Tips for Dementia Care

Making connections between what you know andwhat you need to do.This guide will provide information about dementia along with a variety of strategies that can be used to support those in your care.

Focusing on meeting needs through understanding the links between brain,

environment and behaviour.

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What is Dementia?

Dementia is often referred to an “umbrella” term, as it includes a number of different types of dementia under the “umbrella” (see diagram below), such as Alzheimer’s Disease, Vascular Dementia, Frontotemporal Disease, Lewy Body Disease and Mixed Dementias, each with its own special set of characteristics. While there are different opinions about how many types of dementia exist, some say there are over 50 different types of dementia, each with its own set of symptoms.

Dementia is not a disease, but a group of symptoms that arise out of diseases that cause damage to the brain. These symptoms could include loss of memory, impairment in judgment and reasoning and changes in mood and behaviour. For a diagnosis of dementia these symptoms must be significant enough to result in an inability to effectively engage in activities of daily living.

The signs and symptoms of dementia are dependent on location and severity of the damage. Each person experiences the journey differently, as the damage to the brain PLUS the experiences from the past will influence what you see in the present. One way to think about this is:

If you know one person with dementia,

you know one person with dementia.

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Dementia

Alzheimer's Vascular Dementia Lewy Body Frontal

Temporal Mixed

Stages

Dementia can begin a number of years before the symptoms become quite noticeable. In fact, many people say that hindsight often adds clarity to the things that have happened in the recent, or distant past. When they think back, they may recall that the individual with dementia got lost, forgot important details, made poor decisions (which were inconsistent with how they had previously behaved), had changes in mood and generally they became a concern to those who knew them. Each person experiences these issues differently. The changes continue as the dementia progresses.

While memory is the hallmark feature of dementia, memory loss may not be the first sign, or indication, that something is happening to the person’s brain. However, memory will eventually be affected as the dementia progresses, even if it isn’t the first sign that something is “wrong”. As time passes, the dementia will continue to devastate the brain. Having said that, it is important to stimulate the body and the mind and ensure that social connections are enabled, always focusing on exposing abilities rather than leading towards days of disuse and further decline.

The easiest way to think about the stages is to break them down into the early, middle and late stages of dementia.

Early Stages

Some of the common signs in the early stages include difficulties with:

Naming things or people. Performing tasks (e.g. - in one’s home, social or work settings). Memory (e.g. – finding things, finding locations, remembering names, doing things in the

right order). Judgement (e.g. – making decisions that clearly don’t make sense to others and believing it

is a good decision. The person with dementia lacks insight and does not understand that his/her thinking is quite flawed).

Planning or organizing.

Middle Stages of Dementia

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As the dementia progresses, the brain will continue to struggle. Some of the common features of dementia in the middle stages include difficulties with:

Remembering details about one's own personal history (therefore a memory book is a great way to support the need to have these details at the person’s fingertips)

Facts such as date, day, time and what is on the schedule for today or tomorrow or the next day. An agenda can help to address this problem.

Facts related to finding things and locations become increasingly impaired. Memory cues may help to address this problem.

Bladder and/or bowels (it is important to rule out reversible causes, such as urinary tract or other infections). Some people, with frontal vascular damage, begin to have the “urge” to go to the toilet and spend many hours needing to go and sitting on the toilet. It may be helpful to increase fluid intake, however, consult a doctor to confirm any fluid restrictions before doing so.

Sleep and changes in sleep patterns. When people become bored they often sleep during the day and become restless at night. It is important to address boredom during the day so the person is tired when he/she goes to bed at night.

An increased risk of wandering and becoming lost. Personality and behavioural changes may become apparent.

Late Stage Dementia

The person typically needs round-the-clock assistance with daily activities and personal care.

There is a loss of awareness of recent experiences and surroundings. Experience changes in physical abilities, including the ability to walk, sit and, eventually,

swallow. Has increasing difficulty communicating.

Practical Tips for Caregivers in the Early Stages

Do not commit to promises you cannot keep.

If your loved one understands and remembers he/she has dementia, do not promise that you will never consider a nursing home as an option for care. It may be easy to make that type of commitment now, but later it may be too difficult to honour. The best response: “I understand this is what you want – and I hear you – AND please know that I will always do what is best for you. My goal is to make sure you are happy and safe. My love for you will guide my decisions.”

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Get your legal things in order

Make sure you know where all of the important documentation is kept and get it organized while your loved one still has enough memory to help you find what you will need and make his/her wishes for care and living known (e.g. – favourite foods, important information he/she wants you to know). Make sure you document wants, preferences and wishes related to finances/property and personal care, if this hasn’t already been done.

Document details about your loved one’s past

People with dementia easily forget details about their recent and distant past. Consider putting a memory book together with photos and names of people from the past and the present. In fact, the cover page would have a photo of the person in the past and a current photo beside that one. Your loved one may, now or in the future, remember the person in the old photo, but not the person in the recent photo. It is a good idea to use old and current photos of friends and family as well, as it is the recent memories that may become increasingly impaired first. If you would like to create a personized memory book electronically, visit www.dementiability.com and download the template for a memory book. It is available in a number of different languages. Print and leave a copy for your loved one to enjoy – and if you do this electronically, the file will be on your computer should you need to make another copy.

Care for yourself

It is important for you to care for yourself. Find people to talk to that will listen and support you. The Alzheimer’s Society often runs groups for caregivers. Consider joining such a group. It is important to look after yourself, or you will be of no support to your loved on.

Recognize that you may be grieving – and this can continue throughout the course of dementia

Many people will feel a deep sadness when they support a loved one with dementia. Each time a caregiver sees a loved one decline – moving down that slippery soap to late stage dementia – he/she may feel a deep loss that is much like losing a loved one. While the caregiver has not actually lost a loved one, he/she has lost the person he/she once knew. This is a form of grief that is difficult to understand – because the person is still alive – he/she is still here. However, the person he/she once was is slipping away and becoming less and less of his/her former self. It is

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important to share your feelings with those who are willing to listen – and most importantly, with those who do not judge – they support. Cry if you need to. Cry often if you need to.

Practical Tips and Resources for Dementia Caregivers

Coping Strategy/Resource Description

Support Groups

Support groups refer to programs where peer members provide support and education/strategies for caring for those with dementia.

Support groups are typically organized by recognized organizations such as Alzheimer Society.

If you have interest in joining a free support group, please connect your local chapter of the Alzheimer Society. (In Toronto the number is: 416-332-6560).

CounsellingIf you need some additional support – someone to talk to one on one, consider talking to a counselor who specializes in helping those who care for loved ones with dementia. For example, connect with a social worker from your local Alzheimer Society.

Knowledge, education, and skills training programs

Refer to programs such as Sinai Health System’s CARERS program where caregivers are taught the skills and knowledge to support loved ones affected by Alzheimer’s Disease and other types of dementia. You can also enroll in similar, free workshops through the Alzheimer’s Society website at alz.to/learn-about-dementia/dementia-workshops.

Respite Care

Respite care are the services that provide caregivers with support for their caregiving responsibilities, so that they can have more time to relax and have a break from those responsibilities This type of care can be offered at home, during a short stay at a long-term care home, and at an adult day program.

Respite care can be applied for through your local LHIN. In Toronto, please call 1-4146-310-2222 to find the closest location to you.

Have realistic and attainable goals

Avoid setting unrealistic goals, as they can result in greater frustration and exhaustion

Strategies to Encourage Participation &

Independence in Activities

The pages that follow provide a variety of suggestions for those caring for someone with dementia.

The DementiAbility Methods provide a variety of practical

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ideas that can be used to enhance abilities, connect people to the things they enjoyed in the past, and are able to do now, and add meaning to each day.

Use the DementiAbility WOW Framework to help you to understand behaviours and to create plans to support those in your care (as described in the pages that follow).

Consider assigning a regular/daily designated role/job/task to the individual (table setter, silver polisher and gardener).

Set a routine schedule for individuals, which include a variety of things to do each day (scheduling template included in package).

Ensure the environment is set up for success and contains the necessary cues and materials for the individual to find locations, find things, to do things in the right order and to complete both daily and leisure activities successfully.

Being clear with what you want the individual to do. Provide cueing and examples as needed, and modify the task or activity to match the individual’s abilities.

Thank the individual for completing the activity and, if you establish a routine, ask if he/she would like to do this again, as per the schedule that has been set (e.g. – tomorrow at 10 am).

Use wayfinding signs (such as “To the toilet” or “To the kitchen” to maximize individual ability (use black font on yellow paper for best visibility; simple signs included in package).

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Helpful Tips for Caregivers

Using the DementiAbility Methods

The DementiAbility Methods are a non-pharmacological, evidence-based approach to working with older adults who are affected by cognitive loss. DementiAbility aims to create environments that support the needs, interests, skills/strengths and abilities of individuals with dementia and other forms of cognitive impairment. The focus is on setting each person up for success. This includes:

using memory supports for finding places and things and for completing tasks successfully (such as cues to remind a person what needs to be done when going to the toilet or getting dressed).

providing opportunities for each individual to do things independently (by breaking down tasks to the person’s level of ability).

determining what each person would like to do and adapting these tasks and activities to match the abilities of the individual. For example, you could establish a schedule with daily routines (ranging from small jobs that need to be completed to times that meals are provided), connect the person socially with others and create leisure activities that are made available and accessible according to interests and abilities of the individual with dementia.

Recognizing that when memory is impaired, the environment must hold the information that the brain is no longer capable of retrieving (e.g. – cues for finding locations, activities are out and available and act as a trigger, reminding the person to complete the task and each room looks like its purpose).

Knowing that some memory is spared in dementia, such as emotional memories and overly learned behaviours such as habits and routines. This spared capacity may explain why some people do or do not do certain things. For example, a person won’t go to breakfast until he/she has read the paper (because that is what the person always did). OR, a person who was a farmer may see a plant and urinate in the plant, because it triggers the memory of being in the field.

Recognizing that some abilities are lost due to disuse, not dementia. A person may appear to have no ability to help in the kitchen, but when you demonstrate what needs to be done (such as peeling a carrot with a potato peeler), you may be surprised that the person is still able to do the job. Practice helps with successful outcomes.

Memory loss impacts the ability to remember details about a person’s past. Memory books with photos and details helps trigger memories, and often open up other memories from the past.

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The ability to read may be spared, but the words need to be large enough to be seen, and for those who struggle to remember facts, the stories must be basic and easy to follow.

In general, the DementiAbility Methods focus on connecting what we know about the brain, the person, the environment and behaviour. The WOW Model, which is an information-gathering and problem-solving tool, was created to help make the connections between what we know and what we see (Elliot, G. 2017). The WOW Framework is comprised of the three components described below, and a chart to help you see the connections in writing is provided in the page that follows.

1) Who: Who is/was this person? What do you know about this person – both past and present? Consider their needs, interests, skills and abilities and think about the habits and routines they have had in the recent and distant past. What is the same – and what is different? What do you know? These details are important. Consider creating a memory book to help your loved one with remembering details about his/her life. These details will also help paid workers who provide support and care. These facts are important for conversation and for sorting out details about behaviours. They will also help you when making decisions about what you will do to engage your loved one in life and living.

2) Observations: What do you see? If you are trying to understand changes in behaviour ask yourself when the behaviour happens, and why, and ask yourself when the behaviour does not happen? These observations will also be used to connect to what you know about the person, with the goal of looking for connections between what you know about the person in the past, and how this might be influencing behaviour in the present. All behaviour has meaning. An understanding of brain and behaviour is required to help one figure out what is going on.

3) What are you going to do? Based on the information you gathered in the previous two sections (habits, routines, needs, past and present, interests, skills and abilities), what environmental supports do you want to have in place for the person in your care? What activities, routines, and roles do you want them to fulfill? Is the person bored, lonely, struggling to do things successfully (e.g. – can’t find locations or things and can’t complete tasks successfully) or is the person in pain or is it something else? Are their social and belonging needs being addressed? What does this person need? What are you going to do? Do you need to modify the environment and/or the tasks they do each day? How will you set your loved one up for success, engage him/her in daily life, meet social and belonging needs and add joy, dignity and esteem to each day?

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www.dementiability.com

Who is this person Observations What will you do?

What do you know about this person – past and present?Consider the person’s needs (including the need to love, belong, feel socially connected, live with meaning and purpose and needs related to memory loss). Consider the person’s routines and habits. This would also include needs, interests, skills, and abilities

What do you see? What is happening? When? When does this not happen? Ask: Why the behaviour? Does anything trigger the behaviour or are habits from the past impacting behaviour or has a behaviour been conditioned to create a negative outcome? How does what you see relate to who the person was in the past and/or is in the present? Is the person bored or lonely?

When deciding what to do, consider the person’s needs (e.g. – is she bored, lonely, feeling unsuccessful, in need of memory supports), abilities (are things too hard to do and in need of being simplified), interests (fill in the forms provided to determine interests and jobs that could be completed), skills (including the ability to read, write, play an instrument). Consider the need for memory supports, provide things to do that add meaning, purpose and joy and providing things to do that address needs related to boredom, loneliness and successful outcomes.

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Fill out a memory book (see www.dementiability.com to download a template/memory book – available in multiple languages) to help everyone have the facts related to this person’s life. Summarize memory book details under the “Who” in the form above and document what you know about memory loss, habits, routines and needs, interests, skills and abilities.Ask yourself what is happening and why,and consider all of the questions noted under “Observations”.

Now connect what you know (under “Who”) to what you see (under “Observations).Use the following tools to help you figure out “What to do”.

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Step 1: Document Interests, Abilities and Tasks/Roles

Abilities: (Reference: Zgola, 1987)

Interests/Activities:

Interests

Activities – Things to doPast Present

NOTES(How could the activity be adapted to

match abilities?) We’ve provided some examples for you

Gardening  

 

High functioning: watering indoor and outdoor plants, using gardening tools, planting seeds

Lower functioning: working with personal potted plants

Playing cards  

 

High functioning: traditional card games (i.e. gin, euchre)

Lower Functioning: sort suits or play simpler games (i.e. high card-low card or War)

Cooking     High Functioning: following a recipe, helping with meals

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Abilities: questions to ask ObservationsWhat can the person do?

What does the person do?hoW does he/she do it?Which parts of the task is the person unable to do? How could the task be modified to set the person up for success?Why is he/she unable to do them?Where does he/she perform best?

Lower functioning: stirring, peeling potatoes with peeler

Baking  

 

High Functioning: following a recipe, make cookies, mix and stir, measure, ice a cake

Lower functioning: stirring, kneading dough, organize baking tins, cake/cookie decoration

Animals

   

High functioning: Organize visits with therapy animals, feed and care for animals, take them for walks with a friend

Lower functioning: collect and sort images from books or magazines, pet animals or stuffed animals

ChildrenVisits from family or volunteers, looking at photos, read to the children, call children to read a story before bedtime

Volunteering Call someone who would enjoy a chat at a regular time every day

Helping others

High functioning: folding laundry, sorting socks, wiping counters, making beds, polishing items such as golf clubs or silver

Low functioning: setting table from template, polishing items, cleaning items that can be placed on a table or their lap

Listening to Music (what type?)

   

Create play lists and play the music they enjoy. Consider playing at certain times of the day – so there is something to look forward to. Or play at the time of the day when they begin to get anxious – and start the music before this begins

Reading (what does he/she like to read?)    Select books based on abilities and interests

Swimming    If well supervised, swimming can be enjoyable

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Browsing the internet     Identify topics to search

Yoga    

Crafts (Favourite types?)    

Dancing (Favourite types?)    

Wood working (what types of projects?)

   

Simple sanding projects can be purchased at dollar stores and larger projects may include an item in your home that needs to be sanded and painted

Nature (specify)    

Collecting (stamps, coins etc.)     Sort the stamps and coins

Watching Movies (what types?)    

Travelling (favourite destinations?)    Put a book together of favourite destinations

Fishing    

Knitting (basic/advanced?)    

Hockey/baseball/other (Playing or watching)    

Sort sports cards into teams or sport

Bowling    

Planning parties  

Attending parties

Outer space/Astronomy    

Scrapbooking    

Nutrition and health    

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Wine tasting    

Photography    Sort photos and label photos from the past. Take photos and share with others.

Playing an instrument (guitar, piano etc.)    

Camping    

Riding a motorcycle    

Working out (specify)    

Golfing

   

High Functioning: mini golf with obstacles

Lower functioning: mini golf with straight shots

Fashion (hair, clothing and makeup)    

Shopping (for what?)

Celebrity news    

Bingo    

Comedy (elaborate)    

Going to the cottage    

Going to the theatre    

Acting in a play

Hiking    

Puzzles    Select a puzzle that connects to the individual’s abilities

Painting (what types?)

Creative arts (elaborate)

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Writing (what does he/she like to write about?)

Provide prompts and help the person to write

Bird watching

Learning new things What would the person like to learn about?

Keeping my brain active

Talking on the phone Schedule calls at specific times.

Doing email

Surfing on the computer

Using a tablet/i-pad/etc.

Sending text messages

Trivia

Singing

Other:

(Elliot, G., 2018)

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Roles/Jobs/Tasks that this person enjoyed/enjoys now

Roles/Jobs/Tasks

Daily (sometimes

more than once a day)

Weekly Less often than weekly

Put dishes in the dishwasher

Fold laundry

Make lunches

Set the table

Vacuum

Polish silver

Decide what to have for dinner

Grocery shopping – picking things up from the storeMake a bed

Dust furniture

Home repairs

Sorting out drawers

Make coffee

Wash dishes/dry dishes

Put Dishes awaySweep floorsWash wallsSort out bills/financesCut the lawn/shovel the snow

Cook dinner

Wash floors

Clean the toilet

Clean the sink

Iron

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Lead the meal and/or bedtime prayer

Plan meals

Clean the countersTidy up the house

Rake the leaves

Put children to bed

Phone friends/familyVisit friends/familyWorkOther

(Elliot, G., 2018)

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When interacting with the person with dementia ask if they would like to do something. Do not ask if they “could” or “can” do something. They often say “No” because they have learned they “cannot” do things now. When you ask, “Would you . . .” – you offer choice – and the option to say “No”.

The Three Step Formula for Inviting a Person with Dementia to ENGAGE!

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Would you like to . . . .?

Demonstrate to ensure the person understands what to do. Adapt activities to match abilities - as

needed.

Provide positive feedback such as "Good job". Thank. And if using an agenda, check off the item

on the agenda as per the routine(s) created and ask if he/she would like to do again, as per the schedule.

Important Terms

Responsive Behaviours

Responsive behaviours occur when needs are not met. A responsive behaviour is often referred to as challenging or difficult behaviours. The term responsive behaviour is used to help us understand that a person with dementia may not be able to express what he/she needs (e.g. - the environment may not be set up for success to help find locations, things or to do things in the right order, or there may not be enough to do and the boredom creates behaviours such as agitation or aggression or reaching out to grab onto those who come near.) ALL BEHAVIOUR HAS MEANING. The goal of the caregiver is to figure out the answer to the questions, “Why the behaviour?”

Doll Therapy and/or Stuffed Animal/Pet Therapy Many people with dementia are lonely and need someone or something to love. If people are not available to address this need a doll or a stuffed animal should be considered. Use the WOW model to determine what would work. Don’t assume that a person will not enjoy holding a doll, stuffed animal or real animal. Simply put a doll, stuffed animal or real animal into your hands and gently say, “Look what I have”. Watch for the reactions, are they positive or negative. And then if they are interested and want to hold the doll or stuffed animal, listen to the words they use when talking about what they are holding. Some will think the item is real – others know this is a doll or stuffed animal. If they think it is real, treat is accordingly, with respect and love. Visit www.dementiability.com for Doll Therapy/Stuffed Animal Guidelines.

The chart below provides examples of some of the behaviours that are commonly associated with dementia and explanations about what might be contributing to the behaviour and what you can do about it.

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Responsive Behaviours

Behaviour

(What do you see?)

Why might this be happening?

What to do

Wandering/Pacing/Exit Seeking/Leaving

The person may be looking for a familiar place, people, or things.

The person may be bored and simply want to walk.

The behaviour may be related to previous habits or routines. For example, did they have a job that required them to walk (such as a delivery man, teacher, mail man, security guard, etc.) and, at a very unconscious level, they may simply be doing what they did in earlier times as part of the daily routine. The action takes place without conscious awareness.

Did this person have a habit/routine of doing a certain activity at a certain time of the day? For example, he/she always went outside for a bike ride at 3 pm – and this is when this person heads for the door.

Put up signs to orient the person to place and/or person, and re-assure them that they are safe and their family knows where they are.

Put up signs to help find locations and things.

Put up a schedule/agenda with routines and activities listed to ensure he/she is busy at the time he/she would consider leaving.

Prepare the environment to ensure it is safe. For example, minimize tripping hazards by removing rugs, re-organizing furniture, ensuring sufficient lighting.

If the person wants to leave to ride his bike, invite him to ride a bike indoors (a stationary bike). Extend the invitation before he wants to leave. OR put a sign on exit door to cue the person to turn around. For example, ‘Turn around, keep walking. You have 50 more steps to complete your exercises’.

The person may be bored. The

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General restlessness/agitation

environment may be void of meaning or purpose.

Pain could contribute to agitation. Make sure to treat the treatable.

Provide the person with activities or jobs that used to be part of their daily life. For example, folding laundry, washing dishes, coloring, creative arts, crossword puzzles, etc.

Grabbing onto people This person may be in reaching out for help (e.g. – seeking information about where he/she is or where he/she needs to be), attention, or human contact.

The person may be disoriented, bored and/or lonely.

The person may simply be in need of touch or social connection. He/she may benefit from a hand or foot massage, doll therapy**, and/or pet therapy.

Repetitive questioning and/or repetitive requests for help

If the person is affected by memory loss he/she may repeat the same question or request because he/she does not remember the answer.

For repeated questions, provide the person with memory supports that answer the repeated questions. For example, put up signage or tell the person to refer to an agenda/schedule or details on a dry erase board. For repeated requests for help, ask yourself why this is happening and consider how to address the person’s needs (e.g. – if lonely, find someone to help address the need, if bored, find something to do).

Verbal behaviour (whining, swearing, and screaming)

Begin by considering whether the person is in pain. Treat the treatable.

The person may be hungry or thirsty.

The person may want social interaction/engagement.

Once you have identified possible reasons for the behavior, you will find it easier to determine strategies that may help.

The person may require a reassessment of their current pain medication, medication schedule, their fluid/food intake

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The person may be scared.

The person may be frustrated due to feeling ignored, and/or bored or may be frustrated from lack of success when completing activities or activities of daily living.

or something else that is health related. If possible, have water readily available/accessible.

Provide the person with activities to increase social engagement and decrease boredom.

Reassure the person that he/she is safe. Try to make their setting feel like home (e.g. – place familiar/personal items where they can be seen and enjoyed – thus creating the look and feel of home).

Break down or modify tasks to allow for success and increase participation. This could allow for feelings of independence and success.

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Memory Supports/Cues/Signs

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Pull Down Pants

Sit and use toilet

Take some toilet paper

Wipe

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Put toilet paper in toilet

Pull up pants

Flush toilet

Wash hands

Today’s Schedule

Today is: ___________________________

Note: The time can be general, such as “Morning” or “Afternoon”, or specific times such as “10:00 a.m.” or if the person cannot understand numbers you could insert the face of a clock with the time.

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Time Event Location

Task completed

Know The Difference

The 3 D’s

The signs and symptoms of Delirium, Depression and Dementia can mimic one another, and thus the distinctions are important, making it essential for those who can report details to understand what to watch for and what to report to the medical team. It is therefore important to know the difference between the 3 D’s.

People who have dementia can be more susceptible to developing delirium. Depression is another condition which may be confused with both dementia and delirium.

Depression Delirium DementiaDefinition A change in mood

which lasts at least 2 weeks and it may present as low mood, sadness, disinterest in usual activities, and functional decline (i.e. loss of mobility and neglecting self-care)

A sudden onset of confusion. This confusion can be caused by change in medical status and /or environment

A progressive decline in cognitive functioning due to physical changes in the brain, which could lead to step-wise decline in daily function

Duration At least 6 weeks, could take months to years to resolve

Hours to months depending on how quickly it is diagnosed

Generally progressive over the course of years

Thinking/memory Negative thoughts, difficulty making decisions, sense of hopelessness

Memory is generally intact but can be selective. Person may focus on negative memories.

Fluctuating confusion. Thinking could be clear and rational in one moment, but disorganized and distorted in another. Person can vary within the day. Sometimes incoherent speech is observed.

Impaired recent/immediate memory

Gradual loss of cognitive skills including memory, problem solving, planning, insight/judgement, and safety awareness. Ability to follow instruction and learn new information can be limited.

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Sleep/wake cycle Insomnia or hypersomnia

Often time sleep cycle is reversed (i.e. sleeping during the day but awake at night)Symptoms may be more pronounced at sundown.

Sleep can be fragmented or unaffected. It varies with each individual. Symptoms may be more pronounced at sundown.

Hallucinations and delusions

Severe depression can present with psychotic features including hallucinations and delusions

Not everyone has hallucinations or delusions. If these are present, the nature can vary from pleasant to frightening.

Not everyone has hallucinations or delusions. It is more common in people with Lewy Body dementia.

Sometimes people with dementia may misperceive information or misinterpret a situation.

If any of these symptoms arise, please contact a health care professional for further assessment and treatment options.

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Preventing FallsCognitive impairment can place individuals at higher risks for falls. This risk may increase further in individuals who have impaired mobility, other medical conditions (which can include COPD, arthritis, diabetes, circulatory issues and depression), nutritional deficiencies, and visual impairment. It is important to try to implement fall prevention strategies to reduce the risk of falls and fall-related injuries.

Strategies and Methods

Ensure adequate lighting

People with dementia can have damage to their visual system causing illusions and misperceptions.

-Ensure all areas of the home have sufficient lighting. Dim lighting is not safe for aging eyes. For example, provide a well-lit entrance or walkways, use nightlights in bedrooms/bathrooms, and use natural light when possible.

-Reduce glare

-Limit shadows and dark areas

- Provide time for aging eyes to adjust to significant changes in lighting (e.g. – when coming from the bright sunshine provide time to adjust to indoor lighting, perhaps by sitting until the eyes adjust).

Provide visual cues

People with dementia benefit when colours contrast on items such as dishes on tables, toilet seats and grab bars. It is often difficult for aging eyes to distinguish items on “busy” backgrounds (such as items on a busy floral tablecloth). Peripheral vision may

-Use brightly coloured tape on the edge of stairs or other surfaces.

-Use solid colours with no pattern for surfaces such as floors and table tops.

-Avoid black mats, which may be interpreted as a black hole.

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also be impacted, thus the placement of items need to be aligned with what the person is able to see.

-Minimize clutter on counter tops, tables and nightstands etc.

Enhance accessibility

People with dementia may have difficulty recognizing common tripping hazards.

They may forget where everyday items or daily schedules are kept.

People with dementia often benefit from adaptive aids to increase autonomy and maintain safety during activities of daily living.

-Provide signage to assist with navigation (such as arrows to destinations and room labels, including a photo of the person on their door). If you want the sign to stand out, use large black font on a yellow background.

-Label drawers and cupboards with the name and/or picture of the contents.

-Keep pathways clear to allow for easy access and no tripping hazard.

-Remove scatter mats/rugs or secure with double sided tape.

-Install railings on stairs and in bathroom(s) as needed.

-Consider a bath seat, toilet equipment and a bed rail to help with safety and to increase independence.

-Consider handheld shower with a chair safely positioned to sit on during shower.

-If possible, move bedroom to main floor and/or close to bathroom.

-Keep mobility aids close at hand.

-Keep commonly used items visible and within reach.

-Set up one place where schedules and reminders can be placed and easily accessed

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(for example, a bulletin board/dry erase board)

Always wear safe and comfortable footwear

Some footwear can increase the risk of slips and falls and contribute to poor balance and gait.

-Check the fit of shoes regularly.

-Check soles of shoes for wear and safety.

-Ensure the shoe has good tread, and is made of a non-slip material.

-Ensure the shoes are weather appropriate.

-Purchase shoes with Velcro instead of ties as needed.

-Check the skin for pressure areas and irritation and/or sores.

-Avoid backless shoes both inside and outside of the home (running shoes are recommended).

People with dementia may find it helpful to use a personal emergency response device, which would alert caregivers when they have fallen. These devices can be motion sensitive for those who may not be able to press a button or call for help when they have sustained a fall.

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References and Resources

Bourgeois, M., (2014) Memory and communication aids for people with dementia. Baltimore, MD: Health Professions Press

Elliot, G., (2017), DementiAbility Methods: The Montessori Way, Burlington, ON.

Elliot, G., & Romerill, K, Romiell, B. (2015) Memory Aids for Dementia, Burlington, ON.

Homewatch Caregivers, (2013). Tips for Preventing Dementia-Related Falls, http://www.homewatchcaregivers.com/dementia-care-tips/preventing-dementia-related-falls.aspx

Heerema, Esther, (2012). Causes of Falls in People with Dementia: Understanding why people fall can help reduce and prevent falls (2013), http://alzheimers.about.com/od/symptomsofalzheimers/a/Causes-of-Falls-in-People-With-Dementia.htm

Alzheimer’s Society of Manitoba, (2014). Reducing Risk of Falls for People with Dementia https://www.alzheimer.mb.ca/wp-content/uploads/2013/09/2014-Dementia-Fall-Risk-Checklist-template.pdf

Vancouver Island Health Authority, Differentiating Delirium from Dementia and Depression (2014), https://www.viha.ca/NR/rdonlyres/4B26D86A-80A9-4F73-AE0D-D39B0610FCF6/0/3d.pdf

For additional references visit

www.dementiability.com - bibliography and references

http://www.circleofcare.com/

https://www.mountsinai.on.ca/care/psych/patient-programs/geriatric-psychiatry/dementia-support/caregivers-and-family-members-caring-for-someone-dementia/

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Written by:

Gail Elliot, BASc, MA, Gerontologist, Educator & Dementia Specialist, DementiAbility Enterprises Inc., Burlington, ONFor more information visit the DementiAbility website at: www.dementiability.com

Vivien Lam, Hon.B.Sc., BScOT, Occupational Therapist, Department of RehabilitationSinai Health System, Mount Sinai Hospital, Toronto Shona Sen-Rew, B.Sc. CMMB, BScOT, Occupational Therapist, Department of Rehabilitation, Sinai Health System, Mount Sinai Hospital, Toronto Stephanie Dietrich Occupational Therapist Assistant and Physiotherapist Assistant, Department of RehabilitationSinai Health System, Mount Sinai Hospital, Toronto

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