“The Four M’s” of Caring for an Older Adult with Dementia


Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio

Your older relative has just been diagnosed with dementia. Your head is spinning with questions, concerns, fears, and yes, disbelief.  Still, you want to know all you can. If you are going to be a caregiver, you want to be a good one. So, where to start?

Start with the things that, if not managed well, have the greatest chance of getting your relative into trouble! Start with “The Four M’s.”


From planning to shopping to preparing, meal preparation is a very complicated task—for someone with a memory problem. You may notice that the older person is losing weight, that they eat little at home but eat well when they go out to eat, or that there is spoiled food in the refrigerator.

Try: Have simple foods – especially your relative’s favorite ones – around the house, such as sandwiches, soup, and cereal. Bring in ready meals that just need to be microwaved. Consider arranging for home delivered meals. Try to make meal time a social time when possible. Ask friends, church and family members to stop in and stay during meals.

Medication management can also be overwhelming and older adults are often taking 10 or more medications, including over-the-counter ones.

Try: Discuss simplifying the regimen with the primary healthcare provider. Are all medications still necessary, and how many can be given just daily? Set up the medicine in a “days of the week” pill box and monitor if they are being taken. Call daily to remind. Consider hiring help for in-person reminders. Take over the refill tasks.

For many families, this is a “taboo” topic. But trust me; you don’t want to find out that your relative  is forgetting to pay the bills by having the electricity turned off!

Try: Review the check book (or better yet, go online—make sure you have passwords) on a regular basis to be sure all bills are being paid. Set up automatic payments for as much as possible. Ensure that your relative is not sending more than is reasonable to charities and not at all to sweepstakes and scams. Have a Financial Power of Attorney drawn up so that someone can easily take over when finances become impossible for the older person to manage. Include the older adult in these discussions, if possible.

Mobility (driving)
Most people in the early stages of dementia will be able to continue to drive. It is important to begin discussions early that this privilege will someday end. Ask yourself—would I allow MY child to ride in the car with this person? If the answer is “no”, then this must be addressed! The goal is to find a solution before someone puts themselves at risk by being lost for extended periods of time or by causing an accident or injury to someone else.

Try: Reduce the time spent in the car by limiting the older person to daylight and familiar locations only. Ride with them and see how they do. Ask them to drive you to someplace they should know and avoid giving instructions. Ask the healthcare professional  to write a “do not drive” order. Consider a formal driving assessment. Be prepared to find alternatives, such as making arrangements for others to take the older adult to appointments and errands.

In general, for all of the above issues, the first goal is to monitor, second is to oversee, and third is to take over. Successfully managing “The Four M’s” will go a long way toward keeping your relative safe and as independent as possible. It should also go a long way toward helping you sleep at night!

Related Resources from Healthinaging.org:
Dementia A-Z
Caregiving How-tos: Memory Problems