Even though most dementia develops 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 be achieved through the below standard practices.
GENERAL 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, but the following tactics have proven effective over time:
- Develop a Daily Routine
Assess your day to see if there are routines you can put in place to help things go more smoothly. Most people like to have a sense of what’s coming next, and a daily rhythm can be especially helpful for those dealing with general confusion. If there are times of day when your loved one is less confused or more cooperative, plan major activities for those times.
- Encourage Independence
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.
- Use Music
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 of dementia therapy.
Here are some more tips from the National Insitute on Aging (NIA):
- Minimize Distractions: When you’re preparing to have a focused conversation, turn off the TV and radio.
- Get Your Loved One’s Attention: Call him by name, and make sure he’s looking at and listening to you before speaking.
- Speak Simply and Directly: Choose simple words and short sentences and use a gentle, calm tone of voice. Make sure to treat the person with dementia like an adult; avoid taking a condescending tone.
- Be Patient: Allow enough time for a response. Be careful not to interrupt. If she is truly struggling to find a word or communicate a thought, gently try to provide the word she is looking for.
Dementia can make bathing a frightening, confusing experience. Advance planning can help make bath time better for both of you.
- Limit Bathing: Try replacing some showers with sponge baths. Depending on how active your loved one is, he or she may not need a full shower every day.
- Plan Ahead: Gather everything you need ahead of time, including a towel and change of clothes. Get the water going and set to the right temperature.
- Warm the Bathroom: Undressing can be especially unpleasant when it’s cold. Turn up the heat as needed.
- Narrate What’s Happening: Tell him what you are going to do, step by step, and allow him to do as much as possible.
- Minimize Safety Risks: Use a handheld showerhead, shower bench, grab bars, and nonskid bath mats. Never leave the person alone in the bath or shower.
For those with dementia, getting dressed presents a series of challenges, from choosing what to wear, to figuring out how to properly take things off and put other things on, to manipulating buttons and zippers. Here are some things you can do to simplify the process:
- Encourage Independent Choice: Allow the person to choose from a limited selection of outfits. If she has a favorite outfit, consider buying several identical sets.
- Arrange Clothes in Order: Elimintate the need for decision-making by laying clothing items out in order they are to be put on.
- Provide Instructions if Needed: If the person needs prompting, provide clear, step-by-step instructions.
- Choose Convenient Clothes: Clothing for dementia patients should be comfortable and easy to get on and off. Elastic waists and Velcro closures minimize struggles with buttons and zippers.
- Limit Distractions: Ensure a quiet, calm atmosphere for eating. Limiting noise and other distractions may help the person focus on the meal.
- Serve Small Meals and Snacks: Dementia patients may have limited appetites and attention spans. Plan on serving small portions and supplementing these with snacks.
- Make Eating Easy: Use straws or cups with lids to make drinking easier. Serve finger foods if the person has trouble with utensils. Using bowls instead of plates may also help encourage independent eating.
- Visit the Dentist Regularly: Maintaining a healthy mouth and healthy teeth is key to helping dementia patients eat appropriately.
ACTIVITIES & EXERCISE
Incorporating physical and mental stimulation into daily routines is important for both caregivers and their charges. Here are some tips for making regular exercise and other activities a part of daily life:
- Find Mutually Enjoyable Activites: From daily strolls around the neighborhood, to game nights and regular outings, activities should be simple and fun for everyone.
- Keep Expectations Reasonable: You may need to modify favorite activities to suit current abilities. Go slowly, take things step by step, and avoid frustration and overexertion.
- Take Advantage of Organized Programs: Local senior centers often offer classes and activities suitable for those with dementia. You may also want to check into adult day services, which can be a good source of daily socialization for those with dementia and relief for caregivers.
As the disease progresses, many people with dementia begin to experience incontinence. Sometimes incontinence is due to physical illness, so be sure to discuss it with the person’s doctor. Beyond that, here are some tips for managing bathroom care:
- Develop a Schedule: Take the person to the bathroom at regular intervals. Don’t wait for her to ask.
- Watch for Signs of Discomfort: Is he unusually restless or pulling at his clothes? Take him to the bathroom.
- Prevent Accidents When Possible: Take steps such as avoiding fluids after a certain time of night. 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.
- Stay Calm and Positive: When accidents occur, minimize embarassment by dealing with them matter-of-factly.
Getting enough rest can help ensure optimal mental functioning for those with dementia. Try the following techniques to increase the likihood of everyone getting a good night’s sleep:
- Keep Evenings Peaceful: When it’s getting close to bedtime, dim the lights and avoid stimulating activities such as watching television. You may find that playing soothing music or reading to your loved one helps him or her relax.
- Make Bedtime Consistent: Help your loved one develop an effective internal clock by keeping bedtime within 15 minutes of the same time each night.
- Maintain an Exercise Routine: Getting enough physical activity each day is key to sleeping deeply at night.
- Avoid Caffiene: Limit coffee, tea and soda, especially after lunch and into the evening.
HALLUCINATIONS & DELUSIONS
As the disease progresses, a person with dementia may experience hallucinations and/or delusions. The following techniques can be used to help manage episodes:
- Avoid Arguing: Don’t disagree with the person about what she sees or hears. Try to respond to the feelings she is expressing, and provide reassurance and comfort.
- Offer Distractions: Suggest a change of topic or activity. Sometimes moving to another room or going outside for a walk may help.
- Turn Off the TV: Dark, moody or violent programming can be especially unhelpful for those who have difficulty distinguishing fantasy from reality.
- Ensure Safety: Make sure the environment is free of objects that could be used to cause harm.
HOME SAFETY & 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 dementia often have to look at their homes through new eyes to identify and correct senior home safety risks.
- Install Locks on Possible Exits: All windows and doors should be appropriately secured to prevent wandering. This may involve installing new and unfamiliar locks, or placing new locks where the person can’t reach them.
- Remove Interior Locks: Avoid allowing your loved one to lock him- or herself into any room, including the bathroom. He or she may not remember how to unlock
- Remove Dangerous Objects: This includes anything that could create a tripping hazzard and anything that could be used to cause harm.
- Install Childproof Latches: Secure kitchen cabinets, linen closets and other storage spaces.
- Ensure Proper Identification: 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 medical condition. In addition, keep a recent photograph or videotape of the person with dementia on hand.
Driving generally isn’t safe for those in all but the earliest stages of dementia. Here’s how you can handle the transition:
- Be Firm: Don’t allow your loved one to drive on “good days” but forbid it on “bad days.” Offer sympathy when he or she expresses unhappiness with the situation, but don’t give in.
- Get a Doctor’s 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.
- Take the Car Keys: If just having keys is important to the person, substitute a different set of keys.
- Move the Car: 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
Here are some tips for handling medical appointments:
- Schedule Wisely: 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 least crowded.
- Give Short Notice: 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 matter-of-fact.
- Bring Snacks and Activities: Bring along something for the person to eat and drink and any activity that he may enjoy.
- Bring a Helper: 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.
Update: January 2018