What to do with an old person with dementia? A guide for family caregivers

Approximately 55 million people worldwide are living with dementia, and this number is projected to rise. When facing a dementia diagnosis for an aging loved one, figuring out what to do with an old person with dementia can feel overwhelming and bring many uncertainties, but comprehensive planning and a compassionate approach can make a profound difference.

Quick Summary

This guide covers essential steps for caring for a senior with dementia, including strategies for daily care, managing behavioral changes, ensuring home safety, and planning for the future. It provides information on legal documents, available support resources, and recognizing signs that indicate a need for professional memory care.

Key Points

• Emphasize Dignity and Patience: Approach care with empathy and flexibility, recognizing that behavioral changes are symptoms of the disease, not willful actions.

• Adapt the Home Environment: Modify the living space with improved lighting, clear pathways, and secure dangerous items to enhance safety and reduce confusion.

• Implement Effective Communication Techniques: Use simple, clear language, maintain eye contact, and avoid arguing or correcting misstatements to minimize frustration.

• Establish Routines and Meaningful Activities: Create a consistent daily schedule and engage in simple, enjoyable activities to provide structure and a sense of purpose.

• Plan Legally and Financially in Advance: Appoint a Power of Attorney and update estate plans early to ensure the person's wishes are respected and assets are protected.

• Utilize Available Support Systems: Access resources like support groups, respite care, and helplines from organizations like the Alzheimer's Association to manage caregiver stress.

• Know When to Seek Professional Care: Recognize signs such as severe behavioral challenges, wandering risks, or inability to manage daily tasks, which may indicate a need for a memory care facility.

Caring for an older adult with dementia is a complex journey that requires patience, flexibility, and a deep understanding of the disease's progression. The primary focus is not about "doing something with" the person, but rather creating a safe, stable, and dignified environment that honors their past while managing present challenges. The following comprehensive approach addresses the many facets of dementia care.

Understand the Stages of Dementia

Care needs evolve significantly as dementia progresses. Understanding the stages can help you anticipate changes and plan accordingly.

• Early Stage: In the mild phase, the person can maintain a good degree of independence but may experience forgetfulness, misplace items, or struggle with complex tasks like managing finances. Your role is primarily supportive, helping with planning, gentle reminders, and ensuring their wishes are documented.
• Middle Stage: As the disease progresses, daily tasks become more difficult. The person may have trouble remembering personal details, communicating their needs, or recognizing familiar faces. Behavioral changes, like increased anxiety or restlessness, are common, and establishing a consistent routine becomes crucial.
• Late Stage: In the most severe phase, cognitive function declines significantly, and the person may require 24/7 care and assistance with all daily activities, from eating to hygiene. Nonverbal communication, such as touch and music, becomes increasingly important.

Manage Behavioral and Communication Challenges

Behavioral changes are a direct symptom of the disease, not a deliberate choice by your loved one. Using patience and a calm, reassuring demeanor is key.

Communication Strategies

• Maintain eye contact and speak calmly: Approach the person from the front and get down to their level. Your tone and body language often communicate more than your words.
• Use simple language: Keep sentences and instructions short and straightforward. Avoid complex explanations that can cause frustration.
• Offer limited choices: Instead of open-ended questions like "What do you want for dinner?", offer a choice between two options, such as "Would you like soup or a sandwich?".
• Listen actively: Watch for nonverbal cues and try to understand the feeling behind their words or actions.
• Avoid arguing: If they recall something incorrectly, gently redirect or agree with their reality rather than trying to correct them. Arguing is often unproductive and can increase their agitation.

Managing Specific Behaviors

• Wandering: Restlessness and disorientation can lead to wandering. Ensure the home is secure with locks or alarms. Establish a routine that includes physical activity, and consider a GPS tracker or identification bracelet.
• Agitation and aggression: A calm environment is essential. Identify potential triggers like fatigue, pain, or overstimulation. Distraction with a preferred activity, soothing music, or gentle touch can help de-escalate the situation.
• Sundowning: Increased confusion and agitation late in the day is a common symptom. Try limiting daytime naps, increasing light exposure during the day, and creating a quiet, calming evening routine.

Create a Safe and Supportive Home Environment

As cognitive abilities decline, the home environment must be adapted to minimize risks and reduce confusion.

Home Safety Modifications

• Remove tripping hazards like throw rugs and clutter from walkways.
• Use contrasting colors for furniture, floors, and railings to help with depth perception.
• Increase lighting, especially in hallways, stairways, and bathrooms. Use nightlights to prevent nighttime confusion.
• Lock up potential dangers such as medicines, cleaning supplies, and sharp objects.
• Install grab bars in the bathroom and use non-slip mats in the shower or tub.
• Use safety knobs on the stove and set the water heater to 120°F to prevent burns.
• Label drawers and rooms with large text and clear pictures to aid identification.

Comparison Table: Home Care vs. Professional Care

Feature	Home Care (Family Caregiver)	Professional Memory Care Facility
Level of Care	Best for early to middle stages; depends on caregiver availability and skill.	Best for middle to late stages or complex behaviors; 24/7 specialized staff.
Environment	Familiar surroundings; can be customized, but requires ongoing modification.	Specifically designed dementia-friendly environment with enhanced safety.
Safety Measures	Requires active management and installation of locks, alarms, and safety features.	Built-in security systems, alarmed doors, and secure outdoor spaces to prevent wandering.
Socialization & Activities	Depends on caregiver ability and local community resources (e.g., memory cafes).	Structured activities, therapies (art, music), and social engagement with other residents.
Caregiver Burden	Can be high, leading to stress and burnout. Requires balancing care with personal life.	Reduces burden on family caregivers, providing respite and peace of mind.
Cost	Potentially lower in early stages, but costs for assistive devices and support add up.	Often higher, but covers comprehensive medical, safety, and social needs.

Plan Legally and Financially for the Future

Planning ahead is crucial to honor your loved one’s wishes and protect their assets.

• Appoint a Power of Attorney (POA): A durable POA for finances and healthcare should be established early while the person can still make sound decisions. This designates a trusted individual to make financial and medical decisions on their behalf.
• Create or Update Estate Plans: Review and update wills, living trusts, and beneficiary designations with an elder law attorney.
• Discuss Long-Term Care Costs: Understand your options for funding long-term care, which may include long-term care insurance, Medicare, or Medicaid.
• Protect Against Scams: People with dementia are highly vulnerable to financial scams. Appointing a financial caregiver can help protect against fraud.

Prioritize Caregiver Well-Being

Providing care for someone with dementia is physically and emotionally demanding. Your own health is critical to being an effective caregiver.

• Utilize Respite Care: Take regular breaks. Adult day care or professional respite care services can provide a temporary rest from caregiving duties.
• Join Support Groups: Connect with others facing similar challenges. Sharing experiences can reduce feelings of isolation and provide practical advice.
• Seek Professional Help: If you feel overwhelmed, a therapist or counselor can help you manage stress, guilt, or burnout.
• Take care of your health: Prioritize sleep, nutrition, and exercise. Schedule your own doctor’s appointments and continue with hobbies to maintain balance.

Conclusion: Navigating the Care Journey

Learning what to do with an old person with dementia means focusing on providing empathetic, flexible, and comprehensive care. It is a collaborative effort that involves understanding the disease's progression, adapting the environment, managing complex behaviors with compassion, and planning for the future. By prioritizing a senior's safety and dignity, as well as the caregiver's own well-being, this challenging journey can be navigated with grace and support. For additional resources, the Alzheimer's Association offers a wealth of information, support groups, and a 24/7 Helpline for assistance.

Optional Outbound Link

For more detailed information on understanding dementia behaviors, visit the Family Caregiver Alliance's Guide.

Frequently Asked Questions

What is the best way to handle an old person with dementia who is aggressive?

If an older person with dementia becomes aggressive, remain calm, and avoid arguing or raising your voice. Try to identify and remove the trigger, which could be pain, fear, or frustration. Offer reassurance, distract them with a preferred activity, or use soothing music. If needed, give them space to calm down and ensure everyone's safety.

How can I communicate effectively with someone who has dementia?

Communicate effectively by speaking slowly, clearly, and in a low-pitched, calm voice. Make sure you have their attention, use simple words and sentences, and offer choices instead of open-ended questions. Avoid correcting them, listen with patience, and pay attention to their nonverbal cues.

When is it time for an old person with dementia to go into a care facility?

It may be time to consider a professional memory care facility when safety becomes a major concern, such as increased wandering, frequent falls, or risky behaviors. Other indicators include the caregiver experiencing severe burnout, or the person requiring more intensive, round-the-clock supervision than can be provided at home.

How can I make my home safe for an old person with dementia?

To make a home safe, remove tripping hazards like clutter and rugs, and increase lighting, especially with nightlights. Lock up hazardous items like cleaning supplies and medications, and install grab bars in bathrooms. Consider secure locks on doors and windows to prevent wandering.

What legal documents are necessary for an old person with dementia?

Essential legal documents include a Durable Power of Attorney (POA) for both financial and healthcare decisions. It is crucial to set these up as early as possible while the person still has the cognitive capacity to understand and sign them. Other important documents are a will and advance directives.

Are there activities an old person with dementia can do?

Yes, many activities can be beneficial, including listening to favorite music, looking at family photo albums, simple craft projects, or going for a walk. Memory cafes offer social and cognitive engagement in a supportive environment. Keeping routines and involving them in simple chores like folding laundry can also be comforting.

What is sundowning and how can it be managed?

Sundowning is a phenomenon where people with dementia experience increased confusion, agitation, and restlessness late in the day. Management strategies include maintaining a consistent daily routine, limiting daytime naps, increasing exposure to natural light, and creating a calm, predictable evening atmosphere.