Mr. Premnath RLecturer, Govt. College of Nursing

Thiruvananthapuram

CARE OF PATIENTS WITH DEMENTIA

• 30 million people with dementia worldwide currently, and this is likely to double every 20 year.

• There are about 1.5 million people with dementia in India and this number is likely to increase by 30% in the next four decades.

• In Kerala the prevalence of dementia was 34 per 1000 .

DementiaDementia is defined as a progressive impairment of cognitive functions occurring in clear consciousness. It is often associated with language difficulty, memory lapses, disorientation, poor judgment, and difficulty completing daily care routines such as dressing, eating, or hygiene tasks.

CAUSES OF DEMENTIA

• Many diseases leads to dementia .It can be either treatable or non treatable.

• Common treatable causes are depression, vitamin deficiency, head injury etc.

• Untreatable causes are Alzheimer’s dementia, Multi infarct dementia ,AIDS complex dementia etc.

WARNING SIGNS OF DEMENTIA• Memory loss that disrupts daily life.

• Challenges in planning or solving problems

• Difficulty completing familiar tasks at home, at work or at

leisure

• Confusion with time or place

• Trouble understanding visual images and spatial relationships

• New problems with words in speaking or writing.

• Misplacing things and losing the ability to retrace steps.

• Decreased or poor judgment

• Withdrawal from work or social activities

• Changes in mood and personality.

MAIN RULES :

· Don’t Argue

·Never Say “No”· Maintain Independence

·Improve self esteem and confidence.

·Never ask leading questions.

CARE OF A DEMENTIA PATIENT

Eating

• Ensure that the patients ate food.

• Provide well balanced diet.

• Cut down food into smaller pieces.

• Mix food and give it to them.

• Encourage soft and liquid diet and ensure that client drink enough water.

• Diet supplements like calcium and vitamins

Communication

• Use simple sentences with simple words.

• Speak clearly and slowly.

• Stand in front of the client and look into his face and talk.

• Give the patient time to understand before continuing with the next sentence.

• Observe clients verbal and non verbal responses.

• Don’t argue with the client.

• Use gestures, such as pointing to an object, or demonstrating the action to be done.

• Avoid distractions while talking to client.

Wandering

• Make sure that the person carries identity bracelet with name, address and telephone number.

• Relocate door locks to positions where the person will not look for them.

• Install bells and buzzers that sound when external doors are opened.

• Make the door less visible by painting it the same color, or covering it with a curtain

• Put a large stop sign on the door.

Prepared for wandering• Ensure patient carries identity

• Relocate door locks• Door bells• Stop sign

Bathing:

• Never leave patient alone.

• Encourage hygiene and avoid dependency on the caregiver

• Provide bath stools and grab rails inside the bathroom.

• Keep bathroom clean and dry.

• Check the temperature of water before bath.

• Keep familiar soaps, hair oils, shampoo to remind the patient about bathing.

• Observe for any injuries or sores while bathing.

Toileting

• Monitor for signs of constipation and dehydration

• Assist the patient to toilet at scheduled intervals

• Use signage or symbols leading to toilet.

• Use night lights ,or grab rails in the toilet

• Provide easily removable garments

• Keep the toilet clean and dry.

Dental care

• Monitor dental hygiene ,check for halitosis

• Assist with brushing daily

• Use soft bristled tooth brush

• Check mouth for any sores or ulcers

• Use correct fitting dentures

• Use emollients to prevent drying of lips

Grooming

• Assist with grooming, cutting and filing nails

• Never cut nails closely to avoid injuries

• Apply moisturizers and deodorants to avoid body odour.

• Comb hair properly.

Dressing

• Provide appropriate sized loose cotton clothes.

• Avoid zippers and complicated buttons in the clothings.

• Assist with wearing and removing clothes.

• Reduce the choices for clothing

ADAPT THE HOME FOR DEMENTIA PATIENTS

For reality orientation:

• Place large clocks with the numbers clearly written

• Place a large calendar, date display, so that the patient can see the date,

day, and month/year 

Reminder lists:

• Prominently placed stickies or whiteboards can help.

• Place the reminders close to where the patient will need them

• Messages about the food, Important phone numbers, such as emergency numbers, can be sticked .

Make it easy for the patient to make notes

• Leave notepads and pencils near the phone.

• Tie the notepad and pencil to some fixed object so that the notepad is not lost

• Label articles

Reduce chances of hurting

• Have fewer objects on the floor.

• Remove sharp objects like knives (keep them locked)

• Remove carpets and wires that can cause tripping

• Ensure all electric connections are safe and that there are no exposed wires

Reduce chances of confused interpretation

• Remove mirrors if patient gets frighten by reflection.

• Remove pictures ,masks and decorations which may haunt or frighten the patient.

• Use simple coloured bedsheets linen etc.

• Avoid bright or dark paint inside rooms.

For problems in handling things. 

• Have large, prominent handles on doors

• Use bigger spoons, and plates with blunt edges

• Use mugs with large handles.

For problems in getting up and in walking:

• Use stable, heavy furniture.

• Provide chairs with arms.

• Avoid sharp edges using tie cushions, stick foams etc.

• Install grab rails along the walls, bathrooms etc.

• Provide room and bathroom facilities at the ground floor.

• Place a safety gate at the entrance of the stairs.

• Provide walking sticks and walkers and wheelchairs, if needed.

General Safety

• Replace door bolts and locks with simple latches and hooks which can be opened from outside

• Keep all medicines, poisonous liquids, sharp objects out of reach/ locked

• Keep all electric outlets covered.

• Make sure all switches are safe.

• Keep the kitchen locked so that the patient cannot use it when alone.

• Switch off the gas regulator when not in use and position the gas such that the patient cannot reach the regulator.

• No match boxes or lighters visible in the house

• Install locks on all doors and windows leading outside.

Can you put a name to these faces? Those who struggled to remember famous faces could have dementia, Northwestern University Feinberg School of Medicine in Chicago