch a day with anchor points and rituals for one person, choose an activity that fits their abilities and life story, and recognise when it is too much or too little.

Think about it first. Mrs Novak (fictitious), 83, lives in a care home. Meals come at changing times, the television runs all day and there is a group activity at 3 p.m. that she never joins. In the afternoon she walks up and down the corridor and calls for her sister. What in her day could give her security? What could she do that would feel meaningful to her? Write down two ideas. You will compare them with Figure 6.1 below and the activity guide on the next page.

Learning objectives of this module

  • You understand the importance of daily structure and rituals.
  • You plan meaningful, individual activity.
  • You orient yourself to the person’s resources and life history.
  • You avoid overload and pressure to perform.
  • You can design a day for one person with fixed anchor points, rituals and flexible gaps (apply).
  • You can judge whether an activity fits a person’s abilities and adjust it when it is too hard or too easy (apply, analyse).

Activities that do people good

Meaningful activities for people with dementia are based on their abilities, preferences and life history (Module 5). Examples: familiar everyday tasks (folding laundry, helping to lay the table/cook, gardening, sweeping – they give the feeling of being needed and competent), exercise (walks, seated dance, gymnastics – important for body and mind, cf. Course 08), music (singing, listening to music – often reaches people with dementia deeply, awakens memories and feelings, has a calming/activating effect), sensory stimulation (basic sensory stimulation, multisensory rooms, tactile/olfactory stimuli), reminiscence work (old photos, objects, songs, stories – activate the preserved long-term memory and provide joy/identity), creative activities (painting, handicrafts), animals (animal visits/animal-assisted therapy), and simple sociability (being together, conversations). It is important that the activities are enjoyable and successful (no pressure to perform, no overload – the person should feel competent and comfortable, not overwhelmed/exposed).

For care it is important to understand: activity and occupation are not a ‘luxury’ or a ‘nice extra’ but a basic need and a central part of dementia care. Inactivity and boredom are common (overlooked) causes of restlessness and challenging behaviour (Module 4). Good organisation of everyday life with structure, rituals and meaningful, enjoyable activity promotes wellbeing, independence and contentment and reduces restlessness – it is therefore also ‘therapy’. Care staff shape everyday life consciously (in cooperation with care assistants (Betreuungskräfte)/social care support, occupational therapy and relatives), individually and with dignity. Small moments count too: a song sung together, a walk, folding laundry, a conversation about the old days – all of this gives the day meaning and joy and strengthens personhood. The organisation of everyday life is therefore an essential, often underestimated contribution to the quality of life of people with dementia.

A day with anchor points

“Daily structure” does not mean a rigid timetable. It means a small number of reliable anchor points that return every day in the same order, with flexible time in between. Mealtimes, getting up, a walk, a rest and an evening ritual are typical anchors. The person may not remember the clock, but the body and the senses learn the rhythm: the smell of coffee, the same song, the same carer’s greeting. Figure 6.1 shows a sample day for one person. It is a model to adapt and not a prescription. Someone who always rose at five or liked a long evening will need a different curve.

A sample day with anchor pointsAnchor points of a sample day (to adapt, not to copy)MorningSame greeting,own paceBreakfastFamiliar food,same placeMid-morningWalk or taskin daylightLunch, restQuiet room,time to digestAfternoonCoffee, a song,companyEveningGood-nightritualBetween the anchors: free time, small tasks, visits, quiet.The gold dot marks the evening, often a hard time (Module 4).
Figure 6.1: Anchor points of a sample day (general model, to be adapted to each person). Source: own illustration.

Notice what makes an anchor effective. It is repeated, and it is sensory and personal. A good-night ritual may be a warm drink, a lamp on a low setting, a familiar song and the same words every night. It matters more that the sequence is the same than that it is long. Rituals also protect carers: when the day follows a rhythm, there is less to negotiate, and fewer moments of conflict.