Caring for Patients with Dementia: Tips for Nurses Caring for patients with dementia and Alzheimer’s (the most common type of dementia) can present unique challenges, even for the most experienced nurses. Recognizing each patient’s unique likes, dislikes, needs, and routines is a vital part of delivering personalized care. Outlined below are tips for nurses and other healthcare staff to aid in the delivery of person-centered care.
Dementia by the Numbers The term dementia refers to diseases and conditions characterized by a decline in memory or other thinking skills that affect a person’s daily life and their ability to perform everyday activities. There are several types of dementia, and each type affects different areas of the brain, with some overlap. The impact of dementia on Americans is significant. In 2014, an estimated 5.2 million Americans had Alzheimer’s disease, according to the Alzheimer’s Association. In addition: One in three seniors dies with Alzheimer’s or another form of dementia. Almost two-thirds of Americans with Alzheimer’s are women. Alzheimer’s is the sixth leading cause of death in America. More than 500,000 seniors die every year because of the disease1. Highlighted below are tips for nurses and other caregivers for caring for patients with dementia. Communication Communication can become increasingly difficult for patients with dementia. Often dementia sufferers start out having difficulty finding the right word to describe objects. This can increase over time to the point that eventually the world no longer makes sense to the person. When communicating with dementia patients: Approach the patient from the front, whenever possible, which will help you avoid startling the person. Make eye contact with the patient to help hold their attention.
Minimize distractions, such as television/radio, and other people’s conversations. Speak clearly, calmly, and in short sentences, making one point at a time. Keep in mind that it will take the patient longer than the average person to process information. Listen to the patient carefully, and don’t ignore body language, which can represent up to 90% of communication. Be patient, and never talk down to or yell at patients with dementia. Eating and Drinking Eating and drinking can become a real challenge for people with dementia. They may have trouble identifying cutlery or food and drink items, or they may have difficulty opening packaged foods, cutting their food, and peeling fruit. Do the following to help patients. Place cutlery in the person’s hands, and explain what food and drink items are before putting them on their plate. If using cutlery is too difficult, give the patient finger foods; this allows the person to maintain some independence while making it easier to eat. Make sure the patient is properly hydrated, as dehydration can worsen confusion caused by dementia. If a person has difficulty chewing or swallowing, a speech pathologist may be able to help. Refer the patient to a dietician if they start losing weight, which is common with dementia patients because of changes in eating habits. Use picture images to help patients make food choices in advance and/or to remind the person of the choice they made prior to a meal being served.
Washing and Bathing Bathing is a highly personal and private activity, making it especially important to be sensitive and tactful when bathing patients with dementia. Getting undressed and being washed by another person can be very uncomfortable and embarrassing. To make bathing as comfortable and relaxed as possible, consider the following: Make sure the room is warm before washing/bathing the patient, as older individuals can be more sensitive to cold.
Keep bath water shallow if the patient is alarmed by or afraid of deeper water. Always explain what you are doing as you are doing it. Remove only one item of clothing at a time when giving patients sponge baths, especially if the patient is uncomfortable being undressed in front of others. Use a handheld shower, or opt for a bath for patients who find an overhead shower disorienting or uncomfortable. Set up everything you need before you begin to avoid having to leave the room or move around frequently during the washing or bathing process. If possible, play tranquil music in the background to help relax the patient and make bath time more pleasant. Toileting and Incontinence Like eating, bathing, and dressing, going to the toilet is a basic human activity, and having problems with incontinence can be a humiliating experience for people. Dementia can cause patients to forget to go the toilet or forget where the toilet is. Help patients by: Removing any obstacles in the way of getting to the toilet, Reminding the person to go the toilet or taking them there at regular intervals, Ensuring the person knows where the toilet is by showing them, Watching for signals that the person may need to use the toilet, such as fidgeting or getting up and down, Avoiding problems with incontinence at night by making sure patients have nothing to drink 2-3 hours before bed, and Making sure clothing can be unfastened quickly. Elastic waistbands are ideal over zippers or buttons. Walking off and Wandering People with dementia often feel compelled to walk, which can often lead to them wandering off and getting lost. Patients have a greater likelihood of wandering or walking off in unfamiliar environments like hospitals. Memory care technology that alerts nurses and CNAs when patients wander or stray from their daily habits can be an invaluable tool. This technology is an excellent complement to traditional nurse call systems since it provides vital information about patients, monitors their activity around the clock, and alerts caregivers to potentially urgent situations and changes in behavior. Keep the following in mind with regard to walking/wandering off: Many patients with dementia find it comforting to walk, while others walk when they are bored. If patients feel the need to walk, accommodate them to the greatest extent possible. Especially in unfamiliar settings, a patient may walk or wander in an effort to find something, such as a toilet. Help them find their way around. Certain types of dementia cause hallucinations and distortions in visual perception, which can be disconcerting and disorienting, leading patients to walk or wander. Encourage the
patient to tell you about what they are experiencing, and help reassure them that they are safe. A patient who is in pain may walk in an attempt to “escape” the pain. Be aware of this, and ask patients who walk or wander if they are in pain. People with dementia often become confused about the time, and may even get up and get dressed in the middle of the night. Make sure one or more clocks are visible for patients at all times. Patients with dementia may walk to “find someone” from their past or fulfill duties they used to perform, such as taking care of children, going to work, or cooking meals. Gently remind the patient that they no longer need to do these things, and help the patient find fulfilling activities to occupy their time. Dealing with Unpredictable/Challenging Behavior An unfamiliar environment, such as a hospital, can be stressful for people with dementia. This can cause or worsen behaviors like shouting out or acting aggressively. Providing patientcentered care and recognizing why patients are behaving as they are will help. Here are tips for dealing with challenging behavior: Make sure a patient’s needs are met and that they are not bored or in pain. When patients feel frightened, embarrassed, or disoriented, they may act out. Try and establish what the person is trying to communicate—are they in pain, hungry, or confused? Identifying and meeting a patient’s needs will help reduce aggressive behavior. It’s critical for nurses and other healthcare professionals to remain calm and avoid fighting with patients with dementia, which will only escalate the situation. If the person is getting physically violent, give them their space, and only restrain them if absolutely necessary. Restraining an already angry person often makes the situation worse. Anxiousness and restlessness are signs that the person may soon act out aggressively; try to mitigate the situation before it escalates. Keep in mind that when a patient with dementia acts aggressively, it’s not deliberate, and although their behavior may appear to be targeted at you, it’s more likely they are venting their frustrations on you simply because you’re there. Talk to patients with dementia about what is upsetting them, and do your best to meet their needs.