Dementia Caregiver Tips: How to Provide the Best Care

Dementia can affect one's language skills, such that the person with dementia (PWD) has difficulty understanding what was told or asked, cannot find the right words to express himself or recall the names of loved ones.

Such scenarios can be upsetting and frustrating for both the caregiver and the PWD. To better cope with such situations, caregivers should:

1. Minimise background noise and distractions to help the person with dementia focus.
2. Use short, simple words and sentences. Speak slowly and clearly.
3. Put on hearing aid and glasses to facilitate communication.
4. Avoid questions that require recall from memory.
5. Use a gentle and relaxed tone — a lower pitch is more calming.
6. Ask one question at a time and allow time for them to respond. Repeat information
   or questions if needed.
7. Turn negatives into positives, e.g. say “Let’s go here” rather than “Don’t go there”.
8. Treat the person with dementia (PWD) with dignity and respect. Avoid addressing the PWD the way you address a child.
9. Be patient and supportive. Smile often and assist the PWD with clues and hints when there is a language problem.

What to do if the person with dementia is uncooperative?

Try to understand why the person finds it unpleasant and make adaptations if necessary. Re-examine whether the activity really needs to be done or find a simpler way of doing it.

If needed, stop the activity and try again later, or talk to a healthcare professional experienced in caring for people with dementia.

Dr Vignesh Sivasamy, Consultant from the Department of Geriatric Medicine at Singapore General Hospital (CGH), shares about the various activities suitable for persons with dementia and easy ways to make a home safer for them.

Everyday activities can be classified into three categories:

• Self-care
• Leisure/Rest
• Work/Productivity

Examples of activities suitable for persons with dementia

How to encourage persons with dementia to do these activites

• Breakdown steps
• Provide necessary assistance
• Provide choices
• Provide a just-right challenge
• Focus on the process instead of the result
• Focus on signs of wellbeing
• Give positive encouragement, avoid negative comments

Examples of activity difficulty for persons with dementia

Persons with dementia often cannot remember where they are and sometimes see the environment as threatening. The following tips can help to promote a sense of security and ensure safety at home for patients with dementia. 

1. Prevent accidents before they occur

• Some accidents cannot be avoided. Do not blame or scold the person with dementia when an accident occurs. Identify and rectify the mistake instead.
• Allow plenty of time; do not rush the person with dementia into performing a task.
• If the person with dementia smokes, supervise cigarettes, lighters and matches, as unattended cigarettes are a fire hazard.
• Keeping stimuli to a minimum will help patient to cope with his/her surroundings and thus reduce dysfunctional behavior.
• Having visual cues such as pictures or labels on the outside of cupboards, wardrobes and drawers are also helpful in helping them remember where things are kept.
• Label objects or rooms and place clear instructions that can be easily followed at visible locations to allow the patient to adapt to everyday tasks and maintain independence. 

2. Use home safety devices

• Install gates at the top of stairs and secured handrails along the stairs.
• Install safety latches or locks on cabinets to prevent mishandling of dangerous items such as knives and cleaning products.
• Install electrical safety switches, gas leak detectors or smoke alarms if necessary. 

3. Remove clutter from the home

• Remove all unnecessary furniture as this may block the patient’s path and increase the risk of falls, especially if they are using walking aids.
• Put away items that may cause confusion. For example, do not leave shaving cream next to the toothpaste.

4. Remove items that may cause harm to the person

• Lock up or remove medications, cleaning supplies and insecticides.
• Put sharp objects, appliances and tools, such as razors, hair dryers and sewing machines in a place to be locked.
• Make sure electrical cords are secured and cannot be tripped over.

5. Provide good lighting

• Good lighting reduces illusions.
• Place night-lights in staircase, hallways, bathroom and bedrooms.
• Avoid lighting that casts shadows, which might cause the person with dementia to see things that are not there.
• Ensure your home has sufficient natural lighting to help the person stay aware of the time, day and the weather. 

6. Make the kitchen safe

• Remove knobs from your stove and oven when not in use or check with the Gas Company or an electrician about the best way to make your stove inoperable.
• Supervise cooking if the patient is still able to cook.
• Label items such as sugar, salt, flour, tea, coffee, etc.

7. Make the bedroom safe

• Remove or fasten down carpet, rugs, runner or floor mats to prevent slipping.
• Make sure there is a clear path to the bathroom or provide a bedside commode/ urinal.
• Avoid thick mattresses or beds that are too high. Low beds are safer for elderly who is at risk for falls.

8. Make the bathroom safe

• If your home has a number of rooms, ensure toilet signages (with illustrations) are available on the toilet door.
• Remove unnecessary items in the bathroom except essentials such as soap, towel, toothbrush and toothpaste.
• Use non-skid mats or strips on the floor or in a tub. Use a color that blends with the tub to prevent confusion.
• Install grab bars in the shower and around the toilet.
• Use a bath bench or a hand held shower.
• Ensure the temperature gauge on the hot water heater is turned low to prevent scalding.
• Keep the floor dry to prevent slipping on a wet floor.
• Remove locks from bathroom doors to prevent patient from locking him/herself inside.

9. Prevent wandering

• If the patient wanders, put latches higher or lower than eye level on doors and windows.
• Try a slip of yellow or red safety tape or a sheet hung across doorways to discourage wandering/ opening of the front door. A “STOP” sign or “DO NOT ENTER” sign may help.
• Avoid leaving items which may trigger the idea of wandering around the house, e.g. keys or handbag.
• Place a black mat or paint a black space on your front porch; this may appear to be an impassable hole to the person with dementia.
• Install “child-safe” plastic covers to door knobs.

10. Be prepared for emergencies

• Have a plan for fire and other types of emergencies. Post the plan near the phone with numbers for the police, fire department and doctor. Write legibly and in large bold prints.
• Keep recent photos handy to assist the police in case the patient wanders off.
• Get the patient to wear an identification tag or card that includes statement “Memory Loss”.
• Do not leave the patient at home alone at all times.

Stress and burnout are the most common problems experienced by caregivers. These can manifest as emotional outbursts, poor sleep, weight changes, lethargy, difficulties in concentration, and neglecting other roles and responsibilities.

Challenges of being a caregiver include:

• Lack of understanding of the disease
• Being unaware and unable to access the healthcare system
• Lack of familiarity with available community resources
• Negative impact on their work, marriage and family life due to caregiving duties
• Fatigue and exhaustion
• An “unequal” allocation of responsibility among family members
• Differences of opinion among family members on treatment and care, and disputes
• Unrealistic expectations on the caregiver by other family members
• Financial burden

When caregivers experience burnout they can no longer care effectively, and this has a negative impact on both the caregiver and the person with dementia.

This is where self-care is important. Taking time to rest and recharge and seeking help and support will not only keep caregivers healthy, but also make them better care providers.

Dr Vanessa Mok, Senior Consultant for Psychological Medicine, and Anuradha Kaliappan, a Senior Medical Social Worker, both from CGH, share ways to prevent caregiver burnout.

1. Take time out for yourself
2. Make use of community resources
3. Join a caregiver support group
4. Learn more about the disease
5. Share problems with and get support from family or friends. Family members can help give the caregiver a break by taking turns to care for their loved one
6. Community services such as dementia day care, respite care nursing home and home-based support services can help care for your loved one
7. Learn about the illness; write down your observations of the person. Keep records for quick reference when needed
8. Attend a caregiver’s training programme
9. Establish your caregiver role with health professionals
10. Start planning in advance for potentially difficult decisions
11. Tap into community resources like aic.sg; publicguardian.gov.sg
12. Make 'me' time a priority
13. Join a support group. Share your caregiving concerns with someone you trust
14. Give yourself the credit you deserve