Coping techniques: Caregivers for loved ones with dementia

Please note that you should always consult with your physician before making any changes in your diet, your level of exercise and activity, medication or behaviors related to substance use.

The best way to make use of these techniques is to read through them, select three that stand out to you and practice them. I would be glad to hear from you on your responses.

  1. The very first coping technique is to connect your loved one to a doctor who can address and possibly treat their symptoms of dementia on a biological level.
  2. Bright light therapy has been show to partially counteract sundowner’s syndrome (an increase in disrupted/disruptive behavior observed in people experiencing dementia with an onset in late afternoon/early evening). Light therapy can consist of simply being aware of the available light around the person experiencing dementia—that in general noon is brighter than dusk, that some rooms are darker or lighter than others. Changes from daytime light to dimmer lamplight have been associated with higher levels of disorganization, making the environment seem more overwhelming. It was reported that placing a full-spectrum fluorescent lamp (between 2,500 and 5,000 lux) about 1 meter from the sundowning person within his or her visual field for a couple of hours in the morning may change their circadian rhythm, and decrease their levels of agitation and confusion later in the day.
  3. If the person for whom you’re caring is experiencing hallucinations or delusions, advise their physician of these symptoms, making sure to provide the physician with a full list of medications they’re currently taking. Rather than arguing with the person that he or she isn’t “really” hearing or seeing what they’re responding to, comfort them if they’re distressed. If possible move them into another room where there might not be the same environmental cues for their perceptions, or turn off the television or radio. Distract them with something they find pleasant, or by engaging them in conversation. Make certain there are no objects around with which they could harm themselves or others.
  4. If the person for whom you’re caring is experiencing paranoia, consider whether there might be some basis to this. Ill or elderly people are sometimes taken advantage of by others. Therefore make certain that they’re safe from abuse and theft. Because paranoia can be a response to memory loss, consider that the person might not recognize people with whom he or she would ordinarily be familiar. Address them by name and identify yourself or others in the room. Rather than arguing with them, reassure them that they’re safe. Distract them with an object, such as a photograph or treasured possession, and talk to them about this.
  5. Physical discomfort and illness may be expressed as behavioral abnormalities. Aggression, yelling or refusing to eat may be attempts to communicate pain or symptoms of illness to a caregiver in order to obtain relief. They may also be expressions of frustration at the inability to complete simple tasks, to make choices or to find the right words. They could as well be a response to confusion in the face of changes of environment or people, too many people or too much noise. Useful responses include remaining calm and speaking calmly, listening to their concerns and showing them that you understand their frustration or distress. Maintain as constant a routine as possible, and reduce the amount of clutter around them. Consider limiting the person’s access to sugar, caffeine and alcohol, while providing otherwise tasty treats as a distraction. If the person becomes physically aggressive, striking out, remove yourself and any others to a safe distance so that you’re not at risk for being hurt, but close enough that you can continue to monitor them, until the behavior stops.
  6. Decrease the amount of noise in the environment when possible. This might include speaking more quietly, moving away from loud conversations or traffic and reducing background noise.
  7. When giving instructions keep them simple. Use short sentences. Try changing the words you use in order to get around a bit of incomprehension. For instance, if the question “Are you ready to go to the store?” isn’t understood, try “Let’s go for a drive.”
  8. When speaking with the person make direct eye contact and use their name. Be aware of how you might appear to them (facial expression, posture, one of voice, even clothing) and if necessary make adjustments so as not to seem threatening. Engage them in a two-way conversation as much as possible. Make use of touch, if appropriate, such as stroking or taking their hand. Try not to interrupt them when they speak.
  9. Limit the number of choices that you offer in order to decrease confusion. Ask yes or no questions (“Are you cold?”) rather than open-ended ones (“What’s the temperature like?”) to provide them with structure for their responses.
  10. Stick to a stable daily routine.
  11. Keep the person mentally occupied during the day. Include some physical activity.
  12. Develop a behavioral plan to implement when behavioral abnormalities are initiated. This could be a simple engaging activity.
  13. Monitor the person’s television viewing habits, especially in the evening hours. Redirect them from violent or frightening programs, which because of confusion might not be distinguishable from reality. Consider having copies of their favorite movies available for evening viewing.
  14. Holding someone’s hand, or lightly massaging their hand, may effectively decrease distress.
  15. Make use of validation. Ask the person what it is they want. Even if this is something that can’t be provided or doesn’t seem to make sense (such as contact with someone who has died) don’t challenge their expressed need. Allow them to express their loneliness or grief. Support them in reminiscing—ask them what that person or situation was like, what do they remember about it, what did they most like about it, what do they miss most. Reflect what they say back to them so that they know you’re hearing them. Join with them in their feelings. Tell them “That must feel sad” if sorrow or grief is what they’re expressing.
  16. Support them with reality orientation. Remind them what day and time it is, where they are, why they’re here and who you are.
  17. Support the person in reminiscing. Have them recall episodes from their life. This can be supported with photograph albums, scrapbooks or yearbooks, music from different stages of life or meaningful objects.
  18. If the person is currently living in an institutional setting enrich their immediate environment as much as possible in order to decrease confusion and enhance continuity. Pictures, furnishings, bedding such a favorite blanket or comforter can be helpful.
  19. If possible engage the person in recreational activities. Such engagement is associated to fewer episodes of disruptive behavior.
  20. Whenever possible take breaks if you find yourself becoming frustrated. Consider seeking out and joining a support group for caregivers of people experiencing dementia. Your local hospital or medical center might have one in place.