Day to Day Life
The impaired judgement caused by dementia can be a risk if the person has use of cheque books and cards. A joint account that requires two signatures for bank withdrawals and cheques, may offer a solution. However, a couple that doesn't already have a joint account should take advice before setting one up if it is possible that, at some stage, either party may have their assets assessed for the costs of residential care.
The ideas below might help:
You should check that the person with dementia, and you as a carer, are receiving all the benefits you're entitled to. Always check whether a benefit affects any others you are receiving.
There are 3 benefits you should certainly check:
- Attendance allowance or disability living allowance
- Care allowance
- Pension credit
For further information we suggest you contact
www.workandincome.govt.nz
or
phone 0800 737 777. Alternatively you can contact your local branch of Work and Income New Zealand.
You may also be entitled to a Community Services Card, which will reduce the costs of a range of medical services.
Phone 0800 999 999 for more information.
In the early stages of the disease, the person with dementia may be able to cope with providing their own food, with some help with shopping and a few prompts around the kitchen, or perhaps a meal delivery service. As the dementia progresses it may require someone to be present for at least one meal a day to ensure that they are actually eating enough. They may forget to eat or how to cook food properly.
Older people often have reduced appetites and inevitably lose weight, particularly in the early stages of dementia. Not eating or drinking enough can worsen the symptoms of dementia and affect their general health. While a balanced diet is to be encouraged, the key is to eat and drink plenty and regularly.
Here are some tips for helping someone with dementia to eat and drink enough:
- leave snacks such as biscuits or fruit around the house - perhaps next to the person's favourite chair, on the kitchen table, or by the bed
- put pictures on cupboard doors or even remove the doors completely, to help the person find the food they want
- a 'bar style' fridge with a glass door may also be helpful
- if the person has a favourite food, better for them to eat it frequently than not to eat enough
- try offering milkshakes and protein drinks which help with weight management and are quick and easy
- serve on plates that make a bold statement – such as a bright blue plates – this assists with stimulating the appetite
- people with dementia may not check 'use by' dates or realise food is unsuitable for consumption. Regular checks of their food supply may be needed.
- offering finger foods that don't need cutlery may make it easier for the person to continue to feed them self
- encourage use of adapted cutlery which is easier to hold
- serve food on plates with raised edges
People's tastes may change as their dementia develops. They may suddenly start - or go back to - having sugar in their tea or go off their favourite food, or revert to particular dislikes. Ask what they really fancy for dinner or as a treat. It may seem like extra work but could be worth a stress-free mealtime.
In the later stages of dementia, you may need to feed the person you care for:
- try to be at eye level when helping - maintaining eye contact helps to keep them engaged
- try to make sure you have plenty of time so the mealtime isn't rushed
- try to feed the person slowly, attracting their attention before placing the food into their mouth
- a tip from our own care staff is to ask someone to feed you so you can see how it feels and how to do it well.
Dressing
Maintaining a person's choice and involvement in their clothes for as long as possible can help to keep a sense of identity and dignity.
Here are some tips for helping the person with dementia to dress for themselves as long as possible
- try to leave enough time to avoid feeling rushed and stressed
- offer simple choices such as 'would you like the red or blue jumper' rather than 'what would you like to wear today'
- if they get it wrong, keep it in perspective - does it matter if buttons are not fastened correctly?
- lay clothes out in the order they should be put on, or hand each item to the person in the correct order
- if instructions are needed, keep them simple. Demonstrating may also be useful
- change fastenings from buttons and zips to Velcro to help dressing easier
- it may be useful to label drawers and cupboards where different clothing is kept.
Washing and bathing
Personal hygiene routines are a common source of anxiety for people with dementia and their carers, so this needs to be handled sensitively. The individual will have been carrying out their own personal hygiene activities since they were a child, so requiring help or becoming dependent on others can be embarrassing and awkward, both for the individual and you as their carer. This is a key area where prolonging independence for as long as possible and offering unobtrusive help is important.
Some tips you may find useful:
- encourage the individual to continue with their own routines for as long as possible
- the person may need some prompting, such as handing them a hairbrush to brush their own hair
- encourage involvement and choice, such as 'which bubble bath would you like?' or even 'do you want a bath?' Try not to give too many choices at once however as this can be confusing for them
- thorough drying is important. This can be made easier by allowing the individual to sit for a while in a clean towel or bath robe
- if the person spends a long time sitting or in bed, check for red areas or sores on their skin while they are undressed. These can be the first sign of 'bed sores'.
Allowing the person some privacy to undress or to bathe if they desire will make bathing easier for you both:
- you could leave the room while they undress and get into a dressing gown before walking them to the bathroom
- run the bath for them and allow them to step into it with a towel round them
- you could have the thermostat on your hot water cylinder adjusted so they can't scald themselves if they run the bath themselves
Using the toilet
Continence problems can be very distressing for both the individual and carer. Controlling urges to go to the toilet is taught at an early age and losing this ability can make an individual feel they are losing control of their dignity and life. Many people find it hard to accept help with such an intimate area and they may try to hide their continence problems. Treating the issue in a matter of fact way, or using humour, may help prevent blowing it up into a bigger problem.
Some practical tips to make using the toilet easier:
- remind the person where the toilet is. A picture of a toilet on the door may help or even signs or arrows to direct them to it – or even having a different colour on your toilet door = and leaving others in the house the same colour
- installing hand rails will make getting on and off easier and may reduce the fear of falling
- try to ensure clothes are easy to undo
- moist toilet tissue can help wiping easier (available from most supermarkets)
- agree a sign that indicates the person wants to be removed from the toilet
- make sure the bathroom is well lit, warm and comfortable
- if the toilet is difficult to get to, for example upstairs, then a commode may be useful
- regularly remind the person to go to the toilet
- watch out for signs of needing to go, such as fidgeting or pulling at clothes
- try to establish a routine of going to the toilet before getting dressed.
Activities can really help improve the quality of life for the individual with dementia, as well as providing stimulation and helping them to express themselves.
In the early stages of dementia, encourage the person to continue any activities they already enjoy, if possible. This will help to maintain a sense of self-identity and purpose. You might want to find some activities that the person finds calming, or that enables you to spend calm, peaceful time together. For example, knitting, painting, watching cricket, gardening or listening to music together. You may want to recapture fun and enjoyment, so think about dancing or singing, a game of darts or a trip to a beauty salon.
The symptoms and capabilities of the person may change from day to day and people with dementia often have a short concentration span. To avoid frustration by inappropriate or ambitious tasks, here are some key points that may help:
- give plenty of encouragement to increase confidence
- be patient - don't step in and take over
- give instructions and guidance in short, clear sentences
- avoid giving too many choices or challenges as people with dementia find it hard to process multiple options
- keep tasks short to allow for reduced concentration span
- keep your sense of humour and try to enjoy spending quality time together
In the early stages of dementia the person may be able to cope relatively well on their own, supported by some adaptations around the home and regular visits to check on them. This may continue to be the best option for anything from a few months to a few years. However, dementia is a progressive condition and their symptoms and abilities will worsen. Preparing and planning, during the early stages, for their increased dependency can give you some time to consider the best option for all concerned.
If the person wishes to remain in their own home, there are obvious concerns about their safety and ability to cope. People with dementia can place themselves in danger due to their reduced concentration and impaired judgement.
They may:
- forget to lock or close windows and doors before going out or to bed
- if they have trouble recognising people, they may welcome strangers into their home
- leave food unattended
- leave ovens and gas hobs or heaters switched on
- leave water running
Some points on safety which may be useful:
- replace the telephone for one with bigger buttons and leave a large-typed list of important numbers by the telephone for use by the person with dementia or a neighbour in an emergency
- check whether your local police offer free home security checks
- use 'we don't buy at the door' stickers to put off opportunistic callers
- speak to gas, electricity and water companies about services offered for customers with disabilities. They may be able to install safety devices or adapted controls.
- consider replacing gas cookers or fires with electric ones
- make sure boilers and water heaters are regularly serviced
- install smoke and carbon monoxide detectors
- adapt taps to only let out a certain amount of water to prevent flooding
- remove locks from bathroom doors
Being diagnosed with dementia does not automatically mean that a person cannot drive – however safety must be the overriding factor and it is highly likely that as the dementia progresses they will lose their ability to drive safely.
For further information www.nzta.govt.nz