Aging & Health A to Z

Dementia

Lifestyle & Management

If you’re caring for someone with dementia, it’s essential that you get information, advice, and, when needed, assistance. Your physician and other healthcare providers, your local Alzheimer’s Association, and your local Area Agency on Aging can help. 

Management

These general management strategies can help a person with dementia function as well as possible and stay safe at home:

• Schedule regular doctors’ visits every 3 to 6 months.
• Aim for a moderate amount of interesting, stimulating activity. Too little stimulation. may lead to withdrawal. Too much stimulation can increase confusion or agitation.
• Include physical exercise in the daily routine if possible.
• Make sure there’s enough light for the person to see clearly and, if possible, read.
• Speak in simple sentences and remind the person of the topic of conversation often if necessary.
• To prevent or reduce confusion put clocks, calendars and to-do lists where the person with dementia can easily see them. Newspapers and radio and television news programs may also help in the early stages of dementia.
• Try reminiscing together and mention pleasant experiences from the past. (Note: this technique is usually helpful in the early stages of dementia. Later, it may lead to frustration and agitation because the person with dementia may not be able to remember past events any longer.).
• Ask for advice about handling difficult behaviors.
• Watch for signs of new medical problems, possible side effects from medications, and  behavioral changes and report these to your physician and other healthcare professionals promptly.
• Provide regular daily activities in familiar settings and follow a predictable schedule so the person with dementia eats and sleeps at roughly the same times each day.

To manage certain common problems, such as agitation and aggression, nighttime agitation (also known as “sundowning”), difficulty sleeping, and wandering, you may need several strategies. The following often help. You may discover that there are other things you can do that help as well.

To ease agitation and aggression:

• Eliminate as many sources of stress in the home as possible.
• Try playing soothing music to relieve stress and agitation.
• Take the time to slowly and gently complete a potentially disruptive task such as bathing.
• Stay calm, and try simple distractions for agitated or aggressive behavior.
• If there is a risk that the person with dementia may become aggressive and harm someone, ask your physician whether sedative drugs might be appropriate. Unfortunately, these drugs can increase confusion.

To manage “sundowning”: 

• In the evening, create a soothing environment, such as a quiet room with low lighting and calming music or a low-key television program.
• Spend time quietly talking with the person you are caring for.

To improve sleep:

• Make sure the bedroom is quiet, dark, and neither too hot nor cold
• Treat pain that may be interfering with sleep
• Limit daytime naps to 20 to 30 minutes
• Cut back on fluids late in the day to eliminate or reduce the need for nighttime bathroom visits
• Don’t serve coffee, other caffeinated drinks or alcohol later in the day, and discourage smoking at night; all of these things interfere with sleep.

To discourage wandering:  

• Agitation, depression, hallucinations, pain, boredom, and the need to use the bathroom frequently can contribute to wandering. Addressing these symptoms may help to reduce wandering.
• Lock doors if necessary for safety.
• Just in case, have the person with dementia wear an ID bracelet or pendant.

Caregiver and Family Assistance

Caring for an older person with dementia can be extremely rewarding. But it can also be extremely difficult and stressful. Caregivers need information, support and help.

It’s important for caregivers to understand how dementia will affect the person they’re caring for, and what kind of medical and related care will be needed. It’s also important for caregivers to care for themselves, and to get assistance when needed, so they can avoid burnout.

Joining a caregiver support group can help. So can getting respite care. Respite care options include community adult daycare programs and in-home services. Community organizations, churches, temples, and long-term care facilities near your home may run adult day care centers or offer in-home adult care. In-home care services include companion services, personal care, and home health aide services. 

A caregiver may ultimately have to consider placing a family member in a long-term care facility. Though difficult, it’s important to consider such a move earlier rather than later, so there’s time to make arrangements. Medicare and Medicaid may cover certain long-term care costs under certain conditions. While private long-term care insurance will cover some costs that Medicare doesn’t, it can be quite expensive.  Provisions in the 2010 healthcare reform law aim to make long-term care insurance more affordable. 

Updated: March 2012
Posted:  March 2012