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Caregiver for Dementia Patients

What is Dementia
Dementia can be described as a global impairment of the thinking skills that is progressive and interferes with social and occupational abilities. In other words, it is a disorder in the brain.
Dementia has a wide range of symptoms:
  • Memory loss, mainly short-term
  • Decline in other thinking skills: judgment, language, ability to focus and pay attention, problem-solving ability…
  • Effects and reduces a person’s ability to perform Activities of Daily Living
  • Behaviour changes: Feeling suspicious, depressed, fearful or anxious, Easily being upset at work, at home, with friends, Being upset when out of their comfort zone
  • Disorientation and Confusion.
Dementia is progressive, meaning that the disease is gradually getting worse: 
  • At Early Stage:
    • Person is aware of some changes in memory
    • Relies more on others for reminders
  • At a later stage:
    • Person may get lost easily
    • Unable to drive or manage finances
  • Advanced stage:
    • Person loses ability to eat, drink, bathe, dress, use the toilet without assistance
  • Final stage:
    • Not being able to talk, safely swallow, get out of bed
    • Totally dependent on others for help with every daily activity
The main Causes of Dementia are:
  • 60-80%: Alzheimer’s disease
  • After a stroke
  • Other causes
Benefits of a Specialised Caregiver for a Dementia Patient
A recent study shows that Professional Caregiving has shown efficacy in slowing the progression of cognitive decline.

Source: Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. American Journal of Psychiatry. 2012;169:946-53.

 

Benefits of a Specialised Caregiver for the Family

The most worrying thing for the family is that the Patient could wander around and get lost. In recent years, newspapers have increasingly reported elderly Dementia people getting lost or injured in traffic accidents. With the help of a Specilised Caregiver, this type of tragedy can be avoided.

More generally, knowing that the Patient is taken care of by a professional, Specialised Caregiver will give the family peace of mind, and the satisfaction that the are providing the Very Best Care for their elderly loved ones.

Another positive impact which has been highlighted by many of our clients, is that because the Specialised Caregiver keeps the Patient busy and active during the day, anxiety and wandering diminishes at night, which mean better rest for the whole family!

 

Actions of the Specialised Caregiver for Dementia Patients
Our Caregiving plan for Dementia comprises the following elements, and it will be adjusted to the Patient’s specific condition:
Connecting & communicating
  • Keep requests for the Patient simple;
  • Avoid confrontation & requests that lead to frustration;
  • Remain calm, patient and supportive if the Patient is upset;
  • Speak slowly & calmly at eye level, using short, simple words;
  • If appropriate, use visual cues or pictures to support what you are saying;
  • Avoid interrupting the Patient, but allow the Patient to interrupt you;
  • Limit distraction;
  • Observe non-verbal communication and increase the use of your own non-verbal communication and gestures; 
  • Determine hearing & seeing difficulties.
Encouraging Activities
Meaningful activities are important to people with Dementia: they help reduce behavioral symptoms and improve the quality of life. Caregivers should constantly interact with the person during activities.
Criteria for activities:
  • Adapt the activity to the person’s skills, abilities, interests and habits;
  • Try to limit activities to 30 minutes or less (longer is difficult for people with Dementia) and allow rest breaks;
  • During activities, the person should use his skills to remain as independent as possible;
  • Introduce activities that minimize behaviours as confusion, agitation, restlessness,
Possible activities:
  • Include the Patient during bathing, cooking by helping him to participate (washing vegetables, setting the table);
  • Include the Patient in daily tasks, like cleaning (dusting), watering the plants, etc.;
  • Use the environment in activities: herb or flower gardening, going to the fish pond, looking at family pictures;
  • Try to involve the Patient in the community and family activities if possible (go to a play or a club, helping with doing groceries, etc.).
Supporting the Dementia Patient with personal care
  • Bathing
  • Oral Care
  • Dressing
  • Grooming
  • Toileting
Supporting the Dementia Patient with eating and drinking

Eating and drinking might be affected: the Patient is not able to prepare food, the Patient does not remember to eat or when he last ate, the Patient is not able to say he is hungry; the Patient’s thirst & smell mechanisms are affected. 

  • Keep the Patient’s familiar eating & dining routines for as long as possible

  • Make sure the place for eating is pleasant and the table is free of unnecessary objects

  • Sit with the Patient, make eye contact and speak with the Patient

  • Encourage self-care (if needed, provide more time & assistive devices)

  • Adjust the variety, amount, shape & texture of the food to the Patient’s needs

  • Look at the Patient’s response – if he makes no initiative for eating, place a spoon in his hand

  • Monitor changes in eating habits & avoid major weight changes

  • Promote snacking

  • If necessary, consider the use of supplements or nutrient-dense foods

 
Preventing falls
A person with Dementia has a greater risk of falling (problems with seeing, thinking, moving & balancing). The risk for a new fall increases with every fall.
The Caregiver will work on Patient’s personal risk factors by:
  • Developing a toileting schedule so that there is no rush to the toilet;
  • Introducing or encouraging the use of assistive devices such as walkers, canes… ;
  • The caregiver will also develop a walking program to keep the Patient mobile.
The Caregiver can reduce environmental risk factors by:
  • Adjusting the height of the bed, toilet and other furniture;
  • Making sure all furniture are stable and sturdy (Patient might grab furniture for stability);
  • Keeping floors slip-proof by removing loose rugs;
  • Providing a well lit environment (night lights);
  • Removing obstacles, electrical cords & wires away from the paths.
 
Wandering
People with Dementia may move about in ways that may look pointless to other people, but usually they have a purpose:

  • Patient may have a need for social interaction, may feel bored, depressed or isolated;

  • Patient may be in pain or distress, or have an infection;

  • A noisy environment of change in routine may make a person wander;

  • Patient may have a need for food, fluids, exercise or going to the toilet;

Usually wandering is beneficial and does not need to be stopped (Patient feels fitter or in a better mood), but the caregiver must be cautious for unsafe wandering (leaving the home, going to unsafe areas). This can be reduced by:

  • Addressing the needs (food, toileting, social contact) and wishes of the Patient and anticipating before he goes wandering;

  • Organising activities that promote friendship and have a meaning for the Patient;

  • Taking the Patient outside regularly;

  • Keeping a list of places a person may wander to;

  • Making doors less obvious;

  • Providing cues to help the Patient know where he is;

The important thing is not to fight the need for wandering, but trying to listen to the Patient and propose other meaningful activities

 

Safety of Dementia Patients
General safety:

  • Avoid access to unsafe objects (car keys, knives, scissors);

  • Fire safety: fire extinguishers, information about smoking, lighters & candles (especially when Patient is using oxygen);

  • Hide or lock away cleaning supplies, medication and toxic items;

  • Any change in environment can be unsafe to the Patient!

Bathroom safety:

  • Provide grab bars, non-slip mats;

  • Prevent hot water burns (safety button on tap or adjust water heater).

Kitchen safety:

  • Keep electrical appliances away from water, if possible, use appliances that have an auto shut-off function;

  • Remove knobs from stove burners, and if necessary, turn off the gas or the electric power;

  • Keep the kitchen table clear from medicines, vitamins…

Medication safety:

  • Let the doctor review the medication regularly, and check if they are still needed;

  • Use a pill organizer so that the Patient can only access what he needs;

  • Keep all medication together in one place;

  • In a later stage, lock away all the medication;

  • Check if Patient has actually swallowed or taken the medication;

When it comes to safety, the house should be equally “safe” as for a little child, because the Patient with Dementia progresses gradually into a more childish state where he wants to try,  taste & smell a lot of things.

 

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