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How to Improve the Quality of Life of an Elder with Dementia

By Gilbert Guide

People with Alzheimer's or dementia can still lead meaningful, enjoyable lives. If you have a loved one who has been diagnosed, read on to learn about the many steps you can take to improve the quality of life of the person you care about.

Things to Pay Attention To


Environment

Try to decipher whether problematic behaviors are a result of your loved one's environment. Consider the following issues when assessing the environment:

  • Look for patterns of behavior. Something as innocuous as a doorbell ringing can be upsetting to a person with dementia. If this happens, try posting a note to have visitors knock instead.
  • A person with dementia may mistake dolls and/or images from the TV or in the mirror for actual people. If this is a problem, cover or remove mirrors and dolls and turn off the TV.
  • Busy patterns, particularly on walls or carpeting, can agitate a person with dementia. Choose plain designs if possible.
  • Don't forget that you are an important part of the environment. Some of the best things you can do are to stay calm, divert attention away from a negative stimulus, and speak in soft tones. Sometimes offering praise or treats such as food items can alleviate anxiety.

Routine

Routine is related to the idea of environment. Keeping a routine schedule can help keep confusion at bay. Most daily routines are filled with basic activities like meals, grooming and bathing. Try to include other activities that are engaging and mentally stimulating (but not overly challenging), such as exercise and games that can help with auxiliary issues such as Sundowner's Syndrome. For more ideas on activities to integrate into your loved one's daily routine, read Things to Do.

Sundowner's Syndrome

People with early-stage dementia sometimes become agitated or confused at certain times of the day. The end of the day or late afternoon is a common time for this to occur. This is referred to as sundowning or Sundowner's Syndrome. People who suffer from Sundowner's Syndrome often have trouble sleeping and their dementia symptoms are exacerbated late in the day. According to the Sundowner's Facts Web site, symptoms include increased agitation, anger, confusion, depression, disorientation, paranoia, rapid mood changes and restlessness. These emotions then trigger behaviors such as crying, hiding things, pacing, wandering or even violence. The individual may experience hallucinations. It's still not clear what causes sundowning (e.g., the changing environment and light, or having had a full day of activities, or being tired), but the following suggestions, courtesy of the Alzheimer's Association, can help in dealing with symptoms of Sundowner's Syndrome:

  • Allow for light exposure in the early morning to help set internal clock.
  • Encourage exercise throughout the day to expend excess energy.
  • Limit caffeine intake, particularly in the evening.
  • Have a quiet nighttime activity ready and a private space for relaxing.
  • Consider purchasing a bedside commode to alleviate the need to visit the bathroom during the night.
  • Schedule doctor's appointments regularly and make sure pain isn't an issue.
  • Make sure that the house is secured so your loved one will be safe if he or she wanders at night.

Read Gilbert Guide's home safety solutions.

Important Note: There is disagreement among experts as to whether more or less daytime sleep is better for people with Sundowner's Syndrome. Some experts encourage regulated daytime napping or resting, while others promote the idea of keeping an active daytime schedule so that the person with dementia is tired at the end of the day. Consult a physician with dementia training and experiment to see what works best for you and your loved one.


Things to Do

Understandably, caregivers get overwhelmed from time to time with the amount of work they have to do; however, integrating a new activity or two every day is not only beneficial for the person with dementia, but can also prove relaxing for the caregiver.


Activities

Activities needn't be structured. Whether you're caring for your loved one at home or visiting at a facility, activities can be as simple as playing cards or a board game. Try bringing along a blank photo album with pictures that you can put inside together. The key is to find activities that are stimulating but not overwhelming. Make a list of your loved one's hobbies and interests to help you brainstorm activities that can be adapted to fit his or her current level of dementia.

Animals

If your loved one likes animals, consider animal therapy. Visits from calm animals are a great way to introduce something new and interesting to his or her environment, and research has shown that the interaction between humans and animals have therapeutic healing qualities. Make sure the animal you bring is not aggressive or excitable, and stay close during initial visits.

Exercise

Speak to your loved one's physician so you know what kinds of exercise are physically possible. Daily walks are beneficial for both of you, but if that's not appropriate, you may want to consider chair exercises such as the Sit and Be Fit routines shown on public television. Remember, as with any exercise routine, a little is better than nothing at all.

Music

When a person has lost the ability to communicate, music can sometimes act as a new form of communication. Many of us have a powerful emotional response to music, and dementia patients are no different. Experiment by playing music you think your loved one would enjoy. Big band, classical, New Age mixed with nature sounds or religious music are all good starting points. You'll know you've "struck a chord" if you catch your loved one humming along, mouthing the words or simply showing a better appetite when the music plays.

Reminiscence

You may already be incorporating "reminiscence" activities without even knowing it. Does your loved one tell you stories from the past when a memory springs to mind? This is oftentimes the basis for reminiscing. It can occur organically when you look at photographs or conversation prompts a memory. As a caregiver, you can promote reminiscing by helping with associations that come up in conversation. Many people with dementia are comforted by returning to distant memories, since the past feels far more familiar. Objects from childhood, such as dolls or other toys, can help jog memories from earlier in life.

Listen to Your Elders

A 2006 study conducted by researchers from Florida State University found that asking older adults with dementia to tell them about their children resulted in significantly less coherent responses than when asking for advice regarding issues such as child-rearing or whether or not to have children. The study utilized two groups of seniors; only one group had dementia. Both were asked to teach individuals from the other group a short recipe. Very little differences were seen in the ability to teach, except that the dementia patients needed more prompting to complete the task. The researchers also noted that the effects of the questioning could be psychological, concluding that a person is more likely to feel important and useful when asked for advice rather than just being engaged in social conversation.

Tip: When planning reminiscence activities, try to create ones in which your loved one can pass along knowledge to you. If she has always enjoyed cooking, try pre-cutting ingredients (or laying them out in advance) and asking her how to make a favorite dish. Keep a recipe book out for reference, should you need it.

Socializing

Every person has different social needs. Some people prefer to be left alone for long periods of time, while others enjoy companionship. Assess your loved one's social needs and try to find ways to meet them. Often volunteers can be integrated into a schedule so as to provide companionship and allow you a chance for your own personal time. Adult day care and adult day health care programs give older adults the opportunity to socialize with a group of peers; before making an appointment, make sure the program accepts participants with dementia. Some programs specialize in this type of care and incorporate activities tailored to the needs and interests of people with dementia.

Touching

For many older adults, the only type of human touch they experience is clinical, such as during doctor's appointments. But most humans have a need for physical contact. Small gestures that include touching can provide a sense of well-being and assuage feelings of loneliness. When approaching your loved one, make careful movements that won't cause alarm. Some noninvasive ways of touching include massaging cream into feet or hands and brushing your loved one's hair. Gilbert Guide provides information on massage techniques that can also be effective in pain management. Naomi Feil, the founder of validation therapy, maintains that later-stage dementia patients often respond positively to having their cheeks rubbed, a movement associated with one's mother.