Key points

Introduction

Five basic caregiving principles for people with dementia

Although caregivers have to adjust care plans according to the progress of the disease, the five basic caregiving principles remain unchanged.

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Principle 1: Maintain the ability to perform self-care activitiesExpand

Assist the person to take care of himself or herself and carry out routine tasks as far as possible. This can also help to reduce caregiver stress.

Principle 2: Maintain various functionsExpand

In order to compensate for the decline of cognitive functions, maintaining or improving the remaining abilities is essential for slowing the progress of the disease. Areas of concern include:

Principle 3: Solve the root causes of problems in activities of daily lifeExpand

Different people may have the same problem or behaviour for different reasons. You may solve the problem or stop the problematic behaviour through the following three steps:

  1. Example 1: Refuses to bath

    • Root causes

      • Embarrassment.
      • Forgetting steps.
      • Fear because the bathroom is too dark.
      • Feeling tired when having to stand.
      • Believing he or she is clean.
      • Does not have the habit of bathing.

    • Possible solutions

      • Have family members or care workers of the same sex assist the person to bath.
      • Provide supervision when the person baths.
      • Install more lighting.
      • Provide bathtub transfer boards or shower chairs.
      • Remind the person that bathing is a daily habit.
      • Allow the person to bath two or three times a day.
  2. Example 2: Repeating the same sentence, as in “Dinner.”

    • Root causes

      • The issue is very important to the person.
      • Low self-trust.
      • No topic for conversation.
      • Confusion over time.

    • Possible solutions

      • Comfort the person with comments like "Smells good, right? You can wash your hands first. Dinner will be ready soon."
      • Praise the person with words like "Thank you for reminding me to cook dinner."
      • Divert attention, saying something like "You are waiting for dinner. Oh, vegetables are your favourite. What should I buy this season?"
      • Teach the person to watch the clock with instructions like "We will have dinner when the two arms become the letter I."

(You may revisit the content in "Communication Skills".)

Principle 4: Provide support, time, and cuesExpand

Cognitive functions will decline as the disease progresses. Caregivers have to adjust their expectations and level of assistance accordingly, such as by providing more appropriate cues and giving the person more time.

  1. Example 1: Refuses to bath

    • Expectation

      • Early stage: Independent
      • Moderate stage: Needs some assistance
      • Late stage: Need full assistance

    • Handling

      • Early stage: Give more time
      • Moderate stage: Provide cues
      • Late stage: Put on the clothes for the person
  2. Example 2: Talking

    • Expectation

      • Early stage: May speak more slowly but can carry on conversations
      • Moderate stage: Frequent pauses and use of pronouns
      • Late stage: Incomprehensible sounds

    • Handling

      • Early stage: Give more time
      • Moderate stage: Clarify the meaning of the pronouns, provide choices in the questions
      • Late stage: Observe the person's nonverbal expressions
Principle 5: Provide a suitable environmentExpand

Assist the person to build up daily routines including regular exercise and a specific time to sleep. Improve the home environment with such things as more suitable furniture, equipment, lightings, and temperature controls. (See more details in "Environment & Technology".)

Summary