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Personal Care

Continence

What is incontinence?

Incontinence is the loss of control of the bladder and/or bowel function. Our brains send messages to our bladder and bowel telling them when it is necessary to empty them. Being in control of these functions depends upon awareness of bodily sensations such as the feeling of having a full bladder, and the memory of how, when and where to respond. When there is a decline of intellect and memory as a result of dementia, incontinence may occur.

Where to begin

People with dementia, just like other adults, are susceptible to other causes of incontinence, such as infection, constipation, hormonal changes and prostate enlargement.

Many of these other conditions are treatable, so the first step is always to consult the doctor to obtain a full medical assessment and find out why the incontinence is occurring. Consulting with a continence nurse may also be helpful.

Changes in a person’s ability

The changes in a person’s brain caused by dementia can interfere with their ability to:

  • Recognize the need to go to the toilet
  • Be able to wait until it is appropriate to go to the toilet
  • Find the toilet
  • Recognize the toilet
  • Use the toilet properly

Caring for someone with incontinence

When caring for someone with dementia, incontinence may seem like the last straw. But there are measures that can be taken to alleviate the problem itself or to make it less stressful. It is important for you to seek professional help at an early stage and not struggle on your own. Incontinence can be very distressing for the person with dementia. It helps if you remain calm, gentle, firm and patient and try to accept and get over your own embarrassment in having to help the person in such an intimate way. Sometimes a little humor can help.

Information for the doctor

It is useful if you can provide the doctor with the following information:

  • How often is the person incontinent?
  • Is it urinary and/or fecal incontinence?
  • When did the problem start?
  • Is the person saturated or is it just a dribble?
  • Has there been an increase in confusion or any change in behavior?
  • Has there been any fever or does the person appear to find it painful to go to the toilet?
  • Is the person taking any medication?
  • Does the person pass urine in strange places?

If medical assessment does not indicate that there are any other medical reasons for the incontinence, then the cause is most likely to be the person’s dementia.

Suggestions for managing incontinence

  • Be sure the person is drinking adequate fluids, preferably water (5-8 glasses daily – jelly, ice cream or custard may be substituted). Many people with dementia forget to drink or no longer recognize the sensation of thirst. Try to establish a regular routine for drinking fluids
  • Consider reducing the person’s caffeine intake by using decaffeinated coffee and tea
  • Observe the person’s toileting patterns and suggest they use the toilet at regular times that follow their pattern
  • There are many aids and appliances.

Communication

  • Use short, simple words to give instructions step by step
  • Watch for non-verbal clues such as pulling on clothes, agitation, flushed face
  • Use words which are familiar to the person
  • Do not rush the person
  • Reassure them

Environment

  • Is the distance to the bathroom too far? A commode may help
  • The bed may be too high for the person to feel safe getting in and out
  • The floor and toilet seat may be the same color. Try using different colors for contrast
  • Can the toilet paper be easily seen? A contrasting color to the wall may be helpful
  • The person may have difficulty undressing
  • A lack of privacy may be inhibiting
  • Poor lighting may make the toilet difficult to find
  • Is the toilet clearly marked? Put a sign on the door, use a night light or leave the door open
  • If the person is urinating in inappropriate places, try to remove any objects that may be mistaken for a toilet
  • When using a public toilet the person will usually need help.

Bathroom aids

  • A raised toilet seat and wall grab-bars may help the person get on and off the toilet
  • Make sure the seat is fastened securely to the toilet to reduce the risk of slipping
  • Avoid floor mats to prevent the fear of tripping.

Clothing

  • Simplify clothing. Use Velcro tape instead of buttons or zippers
  • Try elastic waistbands for trousers or wrap around skirts
  • Try not to let the person become accustomed to wet clothes
  • Select clothing that is washable and does not need ironing
  • Protective garments and disposable pads may be useful.

In the toilet

  • If the person is having trouble urinating, try giving them a drink of water or running the tap
  • If the person is restless or hyperactive and will not sit on the toilet, allow them to get up and down a few times. Music may have a calming effect. Try giving something to distract them while they are on the toilet.

Skin care

  • Skin care is very important. Wash the skin after an accident to keep it clean and dry and to prevent rashes. Your local pharmacist can help with soaps and skin creams
  • Make sure the person’s skin does not come in contact with protective plastics as this will cause soreness.

Constipation

  • Try a high fiber diet and be sure the person is drinking at least 6-8 glasses of water a day
  • Plenty of regular exercise will help
  • Try and establish a routine to help keep track of the person’s bowel movements. People with dementia may forget when they have gone
  • If constipation persists, always see your doctor.

Adapted from Understanding difficult behaviors, by Anne Robinsons, Beth Spencer and Laurie White.

Remember

It is important to respect privacy and dignity. Losing control can be humiliating and embarrassing and families and care partners need to be sensitive to these feelings. There are bound to be accidents, so try not to worry too much. Get help in managing the problem and make sure that you take adequate breaks.

Dressing

Getting dressed can be a very complex and overwhelming task because there are so many steps involved. Helping a person with dementia to get dressed can be extremely time consuming and emotionally exhausting, especially if the person is not cooperating. Each person with dementia will react in an individual way and therefore an approach is needed which works best for both you and the person with dementia.

Reasons why a person with dementia might have problems dressing

Physical or medical causes

Depression, or a physical illness can cause a loss of interest in personal hygiene. Changes may have occurred in gross motor skills, creating problems with balance or walking. The changes may be with fine motor skills, causing problems fastening buttons or closing a zipper. The person with dementia may have impaired vision. The side effects of some drugs can cause dizziness or stiff joints.

What to try

Organize for the person with dementia to have:

  • A thorough medical examination to discover any possible causes or medication reactions contributing to problems with dressing
  • Their vision or glasses checked
  • An evaluation for depression, particularly if the person is frequently unwilling to get up or get dressed in the morning.

Forgetting how to dress

Some people with dementia can’t remember whether they are getting dressed or undressed. In addition, they may forget to change their clothes, put them on in the wrong order or put on many layers of clothes. They may realize they have an item of clothing but have no idea which part of the body it goes on.

What to try

  • Careful prompting or reminders may help the person get dressed independently
  • Set out the clothes in a pile with the first item to be put on at the top
  • Try using the task breakdown technique. This involves breaking the task into simple, manageable steps and doing them one step at a time. You may have to gently remind the person with each step, or do several of the steps yourself. Reassurance and praise for each successful step will make the task more pleasurable for both of you.

Problems with the environment

Noise, people, bright lights and clutter in the room can be distracting for a person with dementia trying to get dressed. Some older people, and especially those with dementia, have different temperature needs. Sometimes you will feel that it is oppressively hot inside the house, while the person with dementia finds the temperature quite comfortable.

What to try

  • Remove other distracting items such as out-of-season clothes
  • Make sure the room is warm enough for the person with dementia
  • Provide adequate lighting. Also make sure that the light in the wardrobe is at the same brightness as the light in the room, so that the person won’t have to get used to different light levels.

Lack of privacy

Getting dressed is a very personal and private activity for most of us. Many people have never dressed or undressed in front of another person and this can be an uncomfortable experience. When a person needs assistance it also conveys the message that they are no longer able to care for themselves. This loss of independence can be very difficult to accept.

What to try

  • Close the door and pull down blinds to create a feeling of privacy
  • If the person is able to manage most of the tasks, it is far better to leave them to it and assist from a distance, intervening only when necessary.

Problems deciding what to wear

It is important to encourage a person with dementia to select their own clothing, although for many it may be difficult to make even simple decisions.

What to try

  • Simplify the number of choices. For example, offer two outfits to choose between, or offer a choice between a white shirt and a blue shirt
  • Lay out articles of clothing in sequence on the bed. They should be arranged in the order that they are meant to be put on
  • Try laying out lightly colored clothing on a dark bedspread. For someone with visual problems, contrasting colors may help a person with dementia see articles of clothing from the background color of the bedspread.

Impaired senses

Putting on many layers of clothing regardless of the weather. Judgment and the sensation of hot and cold can be impaired in some people with dementia and they may put on many layers, regardless of the weather.

What to try

If the extra clothes are not causing any discomfort it is easier to leave well alone. It may be worth packing away extra clothing so that it is not visible.

Problems with frequent undressing

Some people with dementia may undress themselves frequently. This can be embarrassing and inconvenient, but they may no longer understand what is appropriate, and are not usually doing this to be provocative. Evaluate the situation:

  • Is the person too warmly dressed?
  • Do they need to go to the bathroom?
  • Are they tired and trying to get ready for bed?
  • Are they bored?

Choosing appropriate clothing and footwear

Maintaining a person’s individuality and style of dress is very important. Introducing clothing that is very different from a former style may cause more problems than it is worth.

However, the following hints may help to manage any problems with dressing:

Maintaining a person’s individuality and style of dress is very important. Introducing clothing that is very different from a former style may cause more problems than it is worth.

However, the following hints may help to manage any problems with dressing:

  • Select clothing that is washable and doesn’t need ironing
  • For some people, buttons, snaps, hooks, zippers and belt buckles are too difficult to manage. These can be replaced with Velcro tape which can be purchased at any fabric store
  • Busy, bright patterns on clothes can be distracting. Choose clothes with simple patterns and with solid contrasting colors as these tend to be easier for many people to see
  • Slip on shoes are easier to put on than shoes with laces and ties. Make sure shoes have non-skid soles.

Other considerations

  • In past times, many people did not change their clothes as often as they do today. It is important that you do not impose your own values about how often clothes need to be changed.
  • Rather than arguing with a person who wants to wear the same outfit day after day, it is often better to buy a couple of the same outfits and let them wear whatever they want.
  • Being reminded to change your clothes can be an embarrassing and humiliating experience. It is important to remember these feelings.
  • Any extra time taken to maintain independence is well worth it. Being able to dress yourself can make a person feel more independent and can build up feelings of pride and self-esteem.

Dental Health

Poor dental health can affect a person’s comfort, appearance, eating, nutrition, behavior and general health. Every person with dementia needs an individualized preventive approach to dental care that should ideally begin as soon as dementia is diagnosed.

People with dementia are susceptible to dental problems for a number of reasons, including:

  • Reduced saliva - Taking medications that reduce the production of saliva by the salivary glands. Saliva is essential to maintain a healthy mouth and to prevent the onset of dental decay and other oral lesions. Or having a reduced flow of saliva, even when not taking medications.
  • Medications -Or taking long-term, sugar based medications which can lead to tooth decay, dry mouth and difficulties using dentures.
  • Changed diet - Changed eating habits such as the replacement of main meals with small snacks or drinking sugared tea
  • Reduced dental care - Reduced abilities over time to maintain their tooth brushing and denture care.

The key to maintaining good dental health for someone with dementia is:

  • Help with dental care - Reminding and assisting people with their tooth-brushing and denture care.
  • Reduce sugar intake - Monitoring and reducing sugar intake where needed for people with natural teeth.
  • Use fluoride - Regularly using fluorides on natural teeth. This includes fluoridated tap water, toothpastes, mouth rinses and gels.
  • Regular dental check-ups - Regular dental visits with dental professionals who understand and are experienced in caring for someone with dementia.

Many people with dementia are unable to express discomfort or pain verbally. They rely on family and care partners to understand any changes in behavior that may indicate dental problems, such as not eating or constant pulling at the face, refusing oral hygiene care or other behavioral problems.

Care of natural teeth

Use of fluoride, antimicrobial and therapeutic dental products

  • Fluoride toothpaste - Fluoride toothpaste should be used to brush natural teeth whenever possible, once or twice a day if possible. After brushing with toothpaste, do not rinse with a lot of water and try to leave some toothpaste behind around the teeth to prolong exposure to fluoride.
  • Fluoride and antimicrobial rinses and gels - If tooth decay is evident, or the person appears to be at risk for developing decay, then the use of fluoride and antimicrobial products (like chlorhexidine). These rises and gels, which are only available at the chemist, will be the most effective in helping to reduce dental decay and gum disease. They should be used weekly, and can be put in a small spray bottle or atomizer to spray onto the teeth. Note that fluorides and antimicrobials should not be used within 2 hours of each other. Perhaps try using one in the morning and one at night. Speak to your dental professional about the best options for use.

Oral hygiene care

  • All surfaces of all teeth, especially the cheek surfaces, should be brushed using a soft toothbrush.
  • Electric toothbrushes, if tolerated, can be helpful.
  • Some people with dementia will require assistance with oral hygiene care as dementia progresses. Breaking down the task into smaller steps can be helpful. Some people find it easier to copy another person who is cleaning their teeth.
  • If brushing another person’s teeth, firstly explain, in their view, what you are about to do.
  • If the person with dementia clenches or spasms their lips and cheeks together, you can use a toothbrush bent backwards at 45 degrees. Bend the toothbrush by running the handle under warm water, then bending. Slide the bent brush into the corner of the mouth to break the muscle spasms and help lift the cheek out of the way.
  • Tooth brushing and denture removal may be easier from the front, side or behind. Experiment to find what suits you and the person with dementia.

Monitoring sugar intake

  • If sugar needs to be reduced, use artificial sweeteners in drinks and snacks - check this with the doctor if the person has diabetes
  • Try to use sugar-free snacks
  • Drink water or diet drinks with reduced or no sugar

Denture care

  • Rinse dentures after every meal and thoroughly brush them with a hard toothbrush, nailbrush or denture brush and plain soap and water.
  • Place a face washer in the sink and fill it with 5cm of water when cleaning a denture, so that the denture will not crack if it is dropped.
  • Dentures should ideally be removed overnight and soaked in water. Denture cleaning tablets are not necessary but can be used if preferred. Physical cleaning is the key.
  • Dentures can also be cleaned professionally on a regular basis.
  • All dentures of people with dementia should be marked for identification.
  • Partial denture clasps can be very damaging to oral tissues and the tongue if caught and can be more difficult to remove than full dentures.
  • In the later stages of dementia, it may not be possible to wear dentures.

Dealing with dry mouth

People with dementia frequently suffer from a dry mouth. Help the person to drink plenty of water, or spray water into the mouth using a spray bottle. Some medications and products are available that may help. Talk to the doctor and dentist about these.

Visits to the dentist

  • Regular check-ups are advised for all people with natural teeth and those with dentures
  • A thorough dental assessment should be done in the early stages of dementia, with a long term, flexible and uncomplicated preventive dental treatment plan made
  • Before a dental visit, discuss any environmental modifications such as reducing noise or the number of people around, transport issues, sedation or pre-medication needs with the dentist and staff.
  • Ensure a full medical history and a list of current medications is available for the dentist, preferably before a visit
  • The presence of a family member or care partner during a dental visit may also help
  • If eligible for public-funded care, contact the dental hospital closest to you as many have staff who specialize in the treatment of people with dementia and other medical problems
  • Inform dental professionals that they can contact Alzheimer’s Australia if they wish to discuss any issues or problems with a counsellor

The contents of this page are based on information provided by Associate Professor Jane Chalmers, a specialist in dementia dental health.

Hygiene

It is quite common for people with dementia to lose interest in, or forget about, personal hygiene. Although this can be upsetting for families and care partners, working out ways of coping without argument or confrontation can be worthwhile.

Types of hygiene issues

Toileting

A person with dementia may need help with toileting. Ensure that they are clean and dry and that underwear is changed as needed. If incontinence is a problem, make sure that they are washed carefully with warm water and dried thoroughly before putting on clean clothes.

Shaving

At first you may simply need to remind the person with dementia to shave each day. If they have been used to an electric razor, then they will probably be able to continue to shave without supervision for longer. If they are used to a traditional razor and begin to cut themselves regularly, you will need to supervise shaving or even do it for them.

Ears

A build-up of ear wax can be a problem for some people and can lead to unnecessary hearing impairment. Speak to the doctor about the best way to deal with ear wax.

Change of clothes

Changes of clothes are important for hygiene and personal freshness. Encourage the person to change regularly. It may mean tactfully removing dirty clothes at the end of the day and substituting clean ones. Try to choose clothes that wash easily and need little ironing to lighten the workload. Most people enjoy being complimented on their appearance, especially when wearing new clothes, or with a new haircut. It is important that a person with dementia has this experience as well.

Dental care

Regular visits to the dentist to check on teeth, gums or dentures are very important. It is always worth advising the dentist when you make the appointment that the person has dementia and may find it difficult to cooperate. You may need to remind the person to clean their teeth, or even do it yourself.

Fingernails and toenails

A person with dementia may forget about, or have difficulty cutting their nails. It is important that this is done regularly as uncut nails can lead to problems. It may be useful to enlist the services of a podiatrist. Consider whether the person enjoys having their nails painted and manicured.

Hair

You may need to spend time finding a way to wash hair that is comfortable for the person with dementia. Some people can become very distressed by having their hair washed. A visit to the hairdresser, or a hairdresser coming to the house may be a better alternative. Many people with dementia continue to enjoy having their hair cut and styled and this can continue to be a pleasurable experience.

Causes of hygiene issues

Possible causes of problems with bathing and some ways of helping;

Lack of privacy

Washing and dressing are intimate, private activities. Many people have never undressed in front of others and may be embarrassed or humiliated by their need for assistance. They may feel particularly embarrassed if they are incontinent and may refuse to bathe or change their clothes to try to disguise the problem.

What to try

  • Pull down the blinds, or close curtains and doors to create a feeling of privacy
  • Cover mirrors if they don’t recognize themselves
  • A great deal of reassurance and patience will be needed

Environment

The person with dementia may feel uncomfortable. The room may be too hot or cold, or produce feelings of claustrophobia. They may not be used to bathing or showering daily. In past times, many people did not bathe as often as they do today. It is important that you do not impose your own values about how often the person should bathe.

What to try

  • Make sure the bathroom is warm enough and inviting
  • Provide adequate lighting in the bathroom, especially during evening hours
  • It may be helpful to play soft music in the background to create a calming and relaxing atmosphere
  • Choose the best time of day for bathing and try to be consistent with the person’s bathing routine before the onset of dementia
  • Consider the time of day when the person is most relaxed and the type of bathing, such as bath, shower or sponge bath, that they are used to

Task is too confusing or complicated

Getting undressed, having a wash and brushing teeth can be very complex tasks because of the many steps involved. Some people with dementia may have a changed sense of perception of hot and cold water caused by damage to the region of the brain which regulates the “internal thermostat”. They may feel a different sensation from water.

What to try

  • Break down the tasks into simple steps, gently explaining each step. Use simple, respectful language.
  • Try offering limited choices – for example, "Would you like to have a bath or a shower?" or "Would you like to have your bath now or before bed?".
  • Let the person feel the water before getting into the bath. Sometimes gently pouring water over their hands reassures them that the water isn’t too hot. Saying something like, "the water feels nice" or "this feels good" can also be reassuring and calming.
  • Encourage the person to undertake as much as possible themselves.
  • Lay out the soap, washcloth, towel and clean clothes in sequence, so that they can be used as needed.

Fears

Fear of water can sometimes be a problem. A person with dementia may be unable to gauge the depth or temperature of the water and be frightened to step into it. Fear of falling may be another problem. Feeling out of control and powerless may add to a person’s lack of cooperation with bathing. The person with dementia may fear drowning, particularly if water is being passed over their head.

What to try

  • Prepare the bath ahead of time. Check the water level. Some people prefer only a small amount of water in the bath; others prefer more.
  • Try separating hair washing from bathing. Some people with dementia associate bathing with having their hair washed and become upset because it frightens them to have water poured over their head.
  • Allow plenty of time and encouragement to help the person maintain their skills
    Install a hand-held shower. Installation is very easy.
  • Special bathroom fittings such as rails can make bathing easier.

Eating

Meal times provide us with an opportunity to spend time with our family and friends, as well as sharing food together.

When caring for someone with dementia meal times can sometimes become stressful. Loss of memory and problems with judgment can cause difficulties in relation to eating and nutrition for many people with dementia. There are many ways to improve the situation.

Loss of appetite

Forgetting how to chew and swallow, ill-fitting dentures, insufficient physical activity, and being embarrassed by difficulties can all result in a loss of appetite.

What to try

  • Check with the doctor to make sure that there are no treatable causes for loss of appetite, such as acute illness or depression
  • Offer meals at regular times each day
  • Allow the person to eat when hungry
  • Encourage physical exercise
  • Provide balanced meals to avoid constipation
  • Try a glass of juice, wine or sherry, if medications permit, before the meal to whet appetite
  • Offer ice cream or milk shakes
  • Try to prepare familiar foods in familiar ways, especially foods that are favorites
  • Encourage eating all or most of one food before moving on to the next: some people can become confused when the tastes and textures change
  • Try to make mealtimes simple, relaxed and calm. Be sure to allow enough time for a meal. Assisting a very impaired person can take up to an hour
  • Consult a doctor if there is a significant weight loss (such as 2.5kg in 6 weeks)
  • Check with the doctor about vitamin supplements

Overeating or insatiable appetite

What to try

  • Leaving snack foods on the table may be enough to satisfy some people
  • Try 5-6 small meals each day
  • Have low calorie snacks available, such as apples and carrots
  • Consider whether other activities such as walks, or increased social contacts may help
  • Lock some foods in cupboards, if necessary

Sweet cravings

What to try

  • Check medications for side effects. Some antidepressant medications can cause a craving for sweets
  • Try milk shakes, eggnogs or low-calorie ice cream

Mouth, chewing and swallowing problems

Some causes of problems with eating may relate to the mouth. A dry mouth, or mouth discomfort from gum disease or ill-fitting dentures are common problems.

What to try

  • Have a dental check-up of gums, teeth and dentures
  • Moisten food with gravies and sauces if a dry mouth is causing problems
  • For chewing problems, try light pressure on the lips or under the chin, tell the person when to chew, demonstrate chewing, moisten foods or offer small bites one at a time
  • For swallowing problems, remind the person to swallow with each bite, stroke the throat gently, check the mouth to see if food has been swallowed, do not give foods which are hard to swallow, offer smaller bites and moisten food
  • Consult the doctor if choking problems develop

Problems at the table

Pouring a glass of juice into a bowl of soup, buttering the serviette or eating dessert with a knife indicate that a person with dementia is having difficulty at the dinner table.

What to try

  • Serve one course at a time and remove other distracting items from the table such as extra cutlery glasses or table decorations
  • Ensure that the crockery is plain and is a different color to the plain table cloth
  • If the use of cutlery is too difficult serve finger food
  • Eat with the person with dementia so that they can copy you
  • Make sure that they are not rushed
  • Keep noise and activities in the environment to a minimum
  • Ensure there is adequate lighting
  • Serve familiar food

Other considerations

  • Keep eating simple. Not all food has to be eaten with cutlery if this is becoming difficult. Finger food can be a nutritious and easy alternative.
  • Keep in mind a person’s history with food. They may have always had a small appetite, been a voracious eater or had a sweet tooth. While warm food is more appetizing, some people with dementia have lost the ability to judge when food is hot or cold. Beware of using Styrofoam cups which not only hold the heat for a long time, but also tip over easily.
  • Spoiled food in the refrigerator, hiding food or not eating regularly may all be signs that someone living alone needs more support.
  • Many people with dementia do not get enough fluids because they may forget to drink or may no longer recognize the sensation of thirst. Be sure to offer regular drinks of water, juice or other fluids to avoid dehydration.
  • Many eating problems are temporary and will change as the person’s abilities deteriorate.

Adapted from Understanding difficult behaviors, by Anne Robinsons, Beth Spencer and Laurie White.

Nutrition

The importance of good nutrition

The type of food we eat affects our health and our quality of life. Poorly nourished people get sick more often and recover from injury and illness more slowly. Poor nutrition is a major health problem for many older people.

For people with dementia, maintaining good nutrition presents extra challenges. A person with dementia may:

  • Experience a loss of appetite
  • Develop an insatiable appetite or a craving for sweets
  • Forget to eat and drink
  • Forget how to chew or swallow
  • Experience a dry mouth, or mouth discomfort
  • Be unable to recognize the food and drink they are given

Daily nutritional balance

The nutritional requirements of someone with dementia will be like other people of their age. However, some people with dementia experience increased physical activity such as pacing, which means they will need larger amounts of food to prevent them from losing weight.

Dietary guidelines for older Australians recommend:

  • Enjoying a wide variety of nutritious foods
  • Eating at least three meals every day
  • Drinking plenty of water
  • Eating plenty of vegetables (including legumes) and fruit
  • Eating plenty of cereals, bread and pastas
  • Eating a diet low in saturated fats
  • Choosing foods low in salt and using salt sparingly
  • Including foods high in calcium
  • Using added sugars in moderation

Common nutritional problems

Forgetting to eat

What to try

  • An alarm clock, or a phone call, may be a useful reminder at mealtimes
  • Snacks that are easy to eat and don’t need to be refrigerated can be left out where they can be easily seen

Can’t or won’t prepare meals for themselves

It can be particularly difficult for people with dementia who are living alone when they can’t or won't prepare meals for themselves.

What to try

  • Meals should be shared social occasions whenever possible
  • Delivered meals such as meals-on-wheels. However, these may not provide all a person’s daily nutritional needs or may not be what the person is used to eating
  • Home support to assist with meal preparation, serving and to discretely prompt with eating
  • Pre-prepared meals from the supermarket
  • Family and friends helping to prepare meals and or eating together
  • Preparing large quantities of food, then freezing into meal size amounts
  • Home delivered ready-to-eat food from restaurants or fast food outlets
  • Eating out. However, check first that the person with dementia will be comfortable with the venue and food
  • Stocking up on healthy snacks such as yoghurt, cheese or dried fruit that do not need preparation or cooking

Person with dementia is a heavy drinker

Alcohol may stimulate the appetite and add to the enjoyment of a meal. However, too much alcohol can replace food and people can run the risk of becoming malnourished. If a person with dementia is a heavy drinker it may be difficult to change their drinking habits.

What to try

  • Make sure that they are well nourished
  • Discourage drinking on an empty stomach
  • Offer drinks other than alcohol
  • Water alcohol down

Difficulty using cutlery

All food should be able to be eaten with dignity. If a person with dementia is having difficulty with cutlery, finger foods can be a nutritious and easy alternative.

Finger foods are simply foods prepared so that they can be eaten with the fingers. This enables people who would otherwise lose this level of independence to feed themselves.

What to try

  • Prepare a plate of nutritious and attractive food that can be picked up in the fingers
  • Make sure that the food is accessible. Put it on a flat plate with no pattern so that the food can be seen clearly. Make sure the plate is in comfortable reaching distance
  • Don’t use complicated table settings and avoid lots of different cutlery, crockery, glasses, foods and drinks together
  • Serve only one plate of food at a time
  • Impairment to taste and smell senses can reduce appetite - the preparation of tasty, strongly flavored and aromatic food may help
  • Allow time for the memory to respond
  • It may be necessary initially to help fingers to convey the food from the plate to the mouth
    It can help to eat together so that the person with dementia can copy you
  • Types of foods served need to take the culture and past eating habits of the person into consideration

Eating in the later stages of dementia

It is common for people in the later stages of dementia to lose a considerable amount of weight. People may forget how to eat or drink, or may not recognize the food they are given. Some people become unable to swallow properly.

Providing nutrition supplements may need to be considered. If a person has swallowing difficulties, or is not consuming food or drink over a significant period and their health is affected, nutrition supplements may be considered for consumption other than by mouth.

This information is based on Finger Foods for Independence: For people with Alzheimer’s disease and other eating difficulties, by Lois Newton and Dr. Alan Stewart, and Reduce the risk: A common sense guide to preventing poor nutrition in older people, by Carolyn Bunney and Rudi Bartl.

Sleeping

Problems with sleeping are a common occurrence for people with dementia. Some people sleep during the day and are awake and restless at night. Some are no longer able to tell the difference between night and day, while others are simply not as active as they used to be and consequently need less sleep.

Causes of sleeping problems

It is important to try to recognize what may be causing the problem – is it the environment, the dementia or the medications used? This will help to decide on which strategies may be helpful.

Some families and care partners find that keeping a log or diary may help them see the pattern of behavior that may be developing, enabling the cause of the problem to be pinpointed.

Physiological or medical causes

  • The brain damage caused by the dementia has affected the 'biological clock' in the brain, which directs our sleep patterns
  • Illness such as angina, congestive heart failure, diabetes or ulcers
  • Pain caused by such things as arthritis
  • A urinary tract infection which causes a frequent need to urinate
  • 'Restless legs' or leg cramps which can indicate a metabolic problem
  • Depression which causes early morning wakening and an inability to go back to sleep
  • Side effects of medication such as diuretics
  • Sleep apnea and snoring
  • A need for less sleep as a person gets older

What to try

  • Discuss with the doctor stopping or changing diuretic medication if you feel this may be contributing to the problem
  • Arrange a medical check-up to identify and treat physical symptoms
  • Treat pain with an analgesic at bedtime if the doctor agrees
  • Discuss with the doctor whether sedatives may be contributing to the problem
  • Ask the doctor whether an assessment for depression may be necessary
  • Ask the doctor about possible side-effects of medication
  • In some situations, it may be necessary to consider discussing with the doctor the appropriateness of either using tranquillizing medication or sleeping medication. The latter may be helpful in the short-term to establish a better sleep cycle, but both types of medication can have negative effects, such as increased confusion

Environmental causes

  • The bedroom may be too hot or too cold
  • Poor lighting may cause a person with dementia to become disoriented
  • They may not be able to find the bathroom
  • Changes in the environment, such as moving to a new home or having to be hospitalized, can cause disorientation and confusion.

What to try

  • Keep the environment as consistent as possible
  • Check whether the person is too hot or too cold on wakening. Dementia may affect their internal thermostat
  • Shadows, glare or poor lighting may contribute to agitation and hallucinations, so provide adequate lighting
  • Not recognizing self or others in a bedroom mirror may cause confusion. Moving the mirror may be helpful
  • Night lights might help cut down on confusion at night and may assist them to find the bathroom
  • If finding the bathroom is a problem, a commode by the bed might help
  • Make sure the bed and bedroom are comfortable. Familiar objects may help with orientation
  • Avoid having day-time clothing in view at night as this may indicate that it is time to get up
  • Try to make sure that they are getting enough exercise. Try taking one or two walks each day.

Other causes

  • Going to bed too early
  • Sleeping too much during the day
  • Over-tiredness causing tenseness and an inability to fall asleep
  • Insufficient exercise so that they do not feel tired
  • Too much caffeine or alcohol
  • Feeling hungry
  • Agitation following an upsetting situation
  • Disturbing dreams

What to try

  • Food and drink
    • Cut down on caffeine (coffee, cola, tea, chocolate) during the day and eliminate after 5pm
    • Cut down on alcohol and discuss with the doctor any possible interaction between alcohol and medication
    • If you think the person may be hungry at night, try a light snack just before bed or when they first wake up
    • Herbal teas and warm milk may be helpful
  • Daily routines
    • Try not to do any tasks that may be upsetting in the late afternoon
    • If the person is refusing to go to bed, try offering alternatives such as sleeping on the couch
    • If the person wanders at night, consider allowing this, but check that the house is safe
    • Try a back rub before bed or during wakeful periods
    • Try a softly playing radio beside the bed
    • Gently remind the person that it is night-time and time to sleep

Other considerations

Problems with sleeping or late evening agitation are often a stage in dementia that eventually passes. Many people with dementia sleep more during the latter stages of the condition

Sleep problems are amongst the most difficult symptoms of dementia. Families and care partners must be able to get adequate sleep themselves. Try to ensure regular periods of rest and regular breaks for yourself, as well as for the person with dementia.

 

Information adapted from © Alzheimer’s Australia 1999 Reviewed 2005, 2012, 2013, 2016