Patients with Dementia

Its very important that people with dementia are treated with respect.
If you can understand what the person is going through, it might be easier
for you to realize why they behave in certain ways. It is important to
remember that a person with dementia is still a unique and valuable human
being, despite their illness.

ESTABLISH ROUTINES BUT KEEP THINGS NORMAL

A routine can decrease the decisions you will need to make and bring order
and structure into an otherwise confused daily life. A routine may come
to represent security for the person with dementia. Although a routine
can be helpful, it is important to keep things as normal as possible.
As much as their changing condition will allow, try to treat the person
as you did before the disease.

SUPPORT THE PERSONS INDEPENDENCE

It is necessary that the person remains independent as long as possible.
It helps to maintain self- respect and decreases the burden on you. Help
the person maintain dignity. Remember that the person you care for is
still an individual with feelings. What you and others say and do can
be disturbing. Avoid talking about the persons condition in their
presence without involving them in the conversation.

AVOID CONFRONTATION

Any type of conflict causes unnecessary stress on you and the person with
dementia. Avoid drawing attention to failure and maintain a calm composure.
Becoming upset can only make the situation worse. Remember it is the disease,
not the persons fault.

SIMPLIFY TASKS

Try to make things simple for the person with dementia. Dont offer
too many choices. For example, in the early stages of the disease, the
person may be able to dress themselves but as the disease progresses you
will need to guide them and, eventually, clothe the person yourself.

MAINTAIN A SENSE OF HUMOR

Laugh with the person with dementia. Humor can be a great stress reliever.

MAKE SAFETY IMPORTANT

Loss of physical coordination and memory increases the chance of injury,
so you should make your home as safe as possible.

ENCOURAGE FITNESS AND HEALTH

In many cases, this can help maintain the persons existing physical
and mental abilities for a time. The appropriate exercise depends on the
persons condition. Consult a health care professional for advice.

COMMUNICATING WITH THE PERSON WITH DEMENTIA

• Speak clearly, slowly, face to face and at eye level
• Show love and warmth by showing affection if this is comfortable for the person
• Pay attention to the persons body language “ people whose
  Ianguage is impaired communicate through non-verbal means
• Be aware of your own body language
• Make sure that the person is paying attention to you. Eye contact is important.
  Gently touching and calling the persons name can draw his or her
  attention.
• Keep sentences short and simple. Make one point at a time. Stick to simple,
  familiar ideas rather than complicated new concepts. Make statements and
  not logical arguments.
• Use real names, not pronouns (he, she). This reminds the person of who
  you are talking about.
• Do not ask questions which need a complicated answer. Questions which can
  be answered with a word or two are best.
• Information is not easily taken in. It helps to repeat the important parts
  of a message.
• Gestures, body language (how we use our hands, eyes and posture), touch
  and tone of voice are often understood right through to the late stages
  of the illness. Sit in a position where the person can easily see you.
• Conversation is enjoyable, but the topic needs to be one which both parties
  can grasp. For people with dementia this tends to be the old and familiar
  things in life.

USE MEMORY AIDS

In the early stages of dementia, memory aids can help the person to remember,
and they can help prevent confusion. The following are successful examples:

• Display large clearly labeled pictures of relatives so the person can keep
  track of who is who
• Label doors of rooms with words and bright distinctive colors

‹‹‹‹‹NOTE: Memory aids will not be so useful in the later stages of dementia

BATHING AND PERSONAL HYGIENE

The person with dementia may forget to bathe, or no longer recognize the
need, or may have forgotten what to do. In this situation it is important
to respect the persons dignity when offering to help.

• Maintain the persons former routine for washing as much as possible
• Try to make bathing a pleasant and relaxing occasion
• A shower may be easier than a bath but if the person has not been used
  to a shower it may seem alarming
• Simplify the task as much as possible
• If the person refuses to bathe, try again a little later, when the mood
  may have changed
• Check if teeth are being cleaned regularly
• Allow the person to do as much as possible unaided
• If the person appears embarrassed, keeping portions of the body covered
  while bathing may be helpful
• Think about safety. Something firm to hold on to, such as support rails,
  a non-slip mat or an extra chair all help
• If bathing always leads to conflict, a stand-up wash might be better
• If you constantly have problems helping with this, get someone else to do it

DRESSING

The person with dementia will often forget how to dress and may not recognize
the need to change clothes. People with dementia sometimes appear in public
with inappropriate clothing.

• Lay out clothes in the order they are to be put on
• Avoid clothes with complicated fastenings
• Encourage independence in dressing as long as possible
• Use repetition if necessary
• Use non-skid rubber-soled shoes

TOILETING AND INCONTINENCE

The person with dementia may lose the ability to recognize when to go to
the toilet, where the toilet is or what to do when in the bathroom.

• Create a schedule for going to the toilet
• Make the toilet door more obvious by using bright colors and large letters
• Leave the bath room door open so it is easy to find “ use a night
  light in the bath room
• Make sure clothing can be easily removed
• Limit drinks within reason before bed time
• Providing a bedpan by the bedside may be helpful

EATING

People with dementia often forget if they have eaten, or how to use utensils.
In the later stages of dementia the person may need to be fed. Some physical
problems will arise such as not being able to chew properly or swallow.

• You may have to remind the person how to eat
• Use finger food “ it can be easier to manage and not as messy
• Cut up food in small pieces to prevent choking. In the late stages of the
  disease, it may be necessary to mash or liquidize all food
• Be aware that the person may not be able to sense hot or cold, and may
  burn their mouth on hot foods or liquids
• When the person has difficulty swallowing, consult your physician to learn
  a technique to stimulate swallowing
• Serve one portion of food at a time and remind the person to eat slowly

DIFFICULTY SLEEPING

The person with dementia may be restless at night and disturb the family.
This can be your most exhausting problem as a care giver.

• Try to discourage sleeping during the day
• Try daily long walks, and add more physical activity during the day
• Try to make the person as comfortable as possible at bed time

REPETITIVE BEHAVIOR

• A person with dementia may forget what they have said from one moment to
  the next, leading to repetitive questioning and actions.
• Try to distract the person with dementia, offering something else to see,
  hear or do
• Write down the answer to commonly asked questions
• Give hugs and reassure with affection, if appropriate for the person

LOSING THINGS AND ACCUSATIONS OF THEFT

• The person with dementia may often forget where objects were placed. In
  some cases they will accuse you and others of taking missing objects.
  These behaviors are caused by insecurity combined with a sense
  of loss of control and of memory.
• Discover if the person has a favorite hiding place
• Keep replacements of important items, e.g. keys
• Check waste baskets before emptying them
• Respond to the persons accusations gently NOT defensively
• Agree with the person that the item is lost and help find it

DELUSIONS AND HALLUCINATIONS

• The person with dementia may often forget where objects were placed. In
  some cases they will accuse you and others of taking missing objects.
  These behaviors are caused by insecurity combined with a sense
  of loss of control and of memory. It is not uncommon for the person with
  dementia to experience delusions and hallucinations. A delusion is a fixed
  false belief. For example, the person may hold the false belief of being
  under threat of harm from the care giver. To the person with dementia
  the delusion is very real and causes fear, and may result in distressing
  self protective behaviors. If the person is experiencing a hallucination,
  he/she might see or hear things that are not there; for instance, figures
  at the foot of the bed, or people talking in the room.
• Do not argue with the person about the validity of what was seen or heard
• When the person is frightened try to give comfort. Your calm voice and
  gently holding a hand can be comforting
• Distract the person by drawing attention to something real in the room
• Check with their doctor about medications that are being used, these may
  contribute to the problem

INAPPROPRIATE SEXUAL BEHAVIOR

• The person with dementia may display inappropriate sexual behavior, but
  it is rare. Behavior may include undressing in public, fondling the genitals,
  or touching someone in an inappropriate way.
• Try not to over-react to the behavior “ remember it is the disease
  taking effect
• Try to distract the person to another activity
• If the person removes clothing, gently discourage the behavior, and try
  to distract the person
• If it persists and is troubling, seek help from a professional

WANDERING

• This can be a worrying problem which you may need to manage. People with
  dementia may wander around the home or leave the house and wander around
  the neighborhood. They may get lost. Safety is a primary concern when
  the person with dementia is out in public alone.
• Make sure the person carries some form of identification
• Make sure your home is secure and that the person is safe in your home
  and cannot leave without your knowing
• When the person is found, avoid showing anger “ speak calmly, with
  acceptance and love
• It is helpful to keep an up-to-date photograph in case the person gets
  lost and you must ask for help from others