What is the best way to move an older adult with dementia? A Complete Guide to Safe Transfers

According to the National Institute on Aging, millions of families in the United States care for a loved one with dementia. A key aspect of this care is understanding what is the best way to move an older adult with dementia? Safe and gentle techniques are paramount to protect both the caregiver and the individual.

Quick Summary

The best way to move an older adult with dementia involves prioritizing safety, using clear and simple cues, and employing proper body mechanics. Using assistive devices like gait belts, preparing the environment, and moving at a slow, reassuring pace are critical for a smooth, secure transfer.

Key Points

• Prioritize Safety: The most important aspect is ensuring the safety of both the caregiver and the person with dementia during any transfer, using proper techniques and equipment.

• Use Simple Communication: Give clear, one- or two-word verbal cues in a calm, reassuring tone and repeat them consistently to minimize confusion and anxiety.

• Employ a Gait Belt: A gait belt is an essential safety device that provides a secure, comfortable grip for the caregiver during transfers, reducing the risk of falls and injury.

• Prepare the Environment: Before moving, clear all pathways, ensure adequate lighting, and lock wheels on any equipment. Home modifications like grab bars can significantly improve safety.

• Manage Behavioral Challenges with Patience: If the person resists, remain calm, and use redirection or offer simple choices to give them a sense of control. Never rush the process.

• Know When to Use Assistive Devices: Depending on the person's ability, use a gait belt, sliding board, or mechanical lift to ensure a safe transfer without undue strain on the caregiver.

Prioritizing Safety and Communication

Moving a person with dementia can be challenging due to unpredictable behaviors, confusion, or physical limitations. The primary goal is to ensure the safety of both the caregiver and the older adult while preserving dignity and minimizing anxiety. This requires a combination of effective communication, proper technique, and the right equipment.

Assess the Situation Before Acting

Before every transfer, take a moment to assess the person's current state and surroundings. A person with dementia's ability can fluctuate throughout the day, so what worked this morning might not be effective in the afternoon. Look for signs of agitation, confusion, or physical weakness. Clear the path of any potential tripping hazards like loose rugs, cords, or clutter. Ensure there is enough light and that the destination is clearly visible.

Communication: Simple, Consistent, and Calm

Verbal and non-verbal communication is key when assisting with mobility. Use simple, one- or two-word cues and a calm, reassuring tone of voice. Avoid overwhelming the person with complex instructions. If you need to repeat a cue, use the exact same words to prevent confusion. Combining verbal cues with gentle manual guidance can also be very effective. For example, say "stand up" while gently guiding their hips forward. Pointing to the destination, such as the chair, can provide a visual cue.

Essential Techniques and Assistive Devices

Proper technique is crucial for preventing injuries. Always use your leg muscles, not your back, to lift and move. Keep your back straight, bend at the knees, and keep the person close to your body.

The Stand-Pivot Transfer

For an older adult who can bear some weight, the stand-pivot transfer is a common technique. The process involves:

1. Positioning: Place the destination (e.g., wheelchair) as close as possible to the starting point, at a 45-degree angle. Lock the wheels for safety.
2. Preparation: Help the person move to the edge of the seat, with both feet flat on the floor and wearing non-skid footwear.
3. Instruction: Provide a simple cue like, "On the count of three, we will stand up." Show them the destination.
4. Execution: Use a gait belt for a secure grip. On the count of three, pull the person forward from the hips into a half-standing position. Pivot your body with them, taking small, flat-footed steps.
5. Sitting: Guide them until the back of their legs touch the new seat, then lower them slowly and safely.

Using a Gait Belt

A gait belt is a non-negotiable tool for safe transfers. It provides a secure handle for the caregiver, reducing the risk of a fall and preventing injury from pulling on the person's arms. The belt is placed around the person's waist, over their clothes, and buckled tightly enough to be snug but not restrictive. The caregiver can hold the belt from the back or sides, maintaining a secure grip throughout the transfer.

Sliding Board Transfer

For those with more significant mobility issues who cannot bear weight, a sliding board can bridge the gap between two surfaces, such as a bed and a wheelchair. This technique involves:

1. Preparation: Place the two surfaces as close together as possible, and lock any wheels.
2. Positioning the Board: Help the person lean away from the destination, then place one end of the board under their thigh and the other end on the destination surface.
3. Execution: Provide firm, reassuring guidance as the person scoots across the board. Use slow, deliberate movements.

Comparative Analysis of Transfer Methods

Feature	Stand-Pivot Transfer	Sliding Board Transfer	Mechanical Lift
Cognitive Level	Best for those with moderate dementia who can follow cues and bear some weight.	Suitable for moderate to advanced dementia where weight-bearing is limited.	Recommended for advanced dementia or individuals with no weight-bearing ability.
Physical Ability	Requires partial weight-bearing and ability to follow simple instructions.	Does not require weight-bearing, but requires some upper body strength or caregiver assistance.	Requires no physical input from the person being moved.
Required Equipment	Gait belt, non-skid shoes.	Sliding board, gait belt (optional).	Hydraulic or electric mechanical lift.
Safety	High, when proper techniques and equipment are used.	High, reduces strain on both parties during transfers.	Highest safety for non-ambulatory individuals; requires proper training.
Caregiver Strain	Moderate; requires good body mechanics.	Low to moderate; less lifting involved.	Low; minimal lifting required.
Best Used For...	Transfers between bed, chair, and toilet.	Transfers between bed, wheelchair, or car.	Transfers from bed to chair, toilet, or shower chair.

Managing Behavioral Challenges

Agitation or resistance during a move is common. It's often rooted in fear, confusion, or a perceived loss of control.

• Stay Calm and Reassure: Maintain a calm demeanor and a soothing tone. Your tone of voice can be more important than the words you use.
• Use Redirection: Distract the person by talking about something they enjoy. For example, mention a favorite upcoming meal or activity.
• Offer Choices: Instead of demanding, offer simple choices. "Would you like to sit in the blue chair or the brown one?" This can provide a sense of control.
• Never Rush: Rushing increases anxiety. Move at a gentle, unhurried pace, even if it takes longer.

Home Environment Modifications

Creating a safe, supportive environment can make transfers significantly easier.

• Clear Pathways: Keep all pathways free of obstacles to prevent falls.
• Install Grab Bars: Place grab bars in key areas like the bathroom, beside the toilet, and in hallways.
• Ensure Proper Lighting: Use bright, even lighting to reduce confusion and improve visibility.
• Secure Furniture: Ensure all furniture is sturdy and won't tip over if leaned on.
• Adjust Heights: A raised toilet seat or an adjustable-height bed can reduce the distance of transfers, making them safer and easier.

When to Seek Professional Assistance

While home caregivers can learn many techniques, it's vital to know when to seek professional help. A physical therapist can provide hands-on training and evaluate the older adult's specific needs. A home health aide or professional caregiver can assist with daily transfers and provide expertise. If the person becomes too heavy to lift safely or if resistance becomes a major issue, a mechanical lift may be necessary, and proper training is essential for its use.

For more information on safe patient handling, the American Association of Occupational Health Nurses offers comprehensive resources on proper body mechanics and lifting techniques. You can find detailed guidance at https://www.aaohn.org.

Conclusion

Moving an older adult with dementia requires a compassionate and strategic approach. By prioritizing safety, using simple communication, and employing the right equipment and techniques, caregivers can manage mobility challenges effectively. Remember that flexibility is key, as the person's needs may change. Continued patience and a supportive environment are the best ways to ensure both comfort and security during every transfer.

Frequently Asked Questions

What is a gait belt and how do I use it when moving an older adult with dementia?

A gait belt is a special belt that fits around a person's waist, providing a secure handle for a caregiver. To use it, fasten it snugly over their clothing. During a transfer, hold onto the belt to guide and support the person, distributing force evenly and preventing falls.

How can I communicate effectively with a confused older adult during a transfer?

Use simple, direct language and a calm, reassuring voice. Avoid complex sentences. Say, 'Let's stand up,' or 'Sit down.' Repeat the exact same words and tone if necessary. You can also use visual cues, like pointing to the chair or bed, to aid understanding.

What should I do if the older adult resists or becomes agitated during a move?

If they resist, stay calm and do not force the movement. Try to use redirection by talking about a pleasant memory or upcoming activity. Offer simple choices to give them a sense of control. If agitation continues, take a short break and try again later. It’s important to remember this isn't intentional resistance.

When should I consider using a mechanical lift instead of manual transfers?

A mechanical lift is necessary when an older adult can no longer bear weight or when manual transfers become unsafe due to their size, strength, or behavioral challenges. It significantly reduces the risk of injury to both the caregiver and the person with dementia.

What kind of home modifications can make moving easier for someone with dementia?

Modifications include installing grab bars in key areas like the bathroom and hallways, using non-slip mats on floors, ensuring adequate lighting to reduce confusion, and clearing all clutter to create clear pathways. Secure any unstable furniture.

How can I prevent back injury as a caregiver when moving an older adult?

Always use proper body mechanics. Bend at your knees, not your waist, and keep your back straight. Hold the person as close to your body as possible during transfers to use your strong leg muscles instead of your back. Never twist your body while lifting or moving.

Is it safe to move a person with dementia on my own?

Whether it's safe depends on the individual's condition and your physical ability. Use assistive devices and proper techniques to minimize risk. If the person is non-ambulatory or significantly larger than you, or if resistance is an issue, consider seeking help from another person or using a mechanical lift to ensure safety.