My mother was a beautiful, active lady with a great sense of humor -- and with five children, she needed it! At fifty, she suffered a massive stroke, followed by many more. It affected all of our lives, but it had a drastic effect on my father, who was her caregiver. I'm still not sure who suffers the most: the person with the illness or their loved ones who watch and care for them.
Before Mother's stroke she loved to dance, play bridge, and work on large puzzles. There was always one in the works. But the first stroke left her unable to use her right arm and hand. Nonetheless, she was insistent on trying to do things herself. She taught me how to be strong when the going gets rough, though. Two steps forward, five to the side, is what I always say.
After her stroke, Mother couldn't work on her puzzles anymore; the pieces were too small to handle and the puzzle too large. She played cards for a while, after my father made a cardholder for her, but eventually she couldn't do that either.
Dad took care of my mom for many years after her first stroke. Mother was depressed, frustrated -- even mean, at times. She didn't want anyone's help. Later on, he had caregivers come in to lend an extra hand, and they brought painting books for her. Although the books were for children and she wasn't too excited about them, she worked on them anyway, lacking a more appropriate activity.
Recognizing Memory Loss
Looking back, I recall how she remembered things from her distant past more easily than the things she had done earlier the same day. Some of the symptoms Mom began to display sounded very similar to Alzheimer's or dementia, but those terms weren't as common as they are now, and I didn't know what they meant then.
Years later, hearing about the frustrations of Alzheimer's and dementia patients, I was reminded of my mother, and I wanted to help. I began interviewing nursing home activity directors all over the US. Hearing the same answers to my questions over and over, I realized that no matter where they were, all of these activity directors had the same frustrations about activities for their residents.
Developing the Prototypes
I was determined to find a way to jog the memories of people suffering with Alzheimer's and dementia. Puzzles seemed to fit these needs, and from my conversations with the activity directors, I knew what they wanted:
- Activities that were age-appropriate and enjoyable
- Storytelling themes, to encourage conversation
- Durable, long-lasting puzzles -- not cheap cardboard
- Larger pieces, but smaller puzzles, for easy handling
- Puzzles that could be completed in a single session, imparting a sense of accomplishment rather than failure
In response to these requests, I began to design prototypes. Each facility had different needs; their residents weren't the same as those in the facility down the street or in the next state. Since I couldn't please everyone, I decided to please the ones who needed it most: people in the early-to-mid stages of Alzheimer's became my target audience.
Looking for storytelling themes was fun. I spent hours at the library looking through art books, hauling them home and looking through them again. One of the books was a collection of Norman Rockwell's cover illustrations from The Saturday Evening Post. To me, nothing compares. His work stirs the emotions, and there is a story behind each illustration. Without this art the puzzles wouldn't be as effective as they are. Many people with Alzheimer's or dementia remember and love Norman Rockwell's iconic paintings and The Saturday Evening Post. The storytelling images jog their memories and working on the puzzle encourages them to use their problem-solving skills. One of the most beneficial aspects of the memory jogging puzzles is that they engage the brain, which experts agree can slow the process of memory loss.
Stacking Up to the Competition
Working on a large floor puzzle can be frustrating for people with memory problems, even if it has large pieces. I remember the frustration I felt watching one particular patient. I tried to help him, but even I had a hard time finding the pieces! There were simply too many, and they were scattered over a circle about four feet wide. This gentleman wanted desperately to find the pieces he needed. After much searching, we finally found a few that went together, but they were all from all the other side of the table. The puzzle had a nice picture, but there was no story behind it. The activity was frustrating to the participants, and there was certainly no sense of success at completing a task. Although it was meant as a group activity, two people didn't want to participate because it wasn't "fun." And there was no way they were ever going to complete that puzzle in a single session!
Refining the Products
To test the puzzles, I visited facilities and worked with the residents one-on-one. It was very rewarding. They loved the Norman Rockwell and The Saturday Evening Post themes. Some reminisced about something in the image, or the date on the cover jogged a memory. Many of them remembered putting puzzles together when they were younger.
At 6 x 8", the puzzles fit perfectly in a lap, and I designed them with wooden pieces so that they would last. The twelve-piece puzzles are recommended for early-stage memory loss, and the six-piece is best for people in the mid-stages. My favorite is the six-piece puzzle; it looks nice and it's easy to do. As simple as it is, some people may need guidance. That's okay, too. One unique feature is the interlocking fit of the pieces. Many dementia patients and nursing home residents have shaky hands. When one piece is put in place, it won't be bumped out when the next one is put in. And the matte surface reduces glare so that it's easy on the eyes.
The pieces and puzzles can be handled easily. It's a great group activity, because the participants can help each other find the pieces and put them in place, and the themes encourage conversation and reminiscing. Most importantly, however, with so few pieces, there's always a sense of success when the puzzle is completed.
Karen Miller is the owner of Memory Jogging Puzzles, a company devoted to creating innovative puzzles and playing cards designed especially for individuals with dementia.