The Bristal Assisted Living Blog

Posted by The Bristal  |  May 27, 2015

Creating Quality Time: Dementia and Improvisation


Spending quality time with someone who has dementia can become more difficult as their disease progresses. Many times adult children and family members aren’t quite sure how to deal with issues that commonly arise. When a senior with Alzheimer’s disease fails to remember important things such as where their home is or that a spouse has passed away, it isn’t easy to know how to respond.

Alzheimer’s experts have long encouraged families to “step into their world.” But for many, that advice isn’t enough. They aren’t sure what that really means and how to do it. Interestingly enough, the answers may lie in “improv” or improvisational theatre.

While most of us associate improv with a free-wheeling style of comedy, there are strict rules that apply. Many of which can translate and help families better connect with a loved one who has Alzheimer’s disease.

Using the Rules of Improv for People with Alzheimer’s

What makes improv such a good fit for Alzheimer’s patients is that it doesn’t rely on memory. It is a style of theatre that lives in the moment. The rules of improv are:

1. Say Yes: The first rule of improv is to always respond with “yes.” For someone with this disease, hearing a positive response validates what they are expressing. Because people with Alzheimer’s struggle with confusion and present-day orientation, they are often subjected to people trying to correct them or set them straight. Hearing an affirmation instead can help build their confidence and self-esteem.

2. Follow Up: The second rule of improv is to follow-up the “yes” with “and.” This combination can be an especially beneficial method of communicating with a person who has memory loss. A common situation families face is their loved one routinely asking to go “home” and not understanding that they are already home. Instead of trying to explain that over and over, a family caregiver could say, “Yes, and I was just going to fix a snack. Let’s do that before we do anything else.” Even though this doesn’t really answer their question, it continues the conversation in a positive way.

3. Don’t Ask Questions: Finally, the last hard and fast rule of improv is not to ask questions. It prevents one actor from having to carry the load on his or her own and avoids putting the stress of coming up with an answer on the person with Alzheimer’s.

Other common improvisation tips that can help families communicate with a loved one who has memory loss include:

• Agree with their reality even if it isn’t correct.

• Don’t argue.

• Use your eyes, hands and head to acknowledge and validate.

• Be patient.

• Give commands instead of asking questions.

• Be mindful of your tone of voice.

• Limit choices so as not to overwhelm.

• Use gestures to explain your message.

Learn More about Improv and Alzheimer’s

If you would like to learn more about using improv techniques when caring for a person with Alzheimer’s disease, these resources may be of help:

Improv for Alzheimer’s: A Sense of Accomplishment: In this NPR segment, a conversation with a social worker from the Cognitive Neurology and Alzheimer's Disease Center at Northwestern University's Feinberg School of Medicine and an improv coach from the Lookingglass Theatre are featured. They discuss their partnership and how it supports people with memory loss.

Trying Improv as Therapy for Those With Memory Loss: A New York Times article that shares the writer’s observations of The Memory Ensemble, a group of six older adults working with an improv coach at Chicago’s Northwestern Memorial Hospital.