For care for someone with dementia offers many challenges. There are certain tools that one can use to help the carer cope and manage the patient.
Dementia is a broad term used to describe a deterioration in brain functioning. This deterioration can include the loss of ability to judge, to reason, the loss of memory, your communication and your behaviour. Dementia is a broad term and Alzheimers disease is the most common form of dementia. As people get older their risk of developing dementia will increase. It is however not a normal consequence of getting older.
There are certain medications that can improve cognitive functioning and thereby slow down the rate of dementia.
One can also try the non-medication route e.g. maintain a daily routine, exercise regularly and follow a healthy diet. These could also help to reduce developing Alzheimers and other forms of dementia. The types of food one should eat are greens (kale and broccoli), in other words, leafy vegetables, beans, lentils, wholegrains, fish, poultry, lean meat, olive oil and a glass of red wine per day is recommended. Nuts are also excellent for a healthy mind. They contain fats, fibre and antioxidants. Blueberries are the most potent protectors of the brain. Berries should be eaten at least twice a week. Strawberries are also an excellent source of fibre and are low in carbohydrates.
People with dementia often use bad language.
A reason for this may be that they struggle to find the correct words to express themselves. As a result they use bad language out of frustration. This can be extremely embarrassing for family. One way to cope with this is to remove physical, environmental and phsychological causes of their frustration. If there is no obvious cause for the use of bad language, then the best thing to do is to ignore it and remain calm. You being calm may in turn cause the patient to calm down as well. Another way is to distract the patient by playing music which often brings back happy memories or go for a walk outside.
Someone with dementia may cry or scream.
There may be physical reasons for this happening e.g. pain, they are hungry or may need to use the bathroom. The cause could be external e.g. a change in routine, loud noises or an environment that is too busy. There could be psychological reasons e.g. the person is lonely, bored, depressed, anxious or suffering from delusions. One can also ask a doctor to look at the patient’s medication. Sometimes medication may cause distress and disorientation. It is important never to give up when faced with the challenge of dementia. Often the challenging behaviour has a cause. A caregiver has to improve the quality of life for a person with dementia.
Dementia causes a patient to neglect his/her grooming and personal hygiene.
Setting up a routine is essential to facilitate hygiene and grooming. For example, keep the patient’s regular salon appointment, choose the correct person to help with grooming, a family member which the patient trusts. They may be more effective in persuading the patient to bath, brush teeth etc. It is also important to remain flexible. Sometimes, what was resisted yesterday will be accepted today by the patient. Maintaining a sense of humour will also help one face the daily challenges. A joke will lighten the mood and help to distract you from the confrontation.
OCD (Obsessive Compulsive Disorder) may be prevalent in certain types of dementia.
Once again, adhering to a strict routine will reassure the patient because the OCD is triggered by anxiety in dementia or a poor short term memory. If the OCD becomes harmful for the patient, then anti-depressants seem to give them some relief from OCD.
It is dangerous to use physical restraints on people with dementia.
In the past, restraints were used on patients that became aggressive or those that had a catastrophic reaction. The problem is that the restraints themselves cause extra anxiety and agitation e.g. straight jackets. As a result the use of restraints today is extremely limited.
Other forms of restraint are:
- A lap buddy. It acts as a cushion and prevents the patient from falling out of a wheelchair/chair.
- Seat belt: A wheelchair is fitted with seatbelts, they loosten easily and an alarm sounds when the seatbelt is removed. This will alert someone to assist the patient.
- Recliner chairs. It can be used as a restraint if the patient is too weak to get out of it by themselves.
- Side rails on beds. These may be dangerous because the patient may fall over the top of them or become trapped in them.
- Tucking a sheet in tightly also serves as a restraint.
- Position a patient at a table in a locked wheelchair.
- Position a seat tray which will prevent the patient from getting up.
- According to the March 2006 issue of the Journal of Medical Ethics, the negative consequences of restraints are:
- Decubitis ulcers
- Respiratory complications
- Urinary incontinence and constipation
- Poor nutrition
- Increased dependence in activities and daily living
- Impaired muscle strength and balance
- Decreased cardiovascular endurance
- Increased agitation
- Increased risk of mortality caused by strangulation or as a consequence of serious injuries e.g. fracture or head trauma.
People with dementia often wander aimlessly.
They may be looking for someone, wander due to their medication side effects or they may have a physical need e.g. hungry or thirsty. These are a few steps that can be taken to help decrease the wandering of patients:
- Regular exercise will decrease restlessness
- Install a new lock that needs a key. Place the lock at a high or low position on doors and windows
- Place a curtain in front of a door. Placing a “stop” sign or a “do not enter” sign on the door may also help
- Paint a black square in front of your entrance door. The patient will think it is an impassable hole
- Doorknobs covered with childproof covers
- In your home install a monitoring or alarm system. Use EPS (on the watch or belt) to keep track of the patient
- Let the patient wear an ID bracelet and sew ID labels onto their clothes
- Keep a recent photo of the patient so that it is available should the patient go missing
- Inform neighbours about the wandering habits of the patient and leave your phone number with them
As dementia progresses, incontinence often occurs.
The following steps will help:
- Have a routine for going to the toilet. Try to take the patient every 2 hours to the toilet
- Take a log for fluid intake to prevent dehydration. Give less to drink at night before going to bed
- Place a sign to indicate a bathroom door
- Keep a stock of incontinence pads
- Let the patient wear clothes that are easily removed i.e. elastic bands and Velcro fasteners instead of zips and buttons
Sleeplessness or the so called sundowner behaviour gets worse at the end of the day in people with dementia.
Their biological clock may see night as day. To try to lessen this behaviour one can do the following:
- Increase the amount of exercise during the day
- No napping during the day
- Sugar, caffeine and junk food are a problem as well
- Keep the afternoons and evenings quiet and calm
- Close the curtains at dusk, so that shadows don’t confuse the patient
- Give the patient a night light
By using all these tools one is able to manage dementia and help the patient to feel less anxious. One is able to cope if a strict routine is put into place.