- Healthy routines can support a person with dementia to think and function at their best. A good night's sleep, a healthy diet, daily physical exercise, and meaningful social, creative, and intellectual interactions will profoundly impact how well they fare.
- Enable your loved one with dementia to participate as much as possible in their care tasks. It might be quicker and easier to just do it for them, but this hastens their decline and harms their self-esteem.
- Limit distractions and stimulation so they can focus on the task at hand. Minimize background noise, excessive chatter, and general activity or commotion in the area.
- Every person with dementia is unique, and there's no one best way to help them. You'll need to tune in to where they are in each moment, honor their individual needs and preferences, and get used to trial and error as you discover how to best support them. And once you figure it out, it's likely to change, so be ready to stay flexible and evolve your support along with their progressing needs.
Helping a Loved One with Dementia with Everyday Care
Regardless of the stage or severity of your loved one’s Alzheimer’s disease or dementia, if they need your help with everyday activities – such as eating, dressing, hygiene, showering, or mobility – you’ll need to frequently re-evaluate and evolve what you’re doing to support them as their needs change.
Let’s start with some general guidelines that’ll apply to most individuals at some point during their journey with dementia. Later, we’ll get into some tips for specific areas of care.
Establish a Daily Routine
A consistent daily routine can help a person with dementia think and function at their best. Be sure to allow for flexibility and spontaneity throughout the day.
- Provide a predictable pattern for:
- Periods of sleep and rest
- Meal and snack times
- Daily physical activity
- Care activities, including using the toilet
- Incorporate meaningful activity that they find personally fulfilling, which should incorporate social, spiritual, intellectual and/or creative endeavors daily
- Allow plenty of time to complete tasks
- Plan for breaks throughout the day
Support a Healthy Sleep Pattern
Dementia can affect the body’s sleep cycle. Sometimes altered sleep patterns are unavoidable, but other times these things can help:
- Rise and go to bed at the same time each day to the extent possible.
- Limit naps, or keep them at the same time(s) each day.
- Reduce or eliminate caffeine, especially in the afternoon and evening.
- Follow a daily routine that includes physical activity and meaningful pursuits.
- Follow a relaxing bedtime routine each evening.
Engage the Person
It’s important to involve the person in their care to the extent possible. Respect their lifelong preferences as well as their choices at the moment.
- Encourage their participation, helping only as much as they need in each moment. Their needs will often vary from day to day, or at different points throughout the day.
- Offer simple choices – just not too many. Having a say is important for their mental health, but too many choices can be frustrating or overwhelming. Two or three options are plenty for most people with dementia.
Avoid Overwhelming the Person
- Give simple, clear instructions, one step at a time.
- Talk them through each step.
- Be sure they understand what you’re going to do, so you don’t surprise or frighten them. Look for non-verbal signs they understand and consent to your care, such as subtle nodding and relaxed and cooperative body language
- Minimize distractions – unless they’re helpful. Extra chatter, noise from the television, or other distractions can absorb their attention and get them off track. However, sometimes distractions like talking to them or singing can keep their mind off of an unpleasant task at hand. Just be aware of distractions, and use them strategically.
Communicate on their Level
- Focus on their feelings, not their exact wording.
- Don’t try to reason, and never argue, with them.
- It can help to avoid asking if they “want” or “need” to use the toilet or take a shower. Instead, say “It’s time to go to the bathroom”. Words like “shower” or “toilet” will sometimes trigger resistance. If so, it’s best to avoid using these words at all. Just lead them to the restroom and talk them through each step without ever using the triggering word(s).
- If they resist or say “no”, respect their wishes and stop. This avoids putting them in a position where they feel they must defend themselves the only way they can – often by striking out. Allow them to calm down and then try a different approach.
TIP: People with dementia are extra-sensitive to emotion, so if you’re feeling rushed, irritated, annoyed, or stressed they won’t respond as well. They’re more likely to be uncooperative, resist care or strike out. Before starting to help, take a breath and make sure you’re in a good spot. Attend to your own needs beforehand so you can be at your best, and allow plenty of time so you don’t feel rushed.
Create a Care Plan
If you’re sharing care responsibilities with other family members or hired staff it can help a lot to create a care plan. Even if you are caring for your loved one on your own, it’s a good idea to have a plan written out in case of an emergency.
The care plan should include details such as:
- Names, relationships and contact information of:
- Medical providers
- Key friends, family members and other important people
- Notes regarding your loved one's needs and preferences as they relate to:
- Medical conditions
- Daily routines
- Preferences or best approaches to care
- Favorite meaningful activities
Provide clothing that fits your loved one’s personal style, and is also easy for them to put on and take off independently.
Easier to manage clothing include:
- Elastic waistbands
- Loose-fitting T-shirts
- Button-down shirts with oversized buttons
- Velcro or slip-on shoes (avoid high heels and shoes without an enclosed heel)
TIP: Add a keyring or zipper pull to make zippers easier to grasp for those with poor eyesight or limited dexterity.
Try out any of these tips that apply to your loved one’s situation:
- Lay out the clothing in the order it should be put on.
- Talk them through the process one step at a time, handing them only one item at a time.
- Reduce the amount of clothing in their closet or dresser to make choices less overwhelming. Store extras in a different area.
- If your loved one has a favorite outfit that they wear daily, buy a few copies of it. Replace the used outfit with the clean one when changing out of nightclothes or during a shower.
Toileting and Incontinence Care
Try to prevent incontinence to the extent possible by helping them to the toilet regularly, before an accident occurs.
TIP: If your loved one is suddenly more incontinent than usual, talk to the doctor – they may have a urinary tract infection (UTI) or other medical condition.
Make the Toilet Easier to Find
- Keep the door open and the light on in the bathroom so they can see it.
- A urinal or portable bedside commode can make it easier to get to the toilet at night (as long as they recognize what it's for).
Recognize the Signs
Learn to recognize the non-verbal signs that your loved one may need the toilet. Common signs include:
- Pulling at clothing
- Pacing or wandering
Establish a Routine
Remind or take them to the toilet regularly. A good schedule to start with can be:
- Upon waking up
- After breakfast
- Before lunch
- Before dinner
- Before bed
Add to or adjust their toileting schedule based on their individual needs.
TIP: People with dementia need a good night’s sleep to function at their best! Incontinence briefs designed for overnight use can support good sleep. However, if they’re often rushing to the restroom in the night or early morning, go ahead and schedule a trip to the toilet just before the time they usually get up.
If your loved one is incontinent, they will need to be cleaned after each accident.
- Wipes designed for incontinence care will often be easier to use – and do a better job – than regular toilet paper.
- Women should always wipe front to back to reduce the chance of infection.
- The acidic moisture from incontinence is very hard on the skin. Use a barrier cream to protect it from frequent incontinence.
TIP: Check the skin for redness, rash or other signs of skin breakdown each time you assist with incontinence care or personal hygiene. If noted, talk to the doctor about the right way to treat it. Skin breakdown is a major concern because it can get really bad really fast.
Help your loved one maintain the hairstyle, facial hair and make-up they prefer – whether it’s their lifelong preference or something totally different. These things are an important part of their identity and a source of self-esteem.
Setting up a toothbrush with toothpaste is enough help for some people with dementia. Later, they may need help just to get started, and eventually, they may depend on someone else to physically brush their teeth for them. Provide only the amount of help they need, and try any of these tips that may be helpful.
- Brush your teeth at the same time they do. Watching you can gently remind them how to do it.
- If you need to brush their teeth for them a long-handled or angled toothbrush can help.
- Use an electric toothbrush if your loved one can tolerate it. Electric toothbrushes do a better job of brushing than a standard toothbrush, but they can feel tickly or irritating to people who aren’t used to them.
- Switch to a dentist who specializes in treating people with dementia, if needed.
- Those who have trouble swallowing should brush their teeth or rinse their mouth with water after eating. This prevents bits of food from being inhaled into the lungs and causing pneumonia.
Try to bathe at the same time routinely, ideally at the time they have preferred throughout their life.
- Never leave a confused person alone in the shower or tub.
- Use a non-slip shower mat, grab bars and a shower chair.
- Don’t use bath oil, which can make the tub slippery.
- Check that the water is at a safe, comfortable temperature before beginning.
- Get everything ready beforehand. Washcloths, towels, soap, shampoo, change of clothes, etc. Be sure the bathroom is nice and warm!
- Keep their shoulders, lap, and chest covered with towels (if they want) to keep them warm and protect their modesty.
- Use a handheld showerhead.
- Give them a washcloth and ask them to cover their eyes while their hair is being washed and rinsed. Water around the head and face is very scary or uncomfortable for many people with dementia. If it’s too much for your loved one, skip this step and wash their hair outside of the shower at a different time,
- Encourage them to wash whatever they can reach – perhaps their face and arms – while you assist with the rest, such as their back, feet and legs.
- Engage their attention to distract from anxiety or other unpleasant feelings. Sing or talk about things you know they love to hear about.
- After the shower, pat their skin dry with towels and apply lotion to their back, legs and arms.
When Showers are Too Much
Two or three showers each week are plenty for most people. Use a washcloth to clean high-need areas daily:
- Abdominal folds
- Under breasts
If showering is very distressing for the person with dementia, a sponge bath can be a good alternative that can get the person clean without feeling traumatized.
- Disguise a bed bath as a “massage” using no-rinse soaps or lotions.
- Break a sponge bath up over one or more days, so the person doesn’t get too overwhelmed. Example:
- Daily: Face, hands and perineal (private) area with each incontinence care (at least once per day if no incontinence care needed)
- Monday: Pedicure and lower legs
- Tuesday: Back and underarms
- Wednesday: Manicure and arms
- Thursday: Hair
- Friday: Chest and underarms
- Saturday: Thighs and buttocks – when providing perineal (private area) care
TIP: A daily shower isn’t necessary for all people with dementia, but some find that doing it every day becomes a comforting cornerstone of their routine. Doing it every day can also help keep them more open to it, simply because they are used to it. As long as they aren’t distressed, and it isn’t causing too much trouble, keep it up!
- Continue to have hair done at the salon if it’s possible and they enjoy it.
- Sometimes washing the person’s hair in the kitchen sink with a hose attachment is easier than shampooing it in the shower.
- Some people with dementia are more receptive to having a hairstylist or home care aide come into their home for a special “beauty day” every so often for a shampoo, cut, style or nail care.
Encourage your loved one's independence in eating to whatever extent they can manage for as long as possible.
Start by Setting up for Success
- Minimize distractions, especially if they have trouble staying focused on eating.
- Find a quiet area without a lot of people bustling around.
- Turn off the television
- Consider turning off phones or music
- Ensure that they can see all the food in front of them, especially if they have one-sided vision loss from a stroke or other cause.
Tackle Trouble Ahead of Time
- If they’re overwhelmed by too much food at once, offer small portions, one bowl at a time. Many people with dementia find that five or six small meals each day works better than three larger ones.
- If cutting is a challenge, cut up the food into small (½ inch) pieces before serving.
- If your loved one has trouble getting the food onto a fork, or up to their mouth, adaptive dishes and utensils can make eating easier.
- Talk to their doctor about setting up a consultation with an occupational therapist (OT) to determine what kind will best help them.
- If they have forgotten how to use silverware, opt for a variety of nutritious finger foods instead. Examples include:
- Chicken strips
- String cheese
- Fruit slices or veggie sticks
- Small sandwiches
- Nuts and raisins
Encourage their Independence
- Avoid feeding them unless absolutely necessary. First, try:
- Eating together. Watching you eat will give them subtle yet valuable reminders about what they should be doing.
- Verbal encouragement or reminders to eat.
- If they need physical assistance to eat:
- Load their fork with food and place it in their hand.
- Guide their hand to their mouth.
- Repeat until they start doing it on their own.
- Repeat the process to get them restarted as needed.
Watch for Warning Signs
- Keep an eye on your loved one’s weight and communicate any weight changes to their doctor.
- Many people with dementia eventually develop difficulty swallowing. Report signs to the doctor if noted:
- Coughing with eating or drinking
- Wet, gurgly voice
- Runny nose or eyes after eating
Walking and Transferring
Use a gait or transfer belt to assist your loved one to walk or transfer (move from one seat to another). These inexpensive devices can greatly reduce the risk of falls or injury to both the patient and the caregiver. They can be found online or in pharmacies.
- Walk slightly behind your loved one, and on their weaker side, if they have one.
- Ensure they are wearing well-fitting, non-slip shoes with an enclosed heel before walking or transferring.
- Pay attention to their footing, and ensure the walkway or area is clear of tripping or slipping hazards, including:
- Powder or water on the floor
- Position your body close to theirs, so that if they start to stumble you can steady them.
- Pull them gently toward you, and let them rest against your thigh.
- If they don’t regain their balance you can slide them safely down your leg to the floor, preventing an injury from a fall.
- Don’t try to help someone who is not able to help or cooperate with the transfer.
- Learn about body mechanics, and be vigilant about protecting your body from injury! Assisting with transfers is a major cause of caregiver injury, and body mechanics can make a big difference in preventing injuries. Some of the basics include:
- Tighten your abdominal muscles during the process.
- Bend your knees and lift with your legs.
- Keep your back straight.
- Never twist while lifting.
Your Loved One is One of a Kind
Supporting a loved one with dementia with their everyday care needs isn’t easy. Every person with dementia is unique, and their needs vary and change over time. There’s no one size fits all answer in dementia care. It’s a good idea to learn all you can about the specific kind of dementia that affects your loved one. At the same time, remember who they’ve always been, and pay attention to who they are now. What kind of support do they – specifically – need? Just do your best to be as observant and flexible as possible and evolve along with them, one day at a time.