The challenges of living with, or caring for a person with dementia can be immense. The Alzheimer Association estimates that 4.5 million Americans have Alzheimer’s disease, a number that is likely to swell to 16 million by 2050. The disease process is progressive, and eventually impacts all areas of function: memory, thinking, problem solving, sensory, physical function, movement, emotions and behavior. But, the spirit of the person remains. The art of caregiving is being able to manage the changes through the stages of the disease, while nurturing and preserving the spirit of the person suffering from the disease. While caregiving is indeed an art, there are specific skills and techniques caregivers can use to support the person with dementia.
The overall goal is to provide person-centered care, as recommended by the Alzheimer’s Association. The first step in caring for the person with dementia involves understanding the changes the person is experiencing. In essence, it is helpful for caregivers to see the world from the eyes of the person with dementia.
Above all else, it is important to focus on what a person can do in the various stages of dementia, and what the person needs from the caregiver to function at his or her best.
Listed below is a list of helpful skills caregivers can use to improve the quality of life for a loved one:
Presentation or Approach. This refers to the way in which a caregiver approaches a person. Approach at eye level, in a calm manner, and slightly from the side. Allow time for the person to respond. The caregiver should make certain the person knows you are present, before doing anything else.
Simplification. Break tasks down into simpler steps, communicate in simpler phrases, and simplify choices.
Provide Routine and Consistency. Create a daily schedule that is predictable, and appropriately filled with activity to help the person with dementia be engaged, but not over-stimulated. Try to match the person’s prior routines to the usual daily schedule.
Provide Cues. Cues are prompts that serve to encourage a memory or prompt a person to start, continue and finish an activity. Cues can be visual, such as pictures. Other types of cues could be the use of sound, or aromas such as baking bread to cue mealtimes.
Mirroring. This is a type of prompt that depends upon the caregiver to demonstrate a motion or action as a way to encourage the person with dementia to start, continue or finish a task.
Hand over Hand Assist. This technique requires the caregiver to place a hand over the hand of the person with dementia, and guide him or her to begin an activity such as picking up a spoon.
The interactions caregivers have with their loved ones with dementia are critical to maintaining a positive lifestyle for your loved one. The following are types of interactions that can be helpful:
Evoke a Positive Emotion. The goal is to avoid arguments and power struggles, and instead, focus on conversations and activities that bring out positive, comfortable, and safe feelings in the person with dementia.
The 3 “R’s”: Reassure, Redirect and Re-approach. To reassure means to discern what the person is concerned about, and communicate that you understand him or her. Redirection is an approach that is used to distract a person to think about or do another activity. Re-approach is used when a person is not interested in performing an activity. The caregiver simply stops encouraging the person to engage in the activity, and
re-approaches at a later time.
Validation. This is a technique that encourages caregivers to see the world from the eyes of the person with dementia. The caregiver acknowledges, or validates, the world as the person with dementia is experiencing it. For example, if the person with dementia thinks it is 20 years earlier, then the caregiver agrees, and encourages activities and conversation around what the person was doing 20 years ago.
Use of Procedural Memories, Past Interests and Hobbies. Procedural memories refer to those habits, behaviors, personal interests, or past work and hobbies that a person has done over and over again in their lifetime. These “over-learned” skills are usually activities that generate a sense of success and accomplishment. For example, sanding a block of wood is an over-learned skill for a furniture maker. Feeding one’s self is also an over-learned skill, and one that a person can participate in well into the advanced stages of the disease.
Creating a Supportive Environment. Some of the key elements in a supportive environment include providing proper security when needed and the appropriate use of light and color. It is helpful to focus on what is important for the person to see, then ensuring there is adequate contrast of that item against a background (like a chair contrasting with the floor and wall). Reduction or elimination of background noise is highly recommended. Selection of non-busy, simple fabrics, window and floor treatments and wall hangings is also recommended. The availability of uncluttered wandering paths is encouraged.