Meaningful to Whom? Rethinking Activities in Dementia Care
When people talk about meaningful engagement for someone living with dementia, the same suggestions often come up. Fold laundry. Sort socks. Set the table. Water plants.
Any of these can be meaningful if they fit the person. Someone who always took pride in caring for the home may enjoy folding towels or setting the table. Someone who disliked doing laundry before dementia probably will not find it any more interesting now.
An activity is not meaningful simply because it is familiar or appears on a list of recommended dementia activities. It has to connect in some way to the person.
A recent study asked eight women with mild to moderate dementia what they considered important in their daily lives. The women were living at home and receiving home care services in Norway. Although this was a small study and included only women, their responses raise some good questions for families, professionals and programs.
The women talked about wanting to remain physically active, spend time outdoors, stay connected with other people and participate in activities that had meaning for them. Some attended organized programs but felt the activities being offered did not always meet their interests or needs.
It is easy to assume that an activity will be engaging because it was designed for people living with dementia. But there is no one activity that will appeal to everyone with dementia, any more than there is one activity that will appeal to everyone without dementia.
Who decided the activity was meaningful? Was it chosen because the person enjoyed it, or because it was convenient to offer? Was the person given a real role, or simply expected to sit at the table and follow along?
Being Busy Is Not the Same as Being Engaged
A full activity calendar does not necessarily mean the people attending are engaged.
Someone may sit through a craft group even though they never liked crafts. Another person may be included in a game they no longer understand. Someone else may be given towels to fold because it is considered an appropriate dementia activity, even though it has no connection to the person’s interests or history.
From the outside, this may look like participation. The person is sitting with the group, the supplies are on the table and the activity has been completed. But that does not tell us how the person experienced it.
Engagement is better understood by paying attention to the person. Did they move closer or show interest? Did they begin without repeated prompting? Did they offer an opinion, talk about what they were doing or want to continue? Did they seem comfortable and connected, or did they appear bored, confused or worried about doing something wrong?
A person may also be engaged without completing the activity in the way someone else expected. They may listen to the music without singing, watch other people work before joining or complete only one small part of a larger project. Participation does not have to look the same for everyone.
Start With What Is Known About the Person
Meaningful engagement starts with knowing something about the person. What did they enjoy? What responsibilities were important to them? What did they do well? Did they prefer being with a group or working quietly on their own? Did they enjoy being outside? Were there organizations, causes or communities that were part of their life?
Past interests can give us a place to begin, but it is also important to notice what the person enjoys now. Interests may remain while the way someone participates changes.
A retired teacher may no longer be able to lead a classroom, but could help assemble school supply kits, select books for children or place bookmarks inside donated books. Someone who was active in a church might help prepare a mailing, organize materials for an event or choose messages to include in cards for people who are homebound.
A person who has always loved animals may enjoy sorting donated pet supplies or helping prepare adoption bags for a local rescue. Someone who was known for making people feel welcome might help put together hospitality bags for new members of a program or community.
The activity does not have to duplicate what the person once did. It can preserve the part of that experience that was meaningful. For one person, that may be helping others. For someone else, it may be organizing, creating, teaching, working with their hands or simply being part of a group.
Purpose Can Reach Beyond the Household
People living with dementia are often placed in the role of receiving help. Meals are prepared for them. Appointments are arranged for them. Activities are planned for them. As their abilities change, opportunities to help someone else can gradually disappear.
Dementia does not mean that a person no longer has something to offer.
Volunteer projects can give the activity a purpose beyond filling time. Making tied fleece blankets is one example. The finished blankets could be donated to a children’s hospital, hospice program, shelter or animal rescue.
The project can be divided into different roles. One person may choose the fabric or help match the layers. Another may cut the fringe with support, while someone else ties the ends. A person who cannot manage the knots may smooth the blanket, hold sections in place or attach a card when it is finished.
No one has to complete the entire project independently. Each person can take part in a way that works with their abilities.
The same idea could be used to assemble hygiene kits for a shelter, prepare snack bags for a food pantry or fill welcome bags for new residents. A group could make cards for people who are ill, arrange small bouquets for hospice patients, fill seed packets for a community garden or prepare supplies for a church or nonprofit event.
The project should have a genuine purpose, and the participants should know where their work is going. There is a difference between sorting supplies only to have someone take them apart and start again tomorrow and sorting supplies that will be delivered to a school, shelter or community organization.
The amount of work completed is not the focus. A person may tie only two sections of a blanket, choose a few items for a care package or place one card into an envelope. Their part is still included in something that will help another person.
Choice Needs to Be Real
Choice is another part of meaningful engagement, but the way a choice is offered can make a difference.
Asking, “What would you like to do today?” may seem respectful, but it can require the person to remember the available options, compare them and come up with an answer. Offering two choices that the person can see may be easier.
“Would you like to work on the blankets or help with the garden pots?”
“Should we use the blue cards or the yellow ones?”
“Would you like to sit with the group or work with me at the smaller table?”
Both choices should be acceptable, and choosing not to participate should also be an option.
When someone repeatedly chooses not to take part, it is worth considering why. The activity may not interest them. The room may be too noisy. The directions may be difficult to follow. They may be tired, uncomfortable or afraid of making a mistake. The timing, environment or approach may need to change.
Sometimes Going Outside Is Enough
The women in the study also spoke about being active and spending time outdoors. Outdoor time is sometimes treated as an extra, something to fit in after the scheduled activities are finished. For many people, going outside may be the activity they would choose.
That could mean taking a short walk, sitting on the porch with a cup of coffee, filling a bird feeder, checking the garden or taking a drive through a familiar neighborhood. It offers movement, fresh air and a connection to the time of day and the changing seasons.
Again, it depends on the person. Someone who gardened for years may enjoy planting or watering. Someone who never cared for gardening may prefer watching a ball game outside, walking to the mailbox or sitting where other people are coming and going.
Familiar does not always mean meaningful. The person’s response helps tell us the difference.
The Relationship May Be the Meaningful Part
Sometimes the task is not what holds the person’s interest. It is the time spent with someone else.
A person may not care very much about sorting cards but may enjoy sitting beside someone who talks with them while they work. Someone may lose interest in a puzzle but stay involved when a grandchild joins them. A group may enjoy preparing donation bags because they talk and laugh together during the process.
This is also why large group programs do not work for everyone. Some people are more comfortable with one other person or in a smaller group. Others want to watch for a while before joining. Some may enjoy choosing materials or handing out supplies more than completing the project itself.
There should be more than one way to participate.
Focus on the Process, Not the Finished Product
It can be easy to focus on the finished product. Was the blanket completed? Were the cards made correctly? Were all the items sorted?
But the real value and joy may be found in what happens along the way. The person may enjoy choosing the colors, working beside someone else or knowing that the finished project will help another person. They may contribute to only one part of the activity and still feel included in its purpose.
The knots on a blanket do not have to be perfect. The colors on a card do not need to match. Items do not always have to be sorted according to someone else’s system. Correcting or taking over can quickly change an enjoyable experience into one in which the person feels they have done something wrong.
Instead, pay attention to the process. Was the person interested? Were they given a choice? Could they use abilities they still have? Was the pace comfortable? Did they feel included rather than corrected or rushed?
The finished product may be something that can be donated or shared, but it should not become more important than the person creating it.
Meaningful to Whom?
The women in this study wanted movement, time outdoors, relationships and activities connected to their interests. Their comments are a reminder that offering someone an activity is not the same as giving that person something meaningful to do.
People living with dementia can continue to help, make choices and contribute to their communities. The role may need to change. A project may need to be broken into smaller steps. More support may be needed. But the opportunity to be useful, included and connected should not disappear simply because someone is living with dementia.
Before choosing an activity, it helps to ask what has been important to this person, what they can still do and what might give them a reason to take part.
The answers will be different for everyone, which is why the question should always be: Meaningful to whom?
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Reference
Steindal, S. A., Haugen, I., Brady, O., Engedal, K., & Strøm, B. S. (2026). What Women With Dementia Who Receive Home Care Services Consider Important in Daily Life: A Qualitative Study. SAGE Open Nursing. https://doi.org/10.1177/23779608261479697
