Last updated: March 25, 2013
Even though most
dementia cases come from irreversible causes, there is still
much that families can do to help their loved ones continue to
function as well as possible for as long as possible. Creating a
safe, comfortable, and supportive environment for someone with
dementia can feel like a daunting and even overwhelming task for
the caregiver, but fortunately there are now some accepted
standards of dementia care that can help guide families to care for
their loved one.
Dementia Care Techniques
Researchers, doctors, and eldercare professionals are still
discovering and refining what works and what doesn't when it comes
to dementia care. A lot of different techniques and strategies have
been tried, some with more success than others, but clinicians have
found that there are some principles and practices of dementia care
that can and do work more often than not. For example:
- Encourage and maintain independence for as long as
possible - Studies have found that a technique called
"graded assistance," combined with daily practice and positive
reinforcement can go a long way to maintaining functional
independence. Graded assistance is a method of helping someone
accomplish a task with the least amount of aid possible, using a
spectrum of assistance from verbal prompts to physical
demonstration, physical guidance, partial physical assistance and
complete physical assistance.
- Music can be very effective - Studies have
shown that music soothes and can help reduce problem behaviors,
such as agitation and
aggression (especially during mealtimes and bathing).
However, it's important to note that the music should be something
that the person with dementia prefers, not necessarily what the
caregiver thinks would be nice to listen to. Playing your loved
one's favorite types of music is typically the most effective form
Pet therapy, lighting manipulation and group therapies can be
effective - These therapies concentrate on cognitive
skills and/or social activities that have been tried to varying
degrees of success.1
The following information is adapted from Caregiver Guide:
Tips for Caregivers of People with Alzheimer's Disease, published
by the National Institute of Aging (NIA).2 Although it
was originally written specifically for Alzheimer's care, much of
the information is applicable to other types of dementia care, and
we have included it here for your reference and information.
Remember to consult with your doctor about what is appropriate to
your loved one's condition before following any advice or
From the NIA's Alzheimer's Care Guide:
Finding out that a loved one has
Alzheimer's disease (AD) can be stressful, frightening, and
overwhelming. As you begin to take stock of the situation, here are
some tips that may help:
- Study your day to see if you can develop a routine that makes
things go more smoothly. If there are times of day when the person
with AD is less confused or more cooperative, plan your routine to
make the most of those moments. Keep in mind that the way the
person functions may change from day to day, so try to be flexible
and adapt your routine as needed.
- Consider using
adult day care or respite services to ease the day-to-day
demands of caregiving. These services allow you to have a break
while knowing that the person with AD is being well cared for.
- Begin to plan for the future. This may include getting
financial and legal documents in order, investigating long-term
care options, and determining what services are covered by health
insurance and Medicare.
- Choose simple words and short sentences and use a gentle, calm
tone of voice.
- Avoid talking to the person with AD like a baby or talking
about the person as if she weren't there.
- Minimize distractions and noise-such as the television or
radio-to help the person focus on what you are saying.
- Call the person by name, making sure you have her attention
- Allow enough time for a response. Be careful not to
- If she is struggling to find a word or communicate a thought,
gently try to provide the word she is looking for.
- Try to frame questions and instructions in a positive way.
For some people with AD, bath time can be a frightening,
confusing experience. Advance planning can help make bath time
better for both of you.
- Plan the bath or shower for the time of day when the person is
most calm and agreeable. Be consistent. Try to develop a
- Respect the fact that bathing can be scary and uncomfortable.
Be gentle and respectful. Be patient and calm.
- Tell the person what you are going to do, step by step, and
allow him to do as much as possible.
- Prepare in advance. Make sure you have everything you need
ready and in the bathroom before beginning. Draw the bath ahead of
- Be sensitive to the temperature. Warm up the room beforehand if
necessary and keep extra towels and a robe nearby. Test the water
temperature before beginning the bath or shower.
- Minimize safety risks by using a handheld showerhead, shower
bench, grab bars, and nonskid bath mats. Never leave the person
alone in the bath or shower.
- Try a sponge bath. Bathing may not be necessary every day. A
sponge bath can be effective between showers or baths.
For someone who has AD, getting dressed presents a series of
challenges: choosing what to wear, getting some clothes off and
other clothes on, and struggling with buttons and zippers.
- Try to have the person get dressed at the same time each day so
she will come to expect it as part of the daily routine.
- Encourage her to dress herself to whatever degree possible.
Plan to allow extra time so there is no pressure or rush.
- Allow the person to choose from a limited selection of outfits.
If she has a favorite outfit, consider buying several identical
- Arrange the clothes in the order they are to be put on to help
the person move through the process.
- If the person needs prompting, provide clear, step-by-step
- Choose clothing that is comfortable, easy to get on and off,
and easy to care for. Elastic waists and Velcro enclosures minimize
struggles with buttons and zippers.
- Ensure a quiet, calm atmosphere for eating. Limiting noise and
other distractions may help the person focus on the
- Provide a limited number of choices of food and serve small
portions. You may want to offer several small meals throughout the
day in place of three larger ones.
- Use straws or cups with lids to make drinking easier.
- Substitute finger foods if the person struggles with utensils.
Using a bowl instead of a plate also may help.
- Have healthy snacks on hand. To encourage eating, keep the
snacks where they can be seen.
- Visit the dentist regularly to keep mouth and teeth
Finding activities that the person with AD can do and is
interested in can be a challenge. Building on current skills
generally works better than trying to teach something
- Don't expect too much. Simple activities often are best,
especially when they use current abilities.
- Help the person get started on an activity. Break the activity
down into small steps and praise the person for each step he
- Watch for signs of agitation or frustration with an activity.
Gently help or distract the person to something else.
- Incorporate activities the person seems to enjoy into your
daily routine and try to do them at a similar time each day.
- Take advantage of adult day services, which provide various
activities for the person with AD, as well as an opportunity for
caregivers to gain temporary relief from tasks associated with
caregiving. Transportation and meals are often provided.
Incorporating exercise into the daily routine can benefit both
the person with AD and the caregiver. Not only can it improve
health and help everyone sleep better, but it can also provide a
meaningful activity for both of you to share.
- Think about what kind of physical activities you both enjoy,
perhaps walking, swimming, tennis, dancing, or gardening. Determine
the time of day and place where this type of activity would work
- Be realistic in your expectations. Build slowly, perhaps just
starting with a short walk around the yard, for example, before
progressing to a walk around the block.
- Be aware of any discomfort or signs of overexertion. Talk to
the person's doctor if this happens.
- Allow as much independence as possible, even if it means a
less-than-perfect garden or a scoreless tennis match.
- See what kinds of exercise programs are available in your area.
Senior centers may have group programs for people who enjoy
exercising with others. Local malls often have walking clubs and
provide a place to exercise when the weather is bad.
As the disease progresses, many people with AD begin to
incontinence, which can be upsetting to the person and
difficult for the caregiver. Sometimes incontinence is due to
physical illness, so be sure to discuss it with the person's
- Have a routine for taking the person to the bathroom and stick
to it as closely as possible. For example, take the person to the
bathroom every 3 hours or so during the day. Don't wait for the
person to ask.
- Watch for signs that the person may have to go to the bathroom,
such as restlessness or pulling at clothes. Respond quickly.
- Be understanding when accidents occur. Stay calm and reassure
the person if he is upset. Try to keep track of when accidents
happen to help plan ways to avoid them.
- To help prevent nighttime accidents, limit certain types of
fluids-such as those with caffeine-in the evening.
- If you are going to be out with the person, plan ahead. Know
where restrooms are located, and have the person wear simple,
easy-to-remove clothing. Take an extra set of clothing along in
case of an accident.
Nighttime can be a difficult time. Getting the person to go to
bed and stay there may require some advance planning.
- Set a quiet, peaceful tone in the evening to encourage sleep.
Keep the lights dim, eliminate loud noises, even play soothing
music if the person seems to enjoy it.
- Try to keep bedtime at a similar time each evening. Developing
a bedtime routine may help.
- Encourage exercise during the day and limit daytime
- Restrict access to caffeine late in the day.
- Use night lights in the bedroom, hall, and bathroom if the
darkness is frightening or disorienting.
Hallucinations and Delusions
As the disease progresses, a person with AD may experience
hallucinations and/or delusions.4
- Sometimes hallucinations and delusions are a sign of a physical
illness. Keep track of what the person is experiencing and discuss
it with the doctor.
- Avoid arguing with the person about what she sees or hears. Try
to respond to the feelings she is expressing, and provide
reassurance and comfort.
- Try to distract the person to another topic or activity.
Sometimes moving to another room or going outside for a walk may
- Turn off the television set when violent or disturbing programs
are on. The person with AD may not be able to distinguish
television programming from reality.
- Make sure the person is safe and does not have access to
anything she could use to harm anyone.
Home Safety and Wandering
Creating a safe environment is one of the most important aspects
of caregiving and can prevent many stressful and dangerous
situations. Caregivers of people with AD often have to look at
their homes through new eyes to identify and correct
senior home safety risks, as well as to prevent wandering, a
dangerous tendency of people with AD.
- Install secure locks on all outside windows and doors and keep
them locked, especially if the person is prone to wandering.
Consider a keyed deadbolt or an additional lock up high or down low
on the door. If the person can open a lock because it is familiar,
a new latch or lock may help.
- Remove the locks on bathroom doors to prevent the person from
accidentally locking himself in.
- Be sure to secure or put away anything that could cause danger,
both inside and outside the house.
- Use childproof latches on kitchen cabinets and any place where
cleaning supplies or other chemicals are kept.
- Label medications and keep them locked up. Also make sure
knives, lighters and matches, and guns are secured and out of
- Keep the house free from clutter. Remove scatter rugs and
anything else that might contribute to a fall. Make sure lighting
is good both inside and out.
- Consider installing an automatic shut-off switch on the stove
to prevent burns or fire.
- Make sure that the person carries some kind of identification
or wears a medical bracelet. If he gets lost and is unable to
communicate adequately, this will alert others to his identity and
- Keep a recent photograph or videotape of the person with AD to
assist police if the person becomes lost.
Making the decision that a person with AD is no longer safe to
drive is difficult, and it needs to be communicated carefully and
sensitively. Even though the person may be upset by the loss of
independence, safety must be the priority.
- Look for clues that safe driving is no longer possible,
including getting lost in familiar places, driving too fast or too
slow, disregarding traffic signs, or getting angry or
- Be sensitive to the person's feelings about losing the ability
to drive, but be firm in your request that she no longer do so. Be
consistent-don't allow her to drive on "good days" but forbid it on
- Ask the doctor to help. The person may view the doctor as an
"authority" and be willing to stop
driving. The doctor also can contact the Department of Motor
Vehicles and request that the person be reevaluated.
- If necessary, take the car keys. If just having keys is
important to the person, substitute a different set of keys.
- If all else fails, disable the car or move it to a location
where the person cannot see it or gain access to it.
Visiting the Doctor
It is important that the person with AD receive regular medical
care beyond Alzheimer's care. Advance planning can help the trip to
the doctor's office go more smoothly.
- Try to schedule the appointment for the person's best time of
day. Also, ask the office staff what time of day the office is
- Don't tell the person about the appointment until the day of
the visit or even shortly before it is time to go. Be positive and
- Bring along something for the person to eat and drink and any
activity that he may enjoy.
- Have a friend or another family member go with you on the trip,
so that one of you can be with the person while the other speaks
with the doctor.
- National Institute on Aging, 2012.
1 For more information on the most up-to-date
findings that might help you, talk to your doctor.
2Information provided by the NIA is free of copyright
and in the public domain. Additional information can be found at
the NIA website: http://www.nia.nih.gov/.
3Please also see the reference to research findings
on the use of music, located at the beginning of this article.
4 In some types of dementia, such as Lewy Body
Dementia (LBD), hallucinations can occur at the first onset of
symptoms. For additional information on LBD, please refer to our
article on dementia: Understanding Dementia: A Basic Overview.