by Carmen Bowman

When restraints were much more common, care plans often stated, “Release restraint at meal time.” Why when we felt people needed to be in restraints all day did we feel comfortable releasing restraints at meal times? Some people say because residents were tucked up to a table. Some say because “we were there” supervising. Although both of these are true, I contend that the residents were still because they were eating a meal and engaged with life.

In our latest book, Eliminating Alarms and Preventing Falls by Engaging with Life , Theresa Laufmann, Co-Director of Nursing of Oakview Terrace in Freeman, SD and I go much further into this idea of engaging with real life and hypothesize that by helping individuals do so, we will prevent falls and be able to eliminate alarms. Alarms are meant to immobilize people to prevent falls. However, immobilization also leads to all sorts of maladies we are trying to prevent such as pressure sores, weakness, loss of strength and balance, which, in turn, all lead to more risk of falls. Alarms also cause psychological distress and by startling them, can even cause falls. In fact, we’ve seen homes that have eliminated alarms report fewer falls.

We recommend that instead of focusing on institutional, generic “fall prevention interventions” (which have not done much to prevent falls anyway), to focus on vibrant living, that is engaging individuals with passions, interests and normal parts of daily life. When a person is engaged, happy and comfortable in the moment, they are less interested in wanting to get up and try to go somewhere else in a way that puts them at risk for falling.

If I imagine myself old and living in a nursing home, here are some things that I imagine would do more than “keep me busy” but actually help me to continue to be engaged with my life:

• Poring over the scrapbooks of my life either made for me when I was young or that I have made of my life and of my little baby girl.
• Poring over my well-used Bible, I will need it near me and perhaps a magnifying glass, my glasses and large print one as well.
• Playing Solitaire or cards or other games with someone who loves me and knows what I love to play.
• Listening to the Christian radio or television for long lengths of time.
• Serving others by visiting or praying with someone or encouraging younger people to make it in their marriages and to be good parents.

I encourage you to focus on what engages people as individuals. Start with a collection of special things that provide meaningful engagement for each person that he or she could delve into at any time. Then, figure out what engages a person in a one-to-one setting. People engage one-to-one with other people, but also with animals and even with plants. A resident’s family member may come to visit often but they may run out of things to do together. As we’ve seen, it can get frustrating for the person visiting a person living with dementia. All the more reason for you to step in and help. Once we invited the husband visiting his wife with dementia to be in charge of the altar set up for church services and chapel with her. This gave them something meaningful to do for the life of the community and tapped into some of their previous life activities as a couple. Be creative. Never give up. This is the best part of the work we get to do.

Notice I barely brought up group activities. There is nothing wrong with groups, but perhaps many people go without engagement because so much time and effort is being placed into the group activities listed on a calendar. Only you can analyze and decide how to use your limited resources to ensure each individual is engaged and living a vibrant life.

Carmen Bowman is owner of Edu-Catering, a Regulator turned Educator, instructor for Action Pact’s Vibrant Living workshops, host of the Action Pact Conversations with Carmen web talk show, and author of eight Action Pact culture change workbooks and training resources. Her most recent publication is Eliminating Alarms and Preventing Falls by Engaging with Life.