Caregiving Tips for Elders with Dementia Symptoms

When a Dementia patient arrives in your retirement home, and you are assigned the caregiver duty, it becomes your moral and ethical responsibility to provide the best care you can. But that is easier said than done! It is not as if the person has given up on life due to memory loss, but can experience joy, comfort, meaning, and growth in their lives and any other.

Their quality of life depends on the quality of their relationship with you and their direct care staff. So, to ensure optimal care, you must instill a social environment that nurtures healthy relationships between the residents, their families, and you. Good dementia care comprises an assessment of a resident’s abilities, care planning and provision, and strategies for addressing behavioural and communication changes.

Each dementia patient is unique, having different abilities and needs for support, which change over time as the disease progresses. You can determine how best to serve each resident by knowing as much as possible about their life story, preferences, and abilities. Good dementia care involves using information about a resident to develop “Person-Centered” strategies designed to ensure that services are customized to the circumstances of each individual.

You must assess the dementia resident holistically. Learn about their cognitive health, physical health, physical functioning, behavioural status, sensory capabilities, communication abilities, decision-making capacity, cultural preferences, personal background, spiritual needs, and other priorities. A resident’s functioning may vary across different staff shifts.

Some may become confused, disoriented, or more active in the evening or during staff changes. You may obtain verbal information directly from residents and their families when possible. You can ask residents about their reactions to care routines and provide feedback on successful techniques to the entire care team.

If obtaining information from a resident or family is difficult, you may refer to their medical records and observe the resident’s reaction to particular approaches to care. For instance, a resident repeatedly refusing a distinct food might be due to disliking that food, or a resident resisting entering a shower may need another method to bathe.

Regular monitoring and assessment of residents’ health problems are essential and should be referred to appropriately. For instance, professionals such as physical or occupational therapists can help dementia patients regain physical health and improve their performance in daily activity. Also essential is information about a resident’s preferences regarding palliative care and funeral arrangements which helps ensure that the resident’s wishes will be honoured when the time comes.

An effective care plan is built on the resident’s abilities and incorporates strategies such as task breakdown, fitness programs, and physical or occupational therapy to help residents complete their daily routines and maintain their functional abilities as long as possible. Study all the assessments, care plans, and life stories accessible to you to provide the best possible care to dementia patients.

For instance, by asking family members how they elicit cooperation from dementia patients regarding necessary care activities, you can make those techniques a routine part of care. Care plans need to be flexible enough to adapt to daily changes in a resident’s needs and wishes.

Residents need opportunities and sufficient time to express themselves. For instance, you may speak to them in simple, direct language accompanied by gestures, pictures, written words, or verbal cues to communicate when involved in daily activities. The behaviour and emotional state of dementia patients often are their forms of communication because they may lack the ability to communicate in other ways.

You may need initial and ongoing training to identify potential triggers for a resident’s behavioural and emotional symptoms, such as agitation and depression. Triggers may include visual or hearing impairments, thirst, hunger, pain, lack of social interaction, or inappropriate strategies for care activities by staff. When you recognize these triggers, you can use environmental and behavioural approaches to modify the triggers’ impact.

By providing relaxing physical contact like hand-holding, apologizing if a resident complains of pain during a care activity, listening to resident concerns, and providing reassurance, you may elicit a positive behavioural response from them. Information about residents’ life before admission, such as their culture and role within the family, may provide clues about efficacious approaches to care. For instance, knowing the wake-up time they wake up or how they like their tea or coffee can give insight into their care.

You must also help the family understand the progression of the resident’s dementia, particularly as they approach the end of life. If you learn the prognosis and symptoms of dementia and how this differs from normal aging and reversible forms of dementia, you are better prepared to care for dementia residents. You should not ignore a resident’s report of an event or his or her feelings and thoughts. For instance, when they complain of pain, you may say you understand it hurts and then reports it to a staff member who can address the resident’s pain experience.

A positive environment for dementia patients has recognizable dining, activity, and toileting areas as well as cues to help residents find their way around the residence. The optimal atmosphere you help form should feel comfortable and familiar as a home would, like providing opportunities for privacy, sufficient lighting, pleasant music, and multiple opportunities to eat and drink and even minimize negative stimuli such as loud overhead paging and glare.

For instance, a home environment might entail a private room and bathroom and the opportunity for residents to have personal furnishings, pictures, and other items in their living area, providing easy, safe, and secure access to the outdoors while maintaining control over unauthorized exiting enhancing the environment. Residents who have elopement behaviours need opportunities for safe wandering.

Dementia may lead to reduced food and fluid intake, partly due to decreased recognition of thirst and hunger, declining perceptions of taste and smell, dysphagia or swallowing difficulty, inability to recognize dining utensils, loss of physical control, such as the ability to feed oneself, apraxia or impairment of the ability to move, and depression. Residents with dementia may lose their ability to communicate hunger and thirst or may refuse to eat because of physiological or behavioural conditions or because they are at the end of life.

It will require a concerted effort on your part to address dementia-associated problems and ensure adequate intake of food and fluid. You must promote mealtimes as enjoyable activities, using them as an opportunity to observe and interact with residents, helping to ensure their health, well-being, and quality of life. Put an effort to follow the nutritional problems and resident symptoms such as poor dental health, swallowing difficulties, or distractibility during meals which may affect food and fluid consumption, and refer them to specialists accordingly.

Difficulty with eating may also be the result of having impairments in balance, coordination, strength, or endurance. Ensure that seating adequately compensates for these impairments. Ongoing monitoring of residents is necessary to discover changes in food and fluid intake, functional ability, or behaviours during meals. Any changes should be reported to the dietetic staff and care planners.

Adequate assessment to minimize mealtime difficulties includes observing residents for warning signs such as difficulty chewing and swallowing, changes in swallowing ability, poor utensil use, refusing substitutions, low attentiveness to a meal, or wandering away during the mealtime, or more than 25 percent of food uneaten during a meal. Regular monitoring and recording of a resident’s weight will help you recognize and address the cause of any changes.

You may do this by involving residents in menu planning and table setting, stimulating olfactory senses by baking bread or a pie before the meal, creating a “happy hour” to encourage increased fluid intake, rescheduling meal times for a different time of day if a resident manifests time- or light-dependent agitation, distraction or disorientation. During the meal, residents often require assistance to maximize their ability to eat and drink. Encouraging residents to function alone whenever possible can help prevent learned dependency.

If they can eat independently but slowly, allow them to eat at their own pace, with gentle verbal reminders to eat and drink. Adaptive utensils and lipped plates or finger foods may help them maintain their satiation. Serving one food item at a time is preferable to confuse them less. If they need hand feeding, guide their hand using the “hand-over-hand” technique. You must sit, make eye contact, and speak with them when assisting with meals.

First, try food approaches such as favourite foods and food higher in nutrient density, calories, and protein before giving fortified foods and supplements when necessary. Those with severe and irreversible dementia may no longer be able to eat at the end of life and may need only comfort care. They need their mouths moistened with good oral care, but artificial nutrition and hydration may be withheld, per their wishes, in consultation with the family.

Avoid mealtime interruptions and reduce unnecessary noise and the number of items on the table. Serving in smaller dining rooms can minimize distractions, too. Their attention to food can be increased through visual cues, such as ensuring visual contrast between plate, food, and place setting. Present food in attractive ways and provide small tables that encourage conversation among tablemates.

Incorporate fluids into activities and have popsicles, sherbet, fruit slushes, gelatine desserts, or other varieties of fluids always available to residents to increase their fluid intake. If they cannot handle utensils, try altering the shape of food so they can pick it up with their fingers.

For dementia residents unable to communicate verbally, you can help identify pain and pain behaviours such as size, type, and effect of pain, what triggers it, whether it is acute or chronic, and the positive and negative consequences of treatment through direct observation. It also helps uncover behavioural symptoms, such as agitation and mood changes, or verbal and physical expressions of pain, such as sighing, grimacing, moaning, slow movement, rigid posture, and withdrawing extremities during care leads to appropriate referrals.

Avoid conditions that cause pain, such as infections, fractures, pressure ulcers, and skin tears, by being cautious when caring for residents. Some helpful strategies to ease pain and promote well-being include relaxation, physical activities, superficial heat, and repositioning. Residents and their families should receive information about palliative care options, including hospice, when residents seem to have entered the final stages of dementia.

Signs that a resident may be in the final stages include their inability to walk without assistance and sit up without support, inability to smile, unrecognizable speech, and swallowing problems. Entry into end-of-life care programs can help promote the effective use of pain medication and ease the end-of-life process.

There are various ways to modify the environment to help prevent falls. Adjust bed, wheelchair, other chairs, and toilet heights when indicated to help prevent falls. The toilet height should be about knee height. Make sure that stable handholds are available by providing such items as grab bars and railings. Ensure the furniture is sturdy and in good condition, and adjust furniture location to be as similar as possible to the resident’s previous bedroom-to bathroom path.

Create and maintain a clear path to the bathroom. You may provide non-slip floor treatments throughout the residence, especially in bathrooms and next to beds. Encourage the use of footwear that is non-skid and provides a broad base of support. Ensure good lighting. You can increase residents’ ability to turn on lights by installing motion-activated lighting or sensor lights. Install nightlights between a resident’s bed and bathroom. Use silent alarms to alert you when a resident at risk of falling attempts to leave a bed or chair.

Some key points related to falls that need to be understood are – As maintaining mobility is essential, resident movement should be encouraged. The more they are immobile, the more they are at risk for dangerous falls. Exercise that promotes sit-to-stand activities and walking as part of the daily routine can help preserve a resident’s mobility. Identify and address the specific cause for a fall, such as water on the floor or resident dizziness after standing up.

To reduce falls associated with urgent trips to the bathroom, you should consider using an individual toileting schedule or a bedside commode. Consider clothing that is easy for residents to remove when they need to go to the bathroom. Ensure you are there to help those residents who need assistance with ambulation, dressing, toileting, and transferring. Promote consistent and appropriate use of assistive devices, such as a walker. Some residents may always need you to walk with them to prevent falls.

Have a scheduled and structured exercise or walking program for those residents who can safely participate in maintaining or improving function, posture, and balance. Develop walking programs around a resident’s need to get someplace, such as walking to and from the dining room, instead of using a wheelchair.

Promote a regular sleep-wake cycle by keeping bedding dry and ensuring they are exposed to sufficient daylight, identifying their typical bedtime routine, and matching the sleep-wake process to lifelong sleep habits. Ensure a comfortable sleeping environment with a better quality mattress, optimal temperature, and minimal noise. Ensure that residents who like to bathe or read before bed can do so. Help them choose between extended wear absorbent incontinence products to promote uninterrupted sleep or an individual toileting schedule.

Restraints may be temporarily necessary when a medical professional determines they are required for the safe and effective management of a medical emergency. For instance, a person experiencing delirium may need physical containment to permit medical assessment and safely deliver essential care with the help of staff. Examples of methods or devices that are considered physical restraints include side rails on beds, limb and waist restraints, hand mitts, Geri-chairs, over-the-bed tables and trays that cannot be removed without assistance, chairs or recliners from which a resident is unable to get up on his or her own, involuntary confinement to a room, except when isolation is medically necessary to protect residents from a contagious disease.

With the assistance of consultants, you may implement creative solutions for identifying and meeting individualized care needs regarding safety, behaviours, and postural support. Respond promptly to resident calls and minimize their waiting times. When residents repeatedly slide out of their wheelchairs in an attempt to self-propel, place them in lower-height wheelchairs without footrests or with footrests in a closed position that allows their feet to touch the floor. Be there to identify and help fatigued residents go to bed when they need rest so they won’t attempt to get into bed unassisted.

Use individualized day and night-time activities to increase resident contentment and decrease behavioural symptoms. Seek assistance from a professional to help reduce the use of restraints and thorough evaluation and treatment of physical, cognitive, or sensory impairments. Camouflage and protect areas of active wound care so the resident will not disturb dressings or the healing process. Encourage family members and friends to sit with the resident and provide support or reassurance.

The above caregiving tips would make life easier not only for your dementia resident but for you too.