This fact sheet offers some information and ideas about how to make your daily routine and your home more accessible to a person with dementia.

You may also find the following facts sheets helpful:

· What is dementia?

· Assessment and diagnosis

· Treatment and therapy for people with dementia

· Enduring power of attorney and receivership

A person with dementia is unable to balance the decline in thinking, remembering and reasoning

The way you interact with them and the physical environment (house and other aspects of the home) need, as far as possible, to take account of and compensate for, memory loss and brain damage. The aim is to create a more ‘dementia friendly’ environment.

Carers can try to:

· Develop ways of doing things that reduce the stress of the person with dementia

· Support the skills and abilities that remain

· Keep things familiar and constant

· Prompt memory

· Provide opportunities for maintaining independence

General tips for helping with personal care and other routines include:

· Giving yourself time – making sure as far as possible that you are not rushed or tense

· Always say clearly what you are going to do and repeat what is going to happen

· Talk about what you are doing – this serves to provide reassurance

· Break the tasks down into small manageable steps and prompt both physically (by, for example, making tooth brushing motions) and verbally – “now you put the toothpaste on the brush” instead of saying “now brush your teeth”

· Take over only when the person you care for is becoming frustrated about the next step

· Recognise when someone really cannot manage something anymore

Difficulties around personal care and appearance

Familiar routines are likely to be well remembered and continuing to carry them out provides the person with dementia with an important sense of control and self esteem.

If certain aspects of a routine become difficult, see if there is a way in which you can simplify what has to be done.

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 (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

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.

Washing and bathing

These routines will be ones which a person will have done themselves for many years and carers need to think about 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

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 pad. In Contact (a national organization providing continence advice) or your local Continence Advisor will be able to help you.

Ideas which may help

· Labeling 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

· 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

Cooking

Cooking presents 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

· If in doubt, put sharp equipment away

· If gas appliances are left on, have an automatic turn off switch fitted - ask the gas supplier for advice

· If the person is eating food which is no longer fresh whilst living alone, 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.

Not drinking, resulting in dehydration, is a common problem

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 spoons

· Cut food up into smaller pieces or make easily digestible finger foods

· If swallowing becomes more difficult the consistency of food should be soft and thick

· 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.

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We are constantly looking to improve our information. It helps if you let us know whether the information in this fact sheet was/was not useful and if there are other fact sheets that you would have found helpful that we have not yet provided.

While the information contained in this fact sheet is believed to be correct, DISC does not accept liability for any error/s it may contain.