Dementia - daily care

Help with Memory Loss

People who have early memory loss can give themselves reminders to help them function each day. Some of these are:

• Ask the person you are talking with to repeat what they said, or repeat what they said to yourself 1 or 2 times. This will help you remember it better.
• Write down your appointments and other activities in a planner book or calendar. Keep it in an obvious place, such as beside your bed.
• Post messages around your home where you will see them, such as the bathroom mirror, next to the coffee pot, or on the phone.
• Keep a list of important phone numbers next to every phone.
• Have clocks and calendars around the house so that you stay oriented to time and the date.
• Label important items.
• Develop habits and routines that are easy to follow.
• Plan activities that improve thinking, such as puzzles, games, baking, or indoor gardening. Be sure to supervise any task that may have a risk of injury.

Eating and Nutrition

Some people who have dementia may refuse food or not eat enough to stay healthy. Some tips that may help are:

• Help the person get enough exercise. Ask them to go outside with you for a walk.
• Have someone the patient likes, such as a friend or relative, prepare and serve them food.
• Reduce distractions around the eating area, such as the radio or TV.
• Do not give them foods that are too hot or too cold.
• Give the patient finger foods if they have problems using utensils.
• Try different foods. It is common for people who have dementia to have decreased smell and taste, and this will affect their enjoyment of food.

In later stages of dementia, the person may have trouble chewing or swallowing. Talk with their health care provider about a proper diet. At some point, the patient may need a diet of only liquid or soft foods, to prevent choking.

Tips for Talking with Someone with Dementia

Keep distractions and noise down:

• Turn off the radio or TV.
• Close the curtains.
• Move to a quieter room.

To avoid surprising the patient, try to make eye contact before touching or speaking to them.

Use simple words and sentences, and speak slowly. Speak in a quiet voice. Talking loudly, as if the person is hard of hearing, will not help. Repeat your words, if needed. Use names and places the person knows. Try not to use pronouns, such as "he," "she," and "them." This can confuse someone with dementia. Tell them when you are going to change the subject.

Talk to people who have dementia as an adult. Do not make them feel as if they are a child. Do not pretend to understand them if you do not.

Ask questions in a way that they can answer with a simple "yes" or "no." Give the person clear choices, and a visual cue, such as pointing to something, if possible. Do not give them too many options.

When giving instructions:

• Break down instructions into small and simple steps.
• Allow time for the person to understand.
• If they get frustrated, consider changing to another activity.

Try to get them talking about something they enjoy. Many people with dementia like to talk about the past, and many can remember the distant past better than recent events Even if they remember something wrong, do not insist on correcting them.

Personal Grooming

People with dementia may need help with personal care and grooming.

Their bathroom should be nearby and easy to find. Consider leaving the bathroom door open, so they can see it. Suggest they visit the bathroom several times a day.

Make sure their bathroom is warm. Get them undergarments made for urine or stool leakage. Make sure they are cleaned well after going to the bathroom. Be gentle when helping. Try to respect their dignity.

Make sure the bathroom is safe. Common safety devices are:

• A tub or shower seat
• Handrails
• Antiskid mats

Do not let them use razors with blades. Electric razors are best for shaving. Remind the patient to brush their teeth at least 2 times a day.

A person with dementia should have clothing that is easy to put on and take off.

• Do not give them too many choices about what to wear.
• Velcro is much easier than buttons and zippers to use. If they still wear clothes with buttons and zippers, they should be in the front.
• Get them pullover clothes and slip on shoes, especially as their dementia gets worse.

References

Moniz Cook ED, Swift K, James I, Malouf R, De Vugt M, Verhey F. Functional analysis-based interventions for challenging behaviour in dementia. Cochrane Database Syst Rev. 2012;2:CD006929. DOI: 10.1002/14651858.CD006929.pub2.

Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia.  Cochrane Database Syst Rev. 2012;2:CD005562. DOI: 10.1002/14651858.CD005562.pub2.

Knopman DS. Alzheimer's disease and other dementias.In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 409.

Smith DA, Brechtelsbauer DA. Delirium and dementia. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 48.

Dave J, Hecht M. Dementia. In: Frontera, WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 119.

Petersen RC. Mild cognitive impairment. N Engl J Med. 2011;364:2227-2234.

Update Date: 5/13/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.