How To Handle Dementia Patients

Safe And Happy At Home

Of the 5.2 million people in the United States who have Alzheimersdisease and other types ofdementia, 70 percent remain at home, an option thats been shown to keep peoplehealthier and happier and help them live longer. And with the averagenursing home running $50,000 a year or more, home care can be much moreaffordable than rehab facilities, nursing homes andassisted livingresidences.

But cheaper certainly doesnt mean easiercaregivingoften falls on the shoulders of family members and friends. And thosewell-meaning folks can burn out without the proper support, warnexperts.

The care of dementia is actually the care of two people: the person withthe illness and the person taking care of him, says Johns Hopkins expertDeirdre Johnston, M.B., B.Ch., B.A.O., M.R.C.Psych. But when Johnston and a team of researchers studied more than 250Baltimore residents with dementia as well as their caregivers, they found astaggering 97 percent to 99 percent of both groups had unmet needs.

Keeping your loved one safe and happy at home can seem overwhelming. Butdont lose heart: Plenty of help is out there, for your loved one and you. Here are some tips that may help:

Dont Be Afraid To Ask

Dementia patients can have difficulty communicating, so they may not always be able to tell you what they need. But if something seems off, dont hesitate to ask them questions like How are you feeling right now? or Are you in pain?.

Patients might not have the ability to answer those questions verbally, but they may try to express their feelings through gestures or other nonverbal cues.

Decide On Future Financial And Medical Plans With The Patient

It is important to get clarity on how to cope as time progresses and the dementia worsens. You should have clear plans worked out on who will manage the banking and financial affairs of the individual. Share your number with the utility company, informing them of the condition of your loved one, so that power supply or heating isnt cut off if they forget to pay their bills. Also do the difficult task of discussing which medical treatments they would prefer not to be subjected to, should the need arise at a future date.15 This legal document is known as an advance care directive and details what health decisions can be made on their behalf if they are no longer capable of doing so.16

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Develop Helpful Daily Routines

Having general daily routines and activities can provide a sense of consistency for an Alzheimers or dementia patient and help ease the demands of caregiving. Of course, as your loved ones ability to handle tasks deteriorates, youll need to update and revise these routines.

Keep a sense of structure and familiarity. Try to keep consistent daily times for activities such as waking up, mealtimes, dressing, receiving visitors, and bedtime. Keeping these things at the same time and place can help orientate the person with dementia. Use cues to establish the different times of dayopening the curtains in the morning, for example, or playing soothing music at night to indicate bedtime.

Involve your loved one in daily activities as much as theyre able. For example, they may not be able to tie their shoes, but may be able to put clothes in the hamper. Clipping plants in the yard may not be safe, but they may be able to weed, plant, or water.

Vary activities to stimulate different sensessight, smell, hearing, and touchand movement. For example, you can try singing songs, telling stories, dancing, walking, or tactile activities such as painting, gardening, or playing with pets.

Spend time outdoors. Going for a drive, visiting a park, or taking a short walk can be very therapeutic. Even just sitting outside can be relaxing.

Ensure The Right Nutrition

It is easy for someone with dementia to forget to eat balanced and nutritious meals, making them susceptible to deficiencies and malnutrition, so youll need to also keep track of their diet. Due to an inability to express what they want at times, a person with dementia may not be able to say they are hungry or ask for what they need. Keep food and snacks and drinks readily available and visible to them so they can help themselves to what they need, without having to constantly struggle with asking. A person with dementia may lose their sense of smell so stronger flavors and more seasoning may help them keep up their appetites.13

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How To Deal With Dementia

Dementia is commonly associated with memory loss. But theres another change thats equally disruptive to everyday living: behavioral changes. Its not uncommon for dementia to alter a persons personality and behavior.

Keep in mind that you may not be able to stop changes in a persons behavior, but you can work on being flexible, understanding, and patient in how you respond.

Dementia-associated behaviors vary, but some common ones include poor personal hygiene, wandering, and agitation or dementia outbursts.

Here are some ways you can manage these difficult behaviors:

• Accommodate. You dont have much ability to control the behavior, so instead try to find ways to be flexible with care and communication as they occur.
• Talk with the doctor. Underlying medical issues may be the reason for certain behaviors not just dementia-related changes. If your loved one complains of pain and acts out in bursts because of it, talk with their doctor.
• Look for triggers. Are certain behaviors more common at specific times of the day? For example, if getting dressed or brushing teeth sets off a highly charged reaction, see if you can change how you approach the task.
• Be flexible. You may feel relieved after finding a way to manage a specific behavior, but dont be surprised if yesterdays solution doesnt work today. Do your best to be creative, flexible, and yes, patient.

Tips On How To Care For Someone With Dementia

With one person in the world developing dementia every 3 seconds and an estimated 50 million or more people living with the condition globally, dementia is a very real problem.1 Getting the right care is crucial to maintaining a good quality of life for those coping with this problem. To add to it, dementia doesnt just affect the individual but also those around them. Navigating what can sometimes be a very emotional and difficult path may seem daunting, but there are some ways to make it easier. What follows is a look at how to care for someone with dementia, ways to keep them happier, and for you to cope too.

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Tips For Everyday Care For People With Dementia

Early on in Alzheimers and related dementias, people experience changes in thinking, remembering, and reasoning in a way that affects daily life and activities. Eventually, people with these diseases will need more help with simple, everyday tasks. This may include bathing, grooming, and dressing. It may be upsetting to the person to need help with such personal activities. Here are a few tips to consider early on and as the disease progresses:

• Try to keep a routine, such as bathing, dressing, and eating at the same time each day.
• Help the person write down to-do lists, appointments, and events in a notebook or calendar.
• Plan activities that the person enjoys and try to do them at the same time each day.
• Consider a system or reminders for helping those who must take medications regularly.
• When dressing or bathing, allow the person to do as much as possible.
• Buy loose-fitting, comfortable, easy-to-use clothing, such as clothes with elastic waistbands, fabric fasteners, or large zipper pulls instead of shoelaces, buttons, or buckles.
• Use a sturdy shower chair to support a person who is unsteady and to prevent falls. You can buy shower chairs at drug stores and medical supply stores.
• Be gentle and respectful. Tell the person what you are going to do, step by step while you help them bathe or get dressed.
• Serve meals in a consistent, familiar place and give the person enough time to eat.

Understanding Alzheimers Or Dementia Behavior Problems

One of the major challenges of caring for a loved one with Alzheimers or another dementia is coping with the troubling behavior and personality changes that often occur. Aggressiveness, hallucinations, wandering, or eating or sleeping difficulties can be upsetting and make your role as caregiver even more difficult. Whatever problems youre dealing with, its important to remember that the person with dementia is not being deliberately difficult. Often, your loved ones behavioral issues are made worse by their environment, their inability to deal with stress, or their frustrated attempts to communicate.

As you try to identify the causes, its important to remember that a patient with dementia responds to your facial expression, tone of voice, and body language far more than the words that you choose. So, use eye contact, a smile, or reassuring touch to help convey your message and show your compassion. And rather than take problem behaviors personally, do your best to maintain your sense of humor.

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Deal With Personal Hygiene And Incontinence

Urinary tract infections, incontinence, constipation these are just some issues the elderly have to deal with. Add to that the tendency to forget the need to go to the toilet or even where the toilet actually is, and a person with dementia has even more trouble. Prominently signpost the toilet with a board of some kind, keep the door open for easy access, and ensure the person with dementia has clothes that are quickly removed using a zipper instead of buttons helps. When it comes to personal hygiene, the fear of falling or becoming disoriented might keep someone from washing regularly. Some patients may allow a caregiver to help with this or be present when they are bathing.14

Understanding The Causes And Finding Ways To Cope

While some people living with Alzheimer’s disease or other types of dementia remain pleasant and easy-going throughout their lives, others develop intense feelings of anger and aggression.

When someone with dementia lashes out at you for seemingly no reason, it’s normal to feel surprised, discouraged, hurt, irritated, and even angry at them. Learning what causes anger in dementia, and how best to respond, can help you cope.

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Dont Forget To Care For Yourself Too

Joining a carers group can be a good way for you to find people who truly relate to the situation you are in. It is a good place to share and talk it out or learn coping mechanisms others use to care for those with dementia. Social services or a dementia adviser or counselor can direct you to a local group. Alternatively, there are plenty of online support groups you could consider joining.17

When you are close to someone with dementia you may find yourself asking why me. You may also get upset, angry, or frustrated, and possibly even feel guilty about thinking this way. At times, you may feel you are losing the love or affection you have for that person as these emotions take control. On the flip side, you may also feel guilty for taking time out to do something for yourself, or about losing your temper at them or not being kind enough. Dont beat yourself up about it. This is as hard on you as it is on the person you love who has dementia. And you need downtime too. Some of these things could help:18

References

Repetitive Speech Or Actions

People with dementia will often repeat a word, statement, question, or activity over and over. While this type of behavior is usually harmless for the person with dementia, it can be annoying and stressful to caregivers. Sometimes the behavior is triggered by anxiety, boredom, fear, or environmental factors.

• Provide plenty of reassurance and comfort, both in words and in touch.
• Try distracting with a snack or activity.
• Avoid reminding them that they just asked the same question. Try ignoring the behavior or question, and instead try refocusing the person into an activity such as singing or âhelpingâ you with a chore.
• Donât discuss plans with a confused person until immediately prior to an event.
• You may want to try placing a sign on the kitchen table, such as, âDinner is at 6:30â or âLois comes home at 5:00â to remove anxiety and uncertainty about anticipated events.
• Learn to recognize certain behaviors. An agitated state or pulling at clothing, for example, could indicate a need to use the bathroom.

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Speak In A Gentle Tone

Individuals with dementia can pick up on verbal and nonverbal cues and they often project it back. Hence, it is best to follow these points when communicating with dementia patients as suggested by the Department of Health in Victoria:

• Try not to argue with the person.
• Avoid ordering the person around.
• Do not be condescending towards the individual.
• Limit sighs, raising or furrowing of brows, or any indication of frustration or annoyance.

Hiding Hoarding And Rummaging Through Items

Your loved one, over time, may begin the practice of collecting, hiding, and hoarding items. Hiding items is normally a harmless behavior however, more advanced cases can pose serious health risks.

Common Causes of Hiding, Hoarding, and Rummaging

Hiding items can be a very confusing behavior to encounter however, the causes of this behavior are rooted in confusion and often communicate the need for security, novelty, and control.

• Inability to distinguish trash from other items

  As cognitive functions decline, the ability to distinguish useful items from trash becomes compromised, leading dementia suffers to believe that items of garbage are useful and valuable.

• Need for security

  Collecting items and storing them away indicates that your loved one feels insecure and has begun collecting these items out of fear of needing them some day or out of fear of being robbed.

• Understimulation

  Your loved one may be collecting and hiding items in an attempt to cure boredom and a general lack of stimulating activity.

• Inability to recall placement of items

  Your loved ones hiding of items may also be involuntary. As the ability to recall information degrades as a result of dementia, your loved one may not be able to recall where they placed keys, wallets, remote controls, or other items since they last used them.

Managing and Responding to Hiding, Hoarding, and Rummaging

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Try Diverting The Conversation

Keep a photograph album handy. Sometimes looking at pictures from their past and being given the chance to reminisce will ease feelings of anxiety. It might be best to avoid asking questions about the picture or the past, instead trying to make comments: ‘That looks like Uncle Fred. Granny told me about the time he….’

Alternatively, you could try diverting them with food, music, or other activities, such as a walk.

Tips For Home Safety For People With Dementia

As a caregiver or family member to a person with Alzheimers or related dementias, you can take steps to make the home a safer place. Removing hazards and adding safety features around the home can help give the person more freedom to move around independently and safely. Try these tips:

• If you have stairs, make sure there is at least one handrail. Put carpet or safety grip strips on stairs, or mark the edges of steps with brightly colored tape so they are more visible.
• Insert safety plugs into unused electrical outlets and consider safety latches on cabinet doors.
• Clear away unused items and remove small rugs, electrical cords, and other items the person may trip over.
• Make sure all rooms and outdoor areas the person visits have good lighting.
• Remove curtains and rugs with busy patterns that may confuse the person.
• Remove or lock up cleaning and household products, such as paint thinner and matches.

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Should You Keep Trying To Communicate

Family members may frequently ask, How often should I visit?, or, Should I visit at all, because they dont seem to be understanding what were saying, most of the time they dont seem to recognize me, etc. Caregivers can encourage family members to visit because its important to them. Also, the person with memory loss may catch some things on some days, and if family members can make the interaction a pleasant moment, it can be rewarding for both.

Communication amongst family becomes particularly difficult when the person with dementia and/or Alzheimers doesn’t recognize family members anymore. In this situation, a spouse or children can think that it doesnt do any good to go talk to the personthat anyone could talk to him/her because they dont remember who they are. But there is a richness that happens because of family history together, something that can only come from people that have been family or friends for a long time.

The type of communication families can get out of visits can be pulled from the strength of the patient and/or loved ones long-term memories. They can still talk about the past, and for family members, to hear those things are perhaps a worthwhile gift.

Even though the patient and/or loved one can no longer communicate the way they used to, there are still other ways to enjoy time together. There is beauty and simplicity in being in the present moment.

Dealing With Personal Issues That Cause Agitation

There are other predictable sources of emotional distress in dementia. Someone who has dementia may feel humiliated by their need to accept help with bathing, eating, dressing, or going to the toilet. They may feel overwhelmed by their inability to provide for themselves. They may panic when they can no longer recognize people or places. Even worse, they may retain enough self-awareness to know that they have behaved in ways that embarrass them or embarrass their families.

With these sources of agitation, the key to success is to distract rather than to escalate. Find a way to “change the subject” with the dementia patient to take them out of the downward spiral of fear, anxiety, and loss of self-esteem. And with the help of professionals, consider these interventions for decreasing agitation:

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