When I visited my Mom in a care home in Edmonton, Alberta, Canada, it wasn’t always easy to find things to talk about or do, particularly since her memory loss and verbal communication abilities became increasingly impacted by her dementia. I had to think out of the box a bit. I would bring in Readers Digest magazines and select snippets from the humour section to read together or bring in a few of her favorite recipe books for us to look at and chat about as she loved cooking. My Mom’s faith was important to her so we would play spiritual music and occasionally read from the Bible. I am fond of photography and would often bring in pictures of birds and animals or pictures of familiar places she knew. We would also create cards with various craft items. Other times, we quietly sat together holding hands while looking out a window or watching a travel/nature program. By having things to look at and do, it resulted in less pressure to talk and gave us a lot of fun times together, which I treasured.

Now teaching others about dementia, I have thought more about the psychological needs of Tom Kitwood captured by the now iconic ‘flower’ image. Kitwood invited us to think more about how we can focus on meeting psychological and emotional needs, which are important to all of us as human beings but are likely to be even more enhanced if our cognitive abilities are failing us.

What do most of us want from an average day? I believe it’s a combination of normal everyday experiences which root us in a sense of place and safety, plus some variety in the day which, as the saying goes, is ‘the spice of life.’ Most of us thrive on some movement and exercise and opportunities to feel busy, purposeful, and useful to others. Many of us like to feel needed, appreciated, and loved. We might enjoy companionship but also need relaxed time to do our own thing. Treats and fun can also bring some joy. When thinking about the experience of living in a care home or being in hospital, many of these things are less easy to access. We are literally uprooted. Our psychological stability is turned upside down not just through dementia, but through losing so many of the things we take for granted living in our own homes. How can we support visiting family members to bring some of these things to people?

Here are some ideas for things to do that connect with each petal of the flower – identity, comfort, attachment, occupation, and inclusion.


We often rely on close relatives to know the most about what defines their person’s identity. Is it their role as a parent? Was it their job? What kind of personality do they have? What were the key events in their life that helped shape them? Is their nationality, culture, or religion important? Knowing the answers to these things can help give ideas for things to talk about and do. Perhaps a relative has photographs of things which will remind the person of their achievements and restore that sense of pride and identity. Some people’s identity is reinforced by having pride in how they look. A family member might know the hairstyle the person prefers, a favourite perfume or aftershave, or the accessories the person enjoys – a particular tie, some earrings of sentimental value etc.


To be comforted when we are feeling vulnerable is core to our wellbeing. There are many ways to bring comfort, whether it is holding someone’s hand or bringing in a small child to play or a dog to stroke. A visit from a family member can be a huge comfort to the person. Encourage relatives to do things together which might offer comfort – this could be listening to music, singing, saying a prayer, or watching birds in a garden.


People’s attachment needs relate to what helps them feel secure. These are often associated with babies and children in their early life but can also become more pronounced with the effects of dementia. Insecure attachment can present in a variety of ways, but often shows in very anxious behaviour, repeated questions, and sometimes frequent phone calls. Family members might need to give a lot more reassurance to the person who is experiencing insecure attachment. Telling the person that they are safe and they are loved is the obvious approach. But be aware of other things which can create a sense of security – for some people having access to a handbag or some money in their wallet for example (even if cash isn’t actually needed). A doll or soft toy can also provide both comfort and a sense of attachment. When someone talks frequently about their mother or going home, relatives need support to understand that this is expressing a feeling of wanting attachment and comfort. Being told that mother is no longer living is an easy trap to fall into, so families may need some sensitive education to not correct the person, but instead respond to the feelings behind the words.


Boredom is one of the most frequent problems for those living in care homes. Relatives need to be creative about finding things to do when they visit. Bringing things in to occupy the mind such as word searches or a crossword puzzle to do together is a possibility for those who are still able to do these. For those in the later experiences of dementia, reading to the person, whether from a newspaper, recipe book, short stories, or poems, dependent on the interests of the individuals, can work well. Rummaging and sorting through a box of fabric, tools, or postcards might be worth a try. Families and friends can also bring in something to do that the person could watch i.e., knitting, crocheting, drawing, or writing a card to someone that their relative or friend knows. Encouraging the person to go for a walk ‘round the block’ and sitting in a different part of the building or outside in the garden for a tea or coffee can provide a welcome change of scene.


Many of us benefit from a sense of belonging to a family or a community. A relative or friend can provide a vital link to the person’s sense of feeling included. Making video messages from faraway friends or children or grandchildren can bring ‘family’ to the person. If the person has been part of a church or sporting community, what are the ways in which you can help them still feel in touch with those people? This might involve inviting someone to visit or, where possible,  taking a trip out to the church, golf club or other significant place.

We can help families understand their vital role in meeting emotional and psychological needs, and at the same time acknowledge that there are complex emotions involved when seeing the changes in the person they love, so it isn’t always easy to feel confident in trying new things out.

The National Association for Providers of Activities for Older People (NAPA) has produced two helpful free resources – ‘Meaningful Visits’ a Toolkit for Activity Providers and A Guide for Friends and Family, which offer many inspiring ideas and suggestions. https://napa-activities.co.uk/services/resources/free-resources

Consultant Trainer, MCM
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