Why getting someone with dementia out of bed can be challenging
As dementia progresses, cognitive functions decline, leading to confusion, fear, and disorientation. This can make simple daily activities, like getting out of bed, overwhelming and frightening. Care recipients may no longer understand the need to get up, may fear falling, or simply not recognize you as their caregiver. This is not defiance but a symptom of their disease, and your approach must adapt accordingly.
Factors contributing to morning resistance
- Memory loss and confusion: They may not recognize the time of day or understand why it's time to get up.
- Fear and anxiety: Waking up in a state of confusion can trigger fear, especially if they are disoriented or worried about falling.
- Physical discomfort: Pain from arthritis or other conditions can make moving painful and difficult.
- Sensory changes: Reduced vision or hearing can make it harder to process instructions and navigate the environment.
- Sleep cycle disruption: Many people with dementia experience changes to their circadian rhythm, leading to restlessness at night and wanting to stay in bed during the day.
- Environmental factors: A noisy room or poor lighting can increase confusion and agitation.
Creating a supportive morning routine
Consistency and predictability are cornerstones of successful dementia care. A structured routine reduces anxiety and helps set the body's internal clock.
Establish a positive morning environment
- Wake gently: Avoid loud noises or abrupt movements. A soft, gentle wake-up is less startling.
- Let in light: Open curtains or blinds to signal the start of the day. Natural light exposure helps regulate the sleep-wake cycle.
- Play soothing music: Familiar, calming music can create a positive and relaxing atmosphere.
- Talk calmly and positively: Use a pleasant tone of voice. A reassuring, cheerful tone can be contagious.
Plan a predictable schedule
- Same time every day: Try to wake up and start the morning routine at roughly the same time every day. This creates a rhythm the brain can follow.
- Step-by-step guidance: Break down the process into small, manageable steps. For example, 'First, we'll sit up,' then 'Next, let's put your feet on the floor.'
- Prepare ahead: Lay out clothes and necessary items the night before to reduce morning chaos and choices.
Mastering gentle communication techniques
Your communication style is critical to de-escalating resistance and gaining cooperation. Remember, you cannot reason with someone whose brain is affected by dementia. Your goal is to connect on an emotional level.
Tips for effective communication
- Use simple, direct language: Avoid complex sentences and jargon. State your message clearly and calmly.
- Get to their level: Sit or kneel so you are at eye level. This is less intimidating and shows respect.
- Use nonverbal cues: Gentle touch on the arm or a reassuring hand hold can convey safety and affection when words fail.
- Validate their feelings: If they say they are scared, acknowledge it. Say, "I know you feel anxious, but I'm here with you." Don't argue with their reality.
- Redirect and distract: If they insist they are not getting up, don't confront them. Redirect their attention with a pleasant distraction, like, "I just made some coffee, let's go have a cup together." Or, "The sun is out, let's go see the pretty garden."
Safe physical assistance methods and assistive devices
As mobility declines, physical assistance becomes necessary. Proper technique protects both you and the care recipient from injury.
Proper lifting techniques
- Use a transfer belt (gait belt): A gait belt provides a secure handhold and helps you maintain balance and control during transfers. Wrap it snugly around their waist, over their clothes, but not so tight as to cause discomfort.
- Stand correctly: Keep your feet shoulder-width apart for a wide, stable base. Bend your knees, not your back, and use your leg muscles to lift.
- Pivot, don't twist: Small, deliberate steps to turn your whole body prevent back strain and are less jarring for the person you are assisting.
Using assistive devices
| Device | How it Helps | Considerations |
|---|---|---|
| Adjustable Bed | Raises the head and feet, making it easier to go from a lying to a seated position. | Can significantly reduce the physical strain on the caregiver and increase the patient's independence. Requires a doctor's prescription for insurance coverage. |
| Bed Rails | Provides a sturdy handhold for self-transfer and prevents falls. | Ensure they are properly installed and do not pose a risk of entrapment. Check with a healthcare professional. |
| Sit-to-Stand Pole | A floor-to-ceiling pole with a secure grab handle, ideal for small spaces. | Must be installed correctly to prevent injury. Offers a sense of stability. |
| Slide Sheet | A low-friction sheet placed under the person, allowing for easy repositioning. | Reduces friction and prevents skin shearing. Effective for individuals who require significant assistance with movement. |
When resistance persists
Sometimes, despite your best efforts, your loved one may refuse to get out of bed. In these cases, it's important to know when to pause and reassess.
- Take a break: If you feel your frustration rising, step away for a moment. Take deep breaths and calm yourself before returning. Your anxiety can easily be perceived by the person with dementia.
- Revisit later: Try again in 15-20 minutes. Their mood and cognitive state can shift quickly. A fresh approach may be successful.
- Check for underlying issues: Is there an untreated UTI, pain, or side effect from new medication? Consult a doctor if you suspect a medical cause for persistent resistance.
- Change your tactics: If the usual routine is not working, try a different activity. Perhaps they would be more interested in listening to a favorite album while still in bed, or looking at a photo album, before attempting to transfer.
Conclusion
Getting someone out of bed with dementia is a complex task that requires empathy, patience, and a well-thought-out strategy. By prioritizing a calm and predictable environment, mastering gentle communication, and leveraging the right assistive devices, you can navigate these challenges with greater ease and maintain your loved one's dignity. Remember to be flexible, adapt your approach, and always prioritize safety for both of you. For additional support and resources, the Alzheimer's Association is an excellent place to start.
