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Daily Living

Cooking

Cooking involves a range of hazards that may present dangers to the person with dementia.

  • If possible, cook and prepare drinks and snacks with the person to help them maintain their independence 
  • Finger food is ideal e.g. chips, chicken or nuggets 
  • If in doubt, put sharp equipments away. 
  • If gas appliances tend to be left on, have an automatic turn off switch fitted - ask your gas supplier for advice 
  • If the person with dementia is living alone and is eating food which is no longer fresh, remember cooked meals can be delivered by private companies or a “Meals on Wheels” service. However, don’t rely on the person eating each meal –some contact from a carer will still be needed to ensure food has been eaten.

Eating


People with dementia often lose weight partly because in the early stages of dementia they are often on the move a lot, and because they no longer get the signal that they are hungry and consequently forget to eat. They may have strong likes (for sweets and sweet things) and dislikes that they previously did not have.

Try to:

  • Stick to a routine for meals 
  • Use full cream milk and add supplements on your GP’s or District Nurse’s advice 
  • Don’t worry about table manners, offer spoonsCut food up into smaller pieces or make easily digestible finger foods 
  • If swallowing becomes more difficult the consistency of food should be soft and also seek medical advice 
  • Check that several drinks a day are being consumed - these may have to be offered in beakers with tops and a spout 
  • If the person lives alone, try to join them for a meal now and again - this will make it into a sociable activity and the person will copy your actions of eating and drinking. 
  • Patients may lose weight but conversely they may also put on weight through over eating- remember they often can not remember if they have eaten

If you have any concerns about eating and drinking then it is important you seek medical advice. 

Washing and Bathing 

These routines will be ones which a person will have done themselves for many years and carers need to think about e.g. What the person they care for can do on their own and what they need help with. Remember that it is not a matter of life or death to have a wash or bath as regularly as the person may have done in the past - many arguments start because old routines are not rigidly kept to.

Try: 

  • Supporting people with bathing by emphasizing the pleasantness of the warm water, the scent of soaps etc. 
  • Instead of saying "would you like a bath?" which could lead to a "no", say "what sort of bubble bath would you like today?" or "which towel do you prefer?" 
  • It helps to ‘be alongside’ prompting by showing actions, or actually carrying out the tasks by copying the behaviour, for example miming brushing teeth may help someone remember the action more easily 
  • If it becomes a struggle, try to do a ‘top and tail’ job which maintains hygiene in parts of the body such as between the legs which would otherwise get sore. 
  • Try to help a person get properly dry - this might mean, for example, that they sit for a while wrapped in a clean towel.

Dressing

  • Lay out clothes in the order they are put on 
  • Avoid complicated fastenings – replace or ask a dressmaker to replace buttons with zips or Velcro (showing how they are used) and buckles and belts with elastic 
  • Buy pull-on trousers such as jogging bottoms that are easy to wear and wash 
  • Put away lace up shoes and purchase slip on shoes or buy elastic laces and keep the shoes laced up. 
  • Boxer shorts are easier to manage than men’s Y-Fronts
  • Women’s front opening bras are easier to put on 
  • Give a choice to the patient, for example, by saying “Would you like to wear this dress or top today?” 
  • Consider clothing which is machine washable

Try to simplify dressing routines by replacing shirts with t-shirts or polo shirts and not wearing a tie. For some carers and those cared-for this might mean ending the habits of a lifetime. 

Toileting

People with dementia do not always get the signal that they need to empty their bladder or bowel. They may show signs of incontinence. This is not done on purpose but is a genuine physical problem caused by the dementia. The person will need to be prompted to go to the toilet regularly, every 2-3 hours.

A continence advisor could help with advice on a toileting programme and help with continence aids such as waterproof under sheets and types of incontinence pads. In Contact (a national organization provides continence advice) or your local Continence Advisor will be able to help you.

Ideas which may help: 

  • Labelling the toilet or bathroom door with a picture or easy to read sign. 
  • Making sure clothing can be easily removed 
  • Get aids and equipment put in, such as a raised seat or grab rail, in case people fall off the toilet 
  • At night, ensure the person with dementia goes to the toilet before going to bed and that they can see where they need to go if they are making their own way- this can be done by putting a florescent strip on the carpet to guide them (it will not show up in the daylight)to the bath rooms. 
  • Put a commode or a bed pan (or pot) near the person so it is easily reached. 
  • Put the lid up on a commode so the person recognises what it is - an older person may recognise a pot under the bed better than a modern commode 
  • A movement sensitive light can be fitted which is triggered when the person with dementia is on the move.

Going out Alone

General tip for helping when the person wants to go out

  • Try not to be confrontational 
  • Encourage them to walk in safe areas 
  • Ensure they carry identification 
  • Give contact numbers 
  • If shopping identify items to buy 
  • Only carry amount of money needed for task 
  • If the person is determined to leave, go with them and find a way to divert attention. 
  • It may be helpful to inform trusted neighbours and the local police.

If this aspect of their behaviour is of major concern to you, seek specialist advice e.g. Community Psychiatrist Nurse. 

Repetitive Questioning

  • Try to be patient and tactful 
  • Help them to find the answer themselves 
  • Try to distract them with another activity.

Constantly on the move

  • May be a result of restlessness or boredom 
  • Increase stimulation or physical activity 
  • Keep personal possessions in view 
  • Place a mirror or beaded curtain across door (monitor distress) 
  • Check effects of medication.

Anger

  • If the person is unable to cope – reduce demands upon them; ensure they are not hurried and routine is stress free 
  • Explain things as clearly as possible allowing time for them to respond 
  • Find tactful ways of offering help, without taking over 
  • Break down tasks into small chunks 
  • DO NOT CRITICISE, focus on things they can still do
  • Avoid confrontation 
  • Avoid sudden movements and sharp voices 
  • DO NOT argue 
  • Stay calm 
  • Try to distract them 
  • Leave the room if necessary

If the behaviour is persistent or unmanageable, seek professional advice.

Unusual behaviour

  • Try not to take the behaviour personally 
  • Stay as calm as you can 
  • Be as understanding as possible 
  • Try to be patient 
  • Don’t argue or try to convince the person 
  • Acknowledge what you think the person is trying to say 
  • Prompt memory 
  • Provide opportunities for maintaining independence.

Alcohol & Cigarettes

  • Drinking in MODERATION is OK, but not all drugs can be taken with alcohol, so check with your GP 
  • Remove alcohol & cigarettes from view 
  • Matches should be replaced by a lighter that cuts off 
  • Gentle persuasion to stop may work.

Hallucinations

  • Acknowledge the feelings they are experiencing 
  • Avoid arguing or trying to contradict them 
  • Offer reassurance - respond in a calm and supportive manner 
  • Try to distract them - divert attention to another activity or just talk to them 
  • Change the surroundings if necessary
  • Check area is well lit - shadows can be misinterpreted 
  • Check for noises 
  • Reflections may cause distress 
  • Hallucinations may be due to poor eyesight- arrange regular eye sight tests 
  • Seek medical advice. 

Sleeplessness

  • Encourage the person to be more active during the day. If they sleep in the afternoon they will not sleep at night 
  • Check diet – too much sugar and caffeine can lead to agitation 
  • Try and encourage the person to use their own bed, but if difficulties continue, you may wish to consider a favoured chair. 
  • Ensure room is partly lit – dark surroundings may be frightening 
  • Seek medical advice.