Caring for someone with dementia at home is a difficult and overwhelming task. Each day brings new challenges as the person’s cognitive, physical, and functional abilities diminish and new behavioral patterns emerge. As the disease progresses, the affected individual becomes more and more reliant on the people around them – and more prone to sudden mood swings and aggressive or delusional behavior, as well.
Providing proper care to a senior with dementia and finding effective solutions to daily issues can be extremely challenging – because of the changes the disease causes to their brain, your loved one may behave and react differently than they used to and you may not know how to deal with them. This may be very frustrating and confusing, but it is your caregiving that determines your loved one’s quality of life, so you need to learn how to best care for them.
Here are some dos and don’ts of dementia care that will help you cope with common caregiving challenges and provide the best possible care to your loved one with the disease.
Keep Your Loved One Safe
Without a doubt, keeping your loved one safe will be your top priority when caring for an aging family member with dementia. To achieve this, you need to create a safe environment at home and prevent wandering.
1. Limit wandering
People with Alzheimer’s disease have a tendency to wander away from home. To protect your loved one from getting lost or injured when wandering, you’re advised to:
- Make sure that your loved one always carries some kind of identification with them or wears a medical bracelet;
- Try to redirect pacing or restless behavior into productive activity or exercise;
- Distract your loved one with another activity at the time of day when wandering most often occurs;
- Hide items like purses, hats, and glasses that the person would want when leaving the house;
- Keep exterior doors locked – consider an additional lock up high or down low on the door or a new type of latch your loved one isn’t familiar with;
- Install an alarm that chimes when exterior doors and windows open;
- Notify neighbors and local authorities that your loved one tends to wander and ask them to contact you immediately if your family member is seen alone away from home;
- Enroll your loved one in wandering and/or medical alert programs, like the Alzheimer’s Association Safe Return program or Project Lifesaver, which provide 24/7 response to wandering emergencies.
2. Ensure your loved one’s safety at home
There are many steps you can take to keep your loved one safe and comfortable at home:
- Prevent falls – secure area rugs, avoid extension cords, and reduce clutter to minimize the risk of tripping, slipping, and falling;
- Install grab bars in risky areas like bathrooms, halls, kitchens, toilets, etc.;
- Install railings along both sides of all interior and exterior stairways;
- Install locks on cabinets that contain potentially dangerous items and materials, such as guns, tools, medicines, alcohol, toxic cleaning substances, etc.;
- Ensure proper illumination throughout the home;
- Lower the thermostat on the hot-water heater to prevent burns;
- Take fire safety precautions – keep matches and lighters out of reach, keep a working fire extinguisher at every level of the home, make sure smoke and carbon monoxide detectors have fresh batteries, etc.
3. Develop Daily Routines
Predictable daily routines provide a sense of consistency and security and can help eliminate confusion and frustration for a person with Alzheimer’s or dementia. It is, therefore, important to develop day-to-day routines and schedules when caring for a loved with the disease:
- Try to detect patterns in your loved one’s behavior (for example, they may be less confused and more cooperative in the mornings) and create their daily routine accordingly;
- Keep consistent daily times for activities such as bathing, dressing, eating, and going to bed. Performing these activities at the same time and place can help orient the person with dementia;
- Use cues to establish the times for certain activities – lay your loved one’s clothes on the bed in the morning to indicate it’s time to get dressed for the day, put on quiet music to indicate it’s bedtime in the evenings, etc.;
- Include enjoyable activities in your loved one’s daily schedule to make sure that they’re getting sensory experiences and socialization (but be careful to avoid overstimulation and stressful situations) – choose simple activities without too many steps; include tactile activities such as painting, gardening, or playing with pets; vary activities to stimulate different senses; plan time outdoors (take a walk together, go to the park, sit on a balcony or in the backyard for an hour or so, etc.); consider group activities designed for Alzheimer’s patients (senior centers, community centers, and adult day care centers host such activities); plan for visitors; etc.
Keep in mind that your loved one’s abilities and preferences will change over time and adapt the routine as needed.
Help Your Loved One with Activities of Daily Living
As the disease progresses, it will become increasingly difficult for your loved one to perform simple daily tasks, so they will need your assistance in order to maintain a safe and comfortable lifestyle:
1. Assistance with eating
Eating and drinking require coordinated fine motor functions that may be impaired by Alzheimer’s disease. To make sure your loved one gets the nutrition they need, you’re advised to:
- Ensure the person doesn’t skip meals, but be patient and avoid rushing;
- Maintain consistent mealtime routines;
- Create a quiet, calm atmosphere during mealtimes by limiting background noise and other distractions;
- Provide a balanced, nutritious diet rich in fruits, vegetables, whole grains, and low-fat dairy products and plenty of healthy fluids. Offer appealing foods that vary in taste, texture, and color;
- Make healthy snacks readily available;
- Allow the person to choose what they would like to eat, but limit their options;
- Serve foods that are easy to handle – finger foods, meat and vegetables that are cut in small pieces, etc.;
- Avoid serving food that is too hot or too difficult to chew;
- Provide adaptive utensils – plates with rims, cups with lids, spoons with larger handles, and other easy-to-handle eating utensils;
- Be ready to provide feeding assistance if necessary;
- Encourage the person to drink plenty of fluids throughout the day to avoid dehydration.
2. Assistance with dressing and grooming
A person with dementia may have difficulty choosing what to wear, getting clothes on and off, fastening items with buttons and zippers, etc. To help your loved get properly dressed and groomed, you should:
- Provide comfortable clothes that are easy to put on and take off. Avoid buttons, zippers and shoelaces and go for garments with elastic waistbands, shoes with Velcro straps, etc.;
- Let the person decide what to wear, but offer a limited selection of outfits appropriate for the current climatic conditions and the activities your loved one will be doing;
- If your loved one can dress themselves, lay out the clothes in the order they’re to be put on. Allow plenty of time so they can get dress without having to rush;
- Make sure your loved one’s hair is properly combed and styled, their nails are trimmed and well cared for, their face is shaved (use an electric razor to reduce the risk of cuts), etc.;
- Provide appropriate skin-care products and help your loved one apply them correctly.
3. Assistance with personal hygiene (bathing, dental care, and toileting)
Bathing is a frightening and confusing experience for people with Alzheimer’s – they may be confused by the process and the great number of bathing products or become afraid of the water or a possible fall, etc. To make bathing, dental care, and toileting easier, you need to:
- Plan the bath or shower for a time of day when your loved one is calm and agreeable. Be consistent and develop a routine;
- Make the bathroom as safe as possible – consider walk-in tubs and showers, hand-held shower heads, shower benches or bath stools, grab rails, nonskid bath mats, etc.;
- Make sure the bathroom is warm and well-lit and all the bathing products, towels, and other needed accessories are set up before bringing your loved one into the bathroom. Draw the bath ahead of time;
- Check the temperature of the water in the bath or shower as a person with dementia may easily midjudge the temperature and end up bathing with very hot or very cold water;
- Let your loved one wash themselves, if they’re able to. If needed, tell them what to do, step by step;
- Do not leave your loved one unattended in the shower or tub if they’re frightened, confused, or incapable of bathing themselves;
- Remind your loved one to brush their teeth regularly and assist them as necessary;
- If the person wears dentures, clean them every day and make sure they fit properly;
- Schedule routine visits to the bathroom to prevent accidents;
- Be ready to assist your loved one with using the toilet.
4. Assistance with medication management
Maintain a current list of medications, dosages, and times when each medication should be taken. Give your loved one the correct dosage of the needed medication at the appropriate time and wait until you see that they have taken it.
Alleviate Sleep Problems
Dementia patient – exhaustion, frustrations, a mix-up between day and night, inability to separate reality from dreams, and other disease-related factors may disrupt sleep patterns and prevent the affected person from getting a good night’s rest.
You can help your loved one sleep soundly by:
- Keeping demanding and stimulating activities, like bathing and social interactions, to earlier in the day;
- Encouraging physical activity during the day;
- Limiting caffeine and sugar intake, especially later in the day;
- Serving smaller portions for dinner;
- Limiting prolonged naps during the day (make sure your loved one gets adequate rest though as fatigue can exacerbate sundowning and cause lack of sleep);
- Keeping a regular sleep schedule and consistent bedtime;
- Maintaining your loved one’s lifelong evening routine – watching the evening news, listening to soothing music, drinking a cup of warm milk, etc.;
- Setting a peaceful tone in the evening and reducing noise and light.
Behavioral issues in dementia patients are usually triggered or exacerbated by the person’s inability to deal with stress, so you need to create a calm and positive environment in order to avoid problems and ensure your loved one’s well-being and emotional comfort:
- Reduce potential stressors that can create agitation and disorientation – loud or unidentifiable noises, shadowy or pulsating lighting, confusing information, upsetting news, etc.;
- Avoid giving too many choices, asking confusing questions, and providing unnecessary information;
- Don’t challenge your loved one when they’re wrong about something and don’t point out mistakes;
- Don’t let your loved one feel frustrated or tired;
- Encourage your loved one to share stories from the past, recount happy memories, and bask in their achievements – this will make them feel good and will ease their anxieties;
- Use soothing musicor play your loved one’s favorite songs to help them relax when they’re agitated.
Deal with Hallucinations and Delusional Behavior
People with dementia often experience hallucinations (seeing, hearing, smelling, tasting, or feeling something that is not there) and delusions (false beliefs that the person thinks are real). If your loved one struggles with reality, you need to treat them with patience and compassion:
- Discuss current and recent illnesses and medications with your loved one’s doctor – certain conditions and medications may cause hallucinations or delusions;
- Avoid arguing with your loved one about what they’re experiencing. Don’t dismiss their worries and comfort them if they’re afraid;
- Try to distract your loved one or redirect their attention to another topic or activity;
- Avoid violent movies and other upsetting television programs – an Alzheimer’s patient may not be able to distinguish them from reality;
- Make sure your loved one is safe and does not have access to anything they could use to harm themselves or others.
Deal with Aggressive Behavior
People with dementia may exhibit hostile speech or aggressive actions in response to feeling confused, helpless, or scared.
If your senior loved one has an outburst of aggression, try to remain calm and find out what is causing the problem. Do your best to understand the feelings that are making them behave in such a way and work to de-escalate the situation by shifting the focus:
- Make sure your loved one can’t hurt themselves or cause any harm and give them space to be angry alone;
- Don’t initiate physical contact during outbursts as this may trigger physical violence;
- Don’t engage in arguments, raise your tone, or force the issue that’s causing the outburst;
- Distract the person – change the topic or suggest a more pleasurable activity;
- Look for patterns in the aggressive behavior and try to avoid activities or topics that anger your loved one.
Deal with Cognitive Problems
The deterioration of brain cells caused by Alzheimer’s disease impairs the senior’s ability to process information, evaluate cause-and-effect relationships, and manage their emotions and results in a number of cognitive problems, such as memory loss, confusion, and poor judgment. These cognitive impairments affect the person’s thinking, reasoning, and behavior and cause various problems:
- Extreme anxiety about daily life – repeating statements and questions, asking for confirmation several times, preparing for appointments well ahead of time, etc.
- Difficulty with decision-making
- Difficulty with planning and organizing everyday tasks
- Inability to manage finances
- Poor judgment – falling for scams, giving away money, trusting strangers, etc.
- Poor understanding of safety risks
- Difficulty keeping track of time
- Uncertainty and confusion in familiar surroundings
- Unreasonable fears, anxiety, and/or depression
- Untrue beliefs and loss of touch with reality
- Unfounded accusations and distrust of others – hiding things or believing that others are stealing from them, lying to them, etc.
- Mood swings
Try to be encouraging and reassuring when you see such personality and behavior changes in your loved one with Alzheimer’s. You can reduce anxiety and minimize frustration by offering help in small ways and providing simple explanations along with photos and other tangible reminders. It is also a good idea to change the topic and redirect your loved one’s attention to something else whenever they become upset.
If the person persists in saying something that is incorrect, don’t argue – things just don’t make sense to them the way they used to and trying to reason with them won’t help. Lengthy explanations or rationalizations will only cause greater distress and confusion. Keep in mind that any response that can be interpreted as accusatory or doubting your loved one’s ability to handle a situation will put them on the defensive and anger them even more.
Make Communication Warm, Meaningful, and Enjoyable
Communicating with someone with dementia is extremely challenging as understanding and being understood becomes more and more difficult with time. To be able to stay connected with your loved one, make them understand what they need to know, and show them that you care, you need to:
- Provide a positive and supportive environment – limit distractions and background noise (such as TV and radio) to help the person focus on what you’re saying, sit close to your loved one, keep eye contact with them during the conversation, and use a gentle, calm tone of voice;
- Call your loved one by name and tell them who you are if they appear to be in doubt;
- Speak simply and clearly – speak slowly, say things one at a time, use short sentences and simple words, pause between sentences, repeat or rephrase when necessary, etc.;
- Avoid confusions – avoid complicated questions, give your loved one simple choices, refer to people by name, avoid pronouns, don’t use slang, figures of speech, or unfamiliar words, etc.;
- Allow enough time for your loved one to respond and be careful not to interrupt;
- If your loved one struggles to find a word or express a thought, gently try to provide the word they’re looking for or ask supportive questions to help them convey their message;
- If you can’t understand what your loved one is trying to say, look for clues in their body language and take their surrounding environment into consideration;
- Don’t argue with your loved one and make sure not to preach, accuse, scold, or criticize;
- Try not to show your frustration or anger and use humor when you can;
- Use therapeutic lies or fibs if telling the whole truth will upset your loved one – as bad as lying may be, it may keep a person with dementia from experiencing mental anguish, anxiety, and confusion;
- Treat your loved one with respect – don’t talk to them as if they were a child, don’t talk about them as if they were not there, don’t brush their feelings aside, and respect their privacy;
- Use physical contact to get your loved one’s attention, convey your feelings, and provide reassurance.
Most importantly – focus on the feelings behind your loved one’s words and actions. Remember that when people with Alzheimer’s are shouting or striking out, they’re trying to convey a message that they can no longer explain in words. Try to see the world through your loved one’s eyes, to understand their feelings, and to respond to these feelings, rather than to the actual words or behavior.
Consider In-Home Memory Care
Caring for a loved one with Alzheimer’s is not only challenging, but also physically and emotionally devastating – family caregivers feel frustrated and depressed as they witness their loved one’s decline and experience caregiver burnout unless they get timely and adequate help with caregiving. Using professional dementia care services can help relieve the stress and improve the quality of life of both the family caregiver and their loved one – the experienced specialists know how to care for the elderly with dementia and ensure their safety and well-being.
At Assisting Hands Richmond, we can help seniors with dementia live safely and comfortably in their own homes. We take a person-specific approach to Alzheimer’s and develop a care plan that perfectly suits the needs and preferences of the affected individual and their family. Our kind, compassionate caregivers are properly trained to provide effective memory care and help dementia patients with every aspect of their lives. They treat the elderly with empathy and respect and offer emotional support and friendly companionship.
If you have a loved one with Alzheimer’s or dementia, Assisting Hands Home Care is there for you – you can reach us 24/7 at (804) 500-9787 for memory care services in Richmond City, Henrico and Chesterfiled county, Glen Allen, Midlothian, and Moseley, Virginia.