Dementia - Home Treatment

Home Treatment

Home treatment for dementia involves teamwork among health professionals and caregivers to create a safe and comfortable environment and to make tasks of daily living as easy as possible.

A diagnosis of dementia can create feelings of anger, fear, and anxiety. A person in the early stage of the illness should seek emotional support from family, friends, and perhaps a counselor experienced in working with people who have dementia. Professional counseling may help the person accept the diagnosis and develop coping strategies.

If the condition is diagnosed early, people with mild dementia can be involved with their doctor and caregivers in planning for the future and organizing the home and daily tasks. Dementia progresses at different rates in different people, so a person may have many months, or even years, of stable functioning. People with dementia may be able to stay mentally and physically active for years.

People with dementia and their caregivers face many challenges, such as:

• Whether the person should continue driving. Taking away driving privileges may reduce the person's sense of independence and increase dependence. But it is extremely important to prevent the person from driving when it is no longer safe. People in the very early stages of dementia should have their driving performance checked to make sure they can drive safely. Their doctor should reassess their level of functioning every 6 months.
• What financial and legal planning will be needed. As soon as possible after dementia is diagnosed, the person should write a living will and assign a durable power of attorney for health care. These documents will ensure that the person's wishes for medical care, especially life-sustaining treatment, are recorded. For more information, see the topic Writing an Advance Directive. Family members should also locate all documents necessary to assess the legal and financial affairs of the person. These include prior tax returns, health and life insurance policies, pension information, deeds, mortgages, bank accounts, and investment information.

Other issues for caregivers

Many people who have dementia are cared for at home by partners or other family members and friends. Taking care of someone with dementia can be physically and emotionally draining, but tips and other help can make it easier.

• Make sure your home is safe. Keep rooms uncluttered, with clear walkways. Lock up knives, cleaning supplies, and other dangerous substances. Remove throw rugs and consider installing carpet to help prevent slipping. Install handrails, tub mats, and other assistive devices in the bathroom. Provide good lighting, and put night-lights in bedrooms, hallways, and bathrooms.
• Maintain good nutrition. Offer food more often, including healthy midmorning and midafternoon snacks. If the person has trouble using a spoon or a fork, serve finger foods. Serve one food at a time; choices can be confusing. If the person is losing weight, consider offering a liquid nutrition drink, such as Ensure.
• Manage sleep problems. Keep the person awake and active during the day. Discourage napping unless doing so causes more problems. Offer warm milk or caffeine-free herbal tea before bedtime. A warm bath close to bedtime may help the person relax.
• Manage bladder and bowel control problems (incontinence). Encourage the person to use the bathroom on a regular schedule, such as every 2 hours. Mark the bathroom and toilet clearly with signs; use pictures when the person can no longer understand words. Consider using absorbent pads or briefs such as Attends or Depends. If incontinence is a new problem, make sure it is not caused by another condition, such as a urinary tract infection.

Some people with dementia develop behavior problems, such as aggression. These problems can be especially challenging for caregivers. The following strategies may help.

• Make the most of remaining abilities. It is important to give the person tasks and activities that occupy him or her without pushing too much. Tailor tasks to the person's abilities. For example, if cooking is no longer safe, ask for help in setting the table or making simple dishes such as salad. Reinforce and support the person's efforts to remain independent, even if tasks take more time or aren't done perfectly.
• Help the person avoid confusion. Label often-used rooms, such as the bathroom, and objects. Keep regular routines for daily activities such as meals, baths, and hobbies. Keep furniture, lamps, pictures, and other objects in the same place.
• Understand behavior changes. Strange or disruptive behaviors can be one of the most difficult problems for caregivers. The person may do certain things repeatedly or insist on unusual routines or activities. Think about whether the person's unusual behaviors might be motivated by an urge to continue past activities or habits. If so, you may be able to find ways to change the person's environment and set up daily routines that make these behaviors less of a problem.
• Manage agitation. Keep noise levels low and voices quiet. Develop simple daily routines for bathing, dressing, eating, and other activities. Tell the person in advance about changes in his or her regular schedule (trips, doctor visits), and remind the person often of the upcoming event.
• Manage wandering. Try to figure out why the person wanders. A person who wanders at a certain time of day may always have taken a walk or gone to work at that time. Lock outside doors, and use alarms and other devices to alert you when the person wanders. Get a medical ID bracelet for the person so that you can be contacted if he or she wanders away.
• Communicate successfully. Use short, simple, familiar words and sentences. Explain your actions. Be calm and supportive. Use eye contact and use touch to reassure. Don't argue. Offer reassurance and try to distract the person.

Caregivers should remember to seek support from other family and friends. Get counseling, find a support group, and make use of adult day care or other services to help you through stressful times and bouts of burnout. For more information, see the topic Caregiver Tips.

Nursing home placement

Even with the best care, a person with progressive dementia will decline, perhaps to the point where a caregiver is no longer physically, emotionally, or financially able to provide care. The person may develop uncontrollable behavior problems or may have other medical conditions that the caregiver cannot manage.

Several types of assisted-living arrangements are available, although many people with dementia will need full-time care at some point. Making the decision about nursing home placement is often very difficult. Every family needs to consider its own financial situation, emotional capacity, and other issues. For more information, see:

Should I put my relative with Alzheimer's or other dementia in a nursing home?