An important concept in dementia care is to enable and encourage the person with Alzheimer's or de mentia to operate to the best of their abilities at all times. It is important to allow them to do as much for themselves (perhaps with your guidance) as possible. Not only does it give them self-esteem and a feeling of confidence that reinforces their willingness to do things, it helps them maintain their abilities as long as possible. If you start to do things for them that they are capable of doing, they will lose the ability to do it. This is referred to as "excess disability". It means that the loss of ability was caused by something other than the dementia.
For example, if the person one struggles with buttoning their shirt and you button it for them, they may stop doing it at all. Even though they are still capable of buttoning their shirt (albeit slowly), over time they may no longer be able to recall the steps involved because they are no longer using those steps. There is no physiological reason for the loss, it is caused by lack of practice. This is an excess disability. To minimize this, it is essential that you allow them to do for themselves as much as possible, even though it can be frustrating. There is more information on excess disability in this article.
Much can be done around the house to make it is as easy as possible for the person with dementia to continue doing things for themselves. If the person is having trouble with a task, rather than take it away, see if there is something you can do to make it doable. For example, if the person always did the laundry you may have to help them sort it before they can proceed. If the person always set the table, maybe you have to put the cutlery out on a tray rather than leave it to them to select it from the drawer.
If it seems that the person is unable to do something because they can't find the materials needed, try using signs and labels to help them. If you see them struggle to find the coffee mugs and because of that they don't pour their own cup of coffee, try labeling the cupboard where the cups are stored. That may help the person enough to get them going again. If the label "Coffee Mugs" doesn't work, you can try a picture of a coffee mug instead. If the person struggles with setting the dials on the washing machine, maybe attach an arrow to the machine pointing to the correct position.
If the problem seems to be that the person struggles with the steps involved in doing something, try using written instructions to help them. For example, if they struggle with getting a cup of coffee even after they find a mug, post instructions such as
- Get mug
- Get carafe
- Fill coffee cup
- Add sugar and milk
- Stir
You may have to add more steps such as "Get milk from fridge" and "Open coffee carafe". Use as few steps in the instructions as necessary to ensure that they can successfully complete the task. Things such as using the remote control, doing the laundry, making a pot coffee, checking e-mail are all examples of tasks that may be doable with proper written instructions.
EXAMPLES OF INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL)
- Banking
- Driving
- Cooking
- Using the Telephone
- Shopping
EXAMPLES OF ACTIVITIES OF DAILY LIVING (ADL)
- Dressing
- Bathing
- Toileting
- Walking
- Eating
These types of activities are known as "Instrumental Activities of Daily Living" and in addition to those described above include such things as banking, shopping, cooking and using the telephone. These are activities that are more complex than essentials such as bathing and getting dressed but are still necessary to allow independence. It is important for the person with dementia to maintain these functions as long as possible but they will decrease and disappear before the more basic functions.
Activities such as dressing, eating, bathing, showering and mobility are called "Activities of Daily Living". They are things that are vital to everyday life. Everything should be done to help the person keep these abilities as long as possible. It is extremely important that we support the person in doing these activities to the best of their abilities at all times. Maintaining these abilities allows them to be as independent as they can be for as long as possible. Independence leads to self-esteem which results in a higher quality of life.
Make it is as easy as possible for the person with dementia to be successful at each task. Lay out the necessary materials, undo any buttons on clothing, take away anything unnecessary to avoid distraction and confusion. Break down the task into steps and post a sign describing the steps along with pictures to help. Be sure to include enough steps in the breakdown that the person can complete the task successfully.
Assist them if necessary with these dementia activities, but let them do it. For example, in the earlier stages of dementia you might separate pants from shirts and ask the person to choose one of each to wear. As this becomes too difficult, offer them a choice of two shirts and ask them to pick one. Do not ask them what they want to wear, offer them a specific choice.
All of this can be frustrating because it takes time and effort, but it is critical. Not only does this help the person feel confident and capable, these same abilities will help them in other areas, keeping them at a higher functioning level for longer.