Dementia is a syndrome in which there is deterioration in memory, thinking, behaviour, and the ability to perform everyday activities. It affects mainly older people (65 years old and above); it is not a normal part of ageing.
According to the World Health Organization (WHO), around 50 million people around the world have dementia, with nearly 60% living in low- and middle-income countries. Every year, there are nearly 10 million new cases and it is expected to reach 82 million in 2030, and 152 million in 2050. Much of this increase is attributable to the rising numbers of people with dementia living in low- and middle-income countries.
Alzheimer’s disease is the most common type of dementia and may contribute to 60–70% of cases. In the early stages, memory loss, forgetting once-familiar faces and struggling in recalling recent events are experienced.
The person could experience confusion, irritability, aggressiveness, mood changes, cognitive impairment, loss of memory, withdrawal, and emotional disorders. A problem like shortened attention span, difficulties with language, and an inability to think logically appears. People may also completely lose the ability to speak. Ultimately, conscious thought disappears.
The deterioration of cognitive and motor functions in a patient with Alzheimer’s disease also cause deterioration in the quality of life and psychosocial functioning of the patients. Long-term illness, such as Alzheimer’s, raises a lot of challenges for carers as well as for healthcare professionals involved in the delivery of care for patients.
Tips on how to look after someone with dementia
- Try to know their feelings and enter their world. They sometimes have delusions; if delusions are challenged, it can let them feel threatened and insecure. Always try to acknowledge their emotion and redirect their thinking. Focus on their feelings rather than words. For example, patients with Alzheimer’s may accuse someone of stealing. The carer must respond by saying: ‘You must feel worried that your items are missing. Let’s go look for it.’
- Avoid overstimulation. People with Alzheimer’s disease are sensitive to sounds, especially several sounds at once. Turning off the television and lowering the volume of music while people are talking and eating is a way to avoid confusion.
- Speak calmly. Don’t shout at them; a warm tone of voice can comfort them.
- Avoid using pronouns. The person may get confused about with ‘he’, ‘she’, ‘they’. Use nouns, common and simple word as possible. For example, instead of ‘sit there,’ say: ‘sit in the red chair’.
- Keep communication short, simple, and clear. Give one instruction or ask one question at a time.
- Always use leading statements rather than asking open-ended questions. It helps them to be clear about the task. ‘Would you like to eat fish and chips?’ is better than ‘What would you like to eat?’ A simple, inviting statement like ‘Let’s have fish and chips,’ is even better. Healthy communication can improve a person’s ability to manage their health status with self-esteem, dignity and sense of belonging.
- One can also use closed-ended questions also. Questions which can be answered ‘yes’ or ‘no’ can facilitate communication. For instance, you can ask: ‘Did you enjoy the porridge for breakfast?’ instead of ‘What did you have for breakfast?’
- Never carry a conversation with someone else as if the person wasn’t there. It can be quite challenging for them to follow. They feel that they are treated as if they don’t exist. Talk in front of the person as if they weren’t present. Always include them in any conversation when they are physically present.
- Haptic communication can be a good intervention technique. Haptic communication is communicating by touch. Touch is a way to speak without using words. It becomes important as the disease erodes language-oriented thought. Actions like patting or holding their hand, giving a hug, putting an arm around can be effective. Avoid talking on the phone.
- Don’t use statements as: ‘Do you remember?’, ‘Try to remember,’ ‘Did you forget?’ ‘How could you not know that’. These sort of questions may sound humiliating for the person. Avoid remarks such as: ‘I just told you that.’ Instead, just repeat it over and over.
- Smile and make eye contact. Use nonverbal cues like maintaining eye contact and smile so you can convey that you are glad to be with them. This can help to make the person feel at ease and will facilitate understanding.
- Say things that express positive emotions. Use of strong emotional messages like: ‘I enjoyed this so much,’ ‘I always feel good after talking to you,’ and ‘Seeing you is the best part of my day’. These positive statements can help them feel valued and loved.
- Make the most out of the last word. Patients focus on the last word in a sentence because it is easy to remember. If you ask: ‘Would you like to wear the pink or the blue dress?’ only the word ‘dress’ may linger in the patient’s mind. Instead, ask: ‘Would you like to wear this pink dress or the one that’s blue?’, and the person will say ‘blue’. By doing this, the person can feel that they have decided for themselves rather than being told what to wear. Making choices easier to understand can prevent them from being worried and anxious.
- Help people to maintain existing social relationships and form new ones. This can be achieved by facilitating joint activities with friends and family, joining hobby groups, and encouraging conversations.
As dementia progresses a person’s needs and abilities will evolve. You’ll need to adapt and learn how to cope with these changes. It may sometimes feel like you’re starting again with learning how to support the person you are caring for. You have to be patient and flexible to meet these evolving needs.
Manisha Dhami is a PhD student at Punjab Agricultural University. She carries out research in human development.
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