Most staff and volunteers working within residential aged care agree that they believe many, if not all of their residents are living with depression most of the time. beyondblue offers a range of free information and expertise on depression and issues associated with anxiety, for those living with depression and also for their carers. Click on the beyondblue logo and go straight to their fact sheet download page for areas of interest such as depression after a stroke, depression and arthritis, depression and diabetes, older people, keeping active, and grief and loss.

These fact sheets are concise and informative and will help to educate and remind you and your staff teams of the signs, symptoms and suggested treatments and support for those living with depression. Depression may be common within aged care, but there are ways of implementing management strategies and enhancing the emotional wellbeing of those needing our support on a daily basis.

Daily exercise, social contact, purposeful activity and a sense of future (things to look forward to) are essential areas to help promote life enjoyment and reduce depression in our residents. The opportunity to talk, receive counseling and maintain a lifestyle of spirituality is also extremely important. Past, present and future are three important dynamics to a person's life: who they were, who they are now and what life can look like for them tomorrow. It is easy with the elderly to focus on their past, reminiscing and talking about who they were and what they did. It is also important to have a balance of focus on who they are today, what they enjoy and would also like to do/looking forward to the future. Feelings of hope for the future and an interest in today can only come from nurturing a balanced life and activity opportunities.

With the advantage of plenty of time on their hands, many facilities are now tapping into the potentials of their residents learning something new: pursuing a new interest or hobby or re-visiting a former interest. Yoga, Creative Writing, Art Projects, Spiritual Programs, Music Workshops, Drama, Multicultural Studies are just a few themes and programs that are being facilitated by DT and OT staff across Australia.

Tap into networking opportunities, resources, conferences and our free Empower Newsletter and be inspired about the future directions of aged care...







Work, rest & play: Marketplace & Job Club Initiatives

Marketplace is about creating income generating or working based activities for residents as part of their balanced lifestyle - work, rest and leisure time. Many residents benefit from the daily purpose of working and work tasks can give focus to daily life, enhance cognitive and motor skills and help build confidence and satisfaction from having a responsibility and meaningful purpose to the day.

Examples of Job Club tasks that elderly residents, including those experiencing dementia have undertaken regularly or occasionally include: delivering magazines and newspapers to residents' rooms, simple admin tasks, feeding pets and watering plants, volunteering to visit socially isolated residents, providing musical entertainment at parties, assisting RAO with 1:1 activities and assisting with clean up after meals/morning tea and folding small laundry for staff. Other projects we are hearing about include 2 onsite Coffee Shop initiatives which are operated by residents working as a team, each according to their abilities, and Garden Nursery projects - participants are potting seedlings for the local church fundraising events, and assisting local schools with tasks such as creating paper mache for art classes.

This photo shows an elderly resident enjoying participation in their regular Garden Club (high residential care, VIC). Seedlings are purchased and re-potted, and then tended to until ready to re-pot in larger pots. The plants, once established and reasonable in size are then prepared for market. They are sold locally to raise funds for the local church. This Garden Group is an example of a healthy and fulfilling purposeful working activity for groups. Fresh air, exercise, enhancing concentration and the social aspect plus regular, familiar routine help to establish fulfillment, confidence and the benefit of helping the local community.

We were the recipients of the 2005 Research Grant award from Victoria University for our Marketplace concept and we have presented Marketplace at the 10th National Residential Aged Care Facility Conference for Leisure, Recreation & Lifestyle Staff in Melbourne and for the NSW Diversional Therapy Association. In June 2007 we presented Marketplace at Hammond Care's 4th National Conference on Depression in the Elderly in Sydney. Some recent stories from the field include a Garden Group, potting seedlings to grow and sell and a Jewelry Creations group at a Day Centre. We are very impressed at the high standard of quality of goods created and sold and we are not surprised that sales and profits are favourable to those involved.

For more on Marketplace, why not go to our Workshops page and book a Marketplace presentation at your organisation. This is a workshop and is packed with ideas, practical programming, stories from the field and all you need to know about creating avenues for working lifestyles for your clients. Looking for a resource on working lifestyles within residential care? Why not purchase our Audio Teaching CD on Marketplace for all you need to know to get started. You can listen to an audio sample of the CD on our Resource page.

Sensory Appreciation:

We have four Sensory Appreciation activities to suggest for 1:1 or very small groups, of up to 3 clients experiencing mid to late stage dementia.

Aims: for your participant to experience the textures, colours, aroma and sensations such as warm water, shells, stones and fossils, fruit and flowers. Use one activity ingredient or try all 4 for your participant to explore the differences between each.

Method: Using a brightly coloured plastic or wooden bowl, add one of the four ingredients:

1) Shells, fossils, small pieces of dead wood, smooth stones, large gem stones (tigers eye, crystal, amethyst, amber, agate slices). Use a selection of colours, textures and sizes.

2) Flowers (cut stems) such as gerbera heads, rose buds, lavender, blossom and carnations; add some leaves, empty pods, acorns or a pine cone.

3) Slices of soft fruit: strawberries, cherries, raspberries, orange, lemon, lime and grapes.

4) Footspa bowl for foot soak, floating flowers and sliced oranges and lime.

Add: warm water and small amount of bubbles, or appropriate essential oil (if suitable for your participants) such as rose, citrus, ocean fragrance etc.

Explore: encourage your participant to explore their bowl, picking up objects, drying them/polishing the stones, feeling the textures and enjoying the aromas and colours. You can also encourage studying items through a large magnifying glass, sorting items by colour and placing them in clear glass jars to promote collecting, sorting, arranging and project tasks. Allow plenty of moments for silence so that people can think, use their imagination, creativity and enhance their memory skills. You may also wish to play some quiet background music that ties in with your theme, such as bird sounds, ocean waves, wind chimes. Your environment will need to be quiet and away from interruptions, with plenty of space to take this project experience wherever it may lead. Consider video taping your session, if appropriate, or taking notes to observe facial expressions, reactions and any words or conversation that your participant communicates to you.

Expected outcomes and benefits: these will be varied and unique. Pleasure, stimulation, enhancing concentration and life engagement, enhancing memories, sensory pleasures, promoting appetite and possibly alleviating depression are among some of the hopeful outcomes. Please ensure as with all programs, that you complete the necessary risk assessments and planning, to ensure client wellbeing and safety. Considerations should be given especially to allergies, dry skin, and choking hazards. Alternatives to water can be sand, leaves or grass.

Sensory Food Activities

Activities with purpose have great value and the potential to increase wellbeing in even our most frail and inactive residents. Especially during the warmer months, hydration is essential but can be overlooked when people do not have the ability to communicate that they are thirsty. Lack of fluid can cause great discomfort, such as strong headaches, eyes becoming sensitive to light, skin change, sleeplessness and anxiety. Fluid based activities, such as a drinks party, sampling thickened juices, ice cream and yoghurt, can tantalise the taste buds, increase fluid intake and enhance wellbeing.

Our photograph shows such simple ideas: plastic champagne flutes with ribbons tied at the bottom, bright coloured cakes cases and serviettes. We have used bright colours for visual stimulation as well as the taste sensation ideas. Simply select a few different thickened fluids for those residents that need them, and place in the flutes and cake cases. Find a quiet place in the shade and bring two or three residents to your garden party. Use long handled spoons to assist with feeding and allow your group to sample at least three different flavours of thickened fluid.

Fresh air, hydration, being close to nature and human contact with others, and this simple activity has longer lasting, positive benefits for your group.

(Remember to check with qualified staff about which drinks, thickness and ingredients are suitable for which residents first.)

Download our free Food Activities resource here:

The Honeysuckle Program is an interactive transition program for new residents to your facility. The aims are:

. For your new resident’s transition into your home to be an experience that is as comfortable, affirming and positive for them as possible

. To create an atmosphere of reassurance for the resident; affirming their uniqueness and individuality and quickly establishing areas of their lifestyle and leisure interests that can be continued in their new home

. To establish positive relations quickly with family and friends of the new resident

We’re all really passionate to see our new residents connected to their new home and help them make what can be a difficult time the most positive experience possible. New residents can sometimes quickly isolate themselves and be mistakenly thought of as anti-social or “prefers to be alone”. Often it may be that they are going through a myriad of unsettling feelings such as fear, grief, anger and disempowerment. The move into nursing care for some can be seen as the end of their life’s journey. The reality is that part of life’s journey is the end of life and its final season, which for some people may be at your nursing care home. This 6 page resource looks at the key areas of social, spiritual and recreation lifestyle ideas and suggesitons for your programs and new resident relationships.

Download our free Honeysuckle Program resource here:

Busy Pillows: tactile and fragrant -
Soft, tactile, interesting material and engaging designs make up the style of Busy Pillows and cushions. Gentle fragrance can be added if suitable and appropriate. These are for use with residents experiencing dementia, anxiety, the very frail elderly and those not responding to other stimulation or interventions.

Busy Pillows can be used for a range of benefits: tactile therapy; 1:1 interaction together to create interest and stimulation during quiet times; to alleviate boredom; to help reduce anxiety through the comfort of touch and squeeze; enhance discussion; provide enjoyment and relaxation; soft surface for fragile skin and bones to rest; a place for fragrance to help enhance appetite before meals...there are many unique possibilities.

Our range of specially selected cushions, pillows and large powder puffs place value on women and femininity and demonstrate extravagance. We will bring you more on our Busy Pillows during the year. If choosing cushions and pillows for use with residents we recommend good quality, safe designs and that you beware of small parts that may come apart. Use caution and consider whether your activity with these items should be supervised at all times, depending on the needs of your residents.
Note: if you are concerned about the use of synthetic fragrance and perfumes with residents, we suggest that you do not use them and consult a qualified aromatherapist for some alternative suggestions.

Value on womanhood
Imagine the possibilities: time spent brushing hair in front of the dresser mirror together; trying on beaded jewelry, applying lipstick and sampling perfume with your resident...quiet time to reflect in front of the mirror, enhancing memories and placing value on womanhood - the very nature of being feminine.

At FutureAge Care we believe that even in old age we can and should respect, nurture and enhance the value of womanhood. Whether through beauty products, pampering or conversation together as women, there are many avenues for you to explore and consider. If your facility has room and a small nook somewhere, you can create a special pamper zone with a dressing table, mirror, flowers and carefully selected items to suit. This unique area can be used as 1:1 time with ladies in a wheelchair or princess chair and for those experiencing dementia. This can also be an opportunity for volunteers to help or for private time between residents and family.

Suggestions: A quiet area away from noise and crowded hubs works best, with the opportunity for ladies to use the dresser whenever they wish. This makes for a familiar, home-like activity that can relax and provide therapeutic benefits.

It can also be used as a late afternoon activity for ladies experiencing sundowning. (Some or all items you may wish to keep safe in a locked draw, or you can leave out those items that you feel safe to leave on display for use anytime).

Rummaging, reminisce, sampling items, providing tactile stimulation and sensory interest through visual and aroma are just some of the expected benefits. The dresser experience helps promote familiar life engagement for your participant, enhancing concentration and hand-eye coordination skills. Don’t have room for a dresser? - Scale down this activity by creating a “fascination box” for ladies to rummage through with you, using some of our suggestions or create your own.

Item suggestions for your dresser activity:
Soft brush, comb, soft hair curlers, soft nail buff, string of beads/pearls, hair slides, silk flowers, lace hankies, antique perfume dispenser, fluffy powder puffs, perfumes, lavender bag, scented draw liners, hand mirror, trinkets to rummage through.

Perfume Bar

Perfume bar is a stimulating and easy activity, with positive benefits for those experiencing dementia or those who appear very unstimulated. It can be for men as well as women. We use our own created Perfume Bar at a dementia home, but recommend that you tailor this program to your unique residents.

Our Mobile Perfume Bar: We use a small container of eau de toilette samples from The Body Shop and gently spray fragrance on the collar/clothing of a resident. We do not recommend any perfume being sprayed onto direct skin, but advise spraying onto the clothing, rug, or pillow where it can be experienced during the day. We also spray perfume onto fluffy powder puffs that residents can hold and smell. There have been many positive responses from ladies with dementia, who have literally come alive and started speaking and expressing their interest to this sensory delight.

We have also turned the Perfume Bar experience into a working task for one lady with wandering dementia. This lady visits residents in their rooms and we administer the perfume together. We encourage her to chat and interact with the residents as part of the Buddy Program.

Perfume Bar should be created according to your residents needs and we recommend that you check first to ensure there are no allergies amongst your group. Perfume Bar also works well if you are finding that your residents are not responding positively to aromatherapy essential oils. Older people may not be used to the essential oil aromas and may respond more positively to the more familiar scent that perfumes have.

Perfumes place value on the femininity of women, even in old age. It communicates extravagance and luxury and that they are special and valued people. Fragrance can also increase appetite: trials of liberally spraying "food" aromas such as vanilla, citrus and berries around residents with poor appetite have shown significant improvement in their eating, if this is done 10 minutes before meal times. Other observations have included a lady speaking whom we had never observed speak to this point and another non-communicative lady in her bed was observed drawing the pillow to her face and breathing in the fragrance.

Suggestions: Perfumes and related activities can enhance a sterile environment and make it more "human" and pleasurable, mask odours, and promote womanhood and femininity. Once a week or fortnightly in communal areas, or any appropriate time 1:1 in a client's private room is suggested. Water based (room spray/eau de toilette) perfumes are less potent than oil or musk based aromas and gently and liberally used should not cause discomfort. Clothing or bedding can be lightly sprayed, or items such as silk flowers.

DEMETER Fragrance Library

Sample the Demeter Atmosphere Sprays and create your own collections for your sensory activities and pleasures for your clients. With unique and original scents like Wet Grass, Bonfire, Rain, Dirt, Salt Air, Baby Powder and Laundromat, you can use them for a variety of special uses.

Scents can help with memory enhancements - for eg, use the Baby Powder and Laundromat Scents with soft baby clothes such as pink fleece and wool, and a laundry "rummage" basket with wooden clothes line pegs for small group or 1:1 late afternoon activities: rummaging, sorting and reminiscing. Order and trial some food and fruit based scents to help enhance appetite before meal times. Demeter scents: Pruning Shears, Dirt and Bonfire will be a great asset to your men's activities.

Unsure about the use of fragrance at your home with your clients? Check the Demeter website for further product information for your risk assessments and consider their miniature samples for just US$5 plus shipping. *Always consult with your onsite professional nursing staff and management before using products with your residents* Click on the Demeter logo above to go straight to their website.

Ageing in Place - stories to inspire

Julie* attends a dementia care day centre twice weekly and has shared with us her love for collecting, documenting and observing nature specimens in her viewing jars. She collects simple items from her garden and from monthly bus trips, such as leaves, twigs, pods, grass and shells. She places them in her "specimen jars" which are clear plastic containers and she then observes them over the next few days, watching them change, dry up or "grow cobwebs" as she calls it. She enjoys remembering where they came from and sometimes she also photographs or draws them for her collection albums. This activity helps Julie with her memory and concentration and is extremely important to her life.

Julie will eventually need to move into nursing care as her dementia progresses and she has expressed concern at still being able to continue her love for botany, collecting and drawing. Julie's activities are mentally stimulating and validate her identity and skills with nature preservation, art and photography. Her interests will appeal to others who are from a teaching background, who love the outdoors and also have an interest in gardening, nature and botany. Collections are a common hobby but often within residential care we neglect this avenue of person-centred opportunity. Access to the outdoors, some clear plastic containers, an album and drawing equipment are all that Julie needs to continue her interests, plus some encouragement and enabling from staff.

Collecting souvenirs from outings and bus trips help to cement new memories and life orientation and your residents can still enjoy the memories and experiences of their time outside for many days and weeks to come. Other related activities can include removing and collecting various stones and large seeds from fruit such as peaches, avocado, plums, and collecting large seed pods, pine cones, interesting bark formation and twigs. These items can then be displayed and sketched as part of still life drawing, seasonal orientation or they can be used for decoration, sensory activities and reminiscing.

Magazines and reading material in residential care

Our research with magazines with residents experiencing dementia has shown some interesting results so far. Residents experiencing moderate to late stage dementia have responded positively to certain types of magazines. Glossy real estate magazines with more pictures than words have engaged people's attention for up to an hour as they busy themselves turning each page and looking at the photographs. Home style magazines, architecture and internal decor are also of interest. Painting colour charts from Bunnings for example are tactile and soothing with pastel colour sample squares and different textured surfaces to touch. We have observed ladies with dementia comparing colour samples and feeling the textured surfaces. Suitable reading material that is minimal and not cluttered with lots of pictures and words on each page may benefit your readers. Notebook Magazine is beneficial with dementia as the colour schemes used are visually soothing and many of the photos contain easily recognisable content such as flower arrangements, cottage style decor, foods, plants and outdoor design etc. There are also simple projects such as cutting out bookmarks and reading proverbs and thoughts for the day.

Why not advertise on your noticeboard for magazines such as Notebook, Country Lifestyle, Better Homes, gardening, fishing and sports related material. You can build up a range to suit a variety of interests and people among your group and those donating can be made aware of the benefits of recycling their unwanted magazines.

New Reading Resource - Specially created for reading groups with dementia, Lauretta Kaldor's "Story of the Titanic" is now available to purchase through FutureAge Care. A blend of very large print sentences mixed with imagery to re-tell this famous story, it is a valuable and essential reading resource for your clients with dementia. We have already used this resource and the benefits observed have included relearning speech and pronunciation, enhancing cognitive skills and memory and greater concentration among readers. This book is the first in a series by Lauretta - view our Resource webpage to find out more.

Mirror Mirror

Mirror Mirror is the name for one of our interactive discussion groups, suitable for mixed groups including those experiencing dementia and low level participation. The concept of Mirror Mirror is this: inspirational poetry, story or quotations combined with themed tactile objects relevant to your chosen topics. This activity can be a short 1/2 hour activity or a longer event tailored to suit your group and room size. We suggest: • Large print copies of a poem, inspirational story or quotes (use scriptures if hosting a spirituality-themed activity for example) • Themed tactile props for your group eg: antique mirror, jewellery, leaves, fresh flowers, shells, twigs, old book, travel postcards, scripture cards etc – items that are relevant to your discussion theme

Method: As some group members take turns to recite a line or two of your large print reading material, have ready a few conversation starters, such as what is the poem about, what interesting words are used and how do you think the author was feeling? Let your discussion head naturally into what may even become unchartered territory. Pass around your objects and let every person feel included regardless of their level of participation. Use eye contact, direct smiles, laughter, touch and sit next to someone who may be feeling isolated or who needs greater encouragement to be involved. You can even make up a rummage box of items relevant to your theme and these can be given to those with dementia or who passively participate to hold and explore.

Aims: Mirror Mirror has taken us in many directions and it doesn’t always have to be about reminisce or general discussion. We have used Mirror Mirror to gently address behavioural issues with some residents such as aggression towards others, negativity toward staff or those with dementia, or arguments that occur between people. We have found that in a relaxed and non threatening environment, many residents have appreciated the opportunity to reflect on their own life and character and even allow themselves to be challenged personally, hence the name Mirror Mirror – looking at oneself with thoughtful reflection. We have all enjoyed this refreshing challenge together and enjoyed benefits such as open and honest discussion, becoming “others focussed” and allowing our friends with dementia to feel included in the social, tactile and intimate aspects of the group’s focus. By sitting next to residents who require greater stimulation we have found that they respond more easily when hearing your voice close by, having greater eye contact and the benefits of assistance and prompting with the tactile objects. You will be surprised where Mirror Mirror takes you. Tip: Useful poetry and inspiration website: www.adeepplace.com, Dreamtime Stories and artwork: www.dreamtime.net (Indigenous short stories that can create interesting, simple discussion on life and learning, plus interesting artwork relating to the stories.)

To enhance your activity further and especially if working with larger groups seated over a large layout, we also have added additional sensory interests such as background music relevant to the theme (eg didgeridoo and relaxing bird sounds). We use fragrance where appropriate and with our Dreamtime Mirror Mirror Workshop we added bush fragrant essential oil drops to a soft Koala for a lady with dementia who responds well to touch. Topped off with afternoon tea, this makes for a 5-sensory delight and, we hope, something beneficial and stimulating for everyone.

Human Library - reminisce, affirm identity, share life experiences...

The Human Library is an interesting idea created in Europe that can be adapted to your home’s social group time. The concept is for people to be “loaned” out as human books for a short time (eg 30 minutes) to tell their story and answer any questions that the “book borrower” may have about their experiences. Examples could be a person talking about their experiences as a teacher, living in a rural area, adopting children, war story, living with illness, emigrating…there is no limit to the possibilities.

Your residents need to choose a topic of interesting life experiences that they feel comfortable with sharing. You might want to include yourself and nursing staff in this event. The Human Library can be used as a simple discussion group, or extended to something larger such as a fundraising event/Open Day, interaction with a local school, or a resident and family social to get to know your residents better. Opportunities for people to tell their story helps to validate who they are, allows time for reminisce and memory enhancing and helps to personalise them to other residents and staff. Please write to us if you run a Human Library activity – we would love to hear your stories…

Buddy Program

The Buddy Program is aimed at helping your new and socially isolated residents, by buddying them up with other friendly residents at your home. Residents can provide encouragement, social conversation and companion support. The aim of the Buddy Program is to encourage and help residents connect socially with each other to avoid isolation and depression. A lady experiencing sundowning at 4pm every afternoon was taken to visit residents in their rooms, to chat with them and keep them company until dinner time. Being part of this social support for others helped distract her from her own anxiety at this time of day.

Some facilities have a buddy system in operation, where residents are taken to visit other residents and floors in their home to provide daily social support. This can be a great support to staff and helps develop a culture of being 'others focussed' amongst residents as well.

Community Connect

This is aimed at helping residents stay connected to their community and participating in projects to help others. Reading the local news and affairs to your group, discuss and find an area that your group can help with. Eg writing cards & notes of encouragement to residents living at another local nursing home (pen pals); or sending get well cards to the children's hospital. Write an inspirational letter together to be sent to victims of bushfires, floods, farmers in drought areas etc. Include a return address so that the organisation or those involved can send a reply if they wish. Display a poster of who you have helped each month. Think of a name for your group and encourage community spirit amongst your group.

Seasonal projects can include knitting thick socks and scarves for other residents, writing Christmas cards to local small business in need of encouragement, wrapping gifts for organisations that deliver presents for children in need. Don’t forget to write to us too – we love to hear your amazing stories of help!

Life History

Alzheimer's Australia has a Personal Life History Booklet. Here is what they have written about this valuable resource: This booklet has been designed to collect the unique social and life history of an individual with dementia. This life history will help individualise the care of the person with dementia and maintain their identity. It will also help people caring for the individual to know them and develop strong relationships with them. As everybody is an individual this booklet has been designed to be adapted. Space is provided in the booklet for photos and objects which are important. The booklet may also be used to promote reminiscence with the person. It does not provide information about how to conduct reminiscence, however, a bibliography featuring books on reminiscence and other relevant subjects has been included in the appendix. Brief definitions of dementia, individualised care and reminiscence are also outlined in the appendix. Pages have been included within the appendix to note when and how the booklet is used with the person with dementia and their reactions to its use.Alzheimer's Australia encourage us to make copies of the booklet to use with residents.

It has also had a favourable response with accreditation. To download this booklet, click on the following link: Alzheimer's Australia and enter the words "life history" in the search field.