We often think of dementia as mostly about memory, but it also affects mood, behaviour, thinking and perception.
Unfamiliar environments can prove challenging
A person with dementia will do well with routine and familiar environments. Taking them out of an environment they know can sometimes be a challenge. I learned this the hard way. My mother seemed depressed in the early stages of the disease, so I arranged for us to visit a health spa together. I knew she needed a break so it seemed like a great idea. I felt sure she would enjoy being pampered and we could spend some quality time together in a peaceful environment.
I didn’t bank on her unpredictable behaviour. Mum felt uncomfortable from the moment we arrived. I booked her a pedicure and she didn’t like the therapist ‘pulling’ her feet around. The health spa environment unsettled her. ‘This reminds me of a hospital,’ she told me nervously.
While a holiday may sound like a great idea, give the location careful consideration. Leaving a familiar environment can be stressful for a person with dementia. It may be best to start with a short break not too far from home and see how they respond before committing to a longer break. A sudden change in environment, routine and climate may be too much.
Less pride in appearance
Even if you are caring for someone who has always been very interested in how they dress, you may have noticed that the person is not taking much pride in their appearance. This could be because they find it difficult to wash and dress, or they may simply be less motivated to change their clothes. A shower stool may be a good solution if the person is nervous about slipping over in the shower, but it could simply be that the person can’t see the point in getting washed and dressed. They may be depressed (encourage them to see their GP if you suspect this is the case).
When approaching personal hygiene issues, consider how essential it is for the person to wash or change at that moment in time. Maybe a bath or a shower is not necessary at that point. If they are staying in most of the day, then sitting around in their nightwear won’t be a big deal and a quick wash may be less stressful for them.
If you are helping the person with personal hygiene, try to make them feel at ease. If they are in the early or mid stages of dementia, they may be able to manage and may just need a few prompts. Choose clothes that are easy to pull on or take off. Avoid fiddly zips or tops that need to be pulled overhead. Cardigans will be easier to put on than roll-neck jumpers. Tracksuit bottoms or trousers with an elasticated waistband will be easier to put on and remove than jeans or buttoned trousers.
Dementia and sight
When a person has dementia, their sight can be affected. Although we see with our eyes, the brain has to interpret what we see. It is estimated that up to 60 per cent of those with dementia have trouble with vision. If they seem lost in a familiar environment, or appear to be struggling to see things or recognise people they know, arrange for them to have an eye test and rule out sight problems first. If their sight is fine, they may be receiving distorted information from the brain.
This could lead to them becoming more withdrawn, having falls or growing more confused. Colours and patterns can cause confusion. Choose contrasting colours when trying to make certain objects stand out. Examples include a red toilet seat on a white basin or a blue plate on a yellow tablecloth. Removing patterned rugs from the floor is a good idea, as the person may view them as obstacles.
TV and reality
A person with dementia may also think that people or animals on TV are in the same room. Try to avoid anything too graphic on TV as it could cause unnecessary upset. In some cases, it could be side effects of medication, so speak to the GP if you are concerned. My mother once called me up and said there were people in her living room having drinks and chatting who were refusing to leave. She had confused TV characters with real people – there was nobody in her living room and it was very upsetting to hear her confusion. If they seem distressed by a television show, turn it off and distract the person with something else.
Balance and spatial awareness
A person with dementia may be more prone to falls in some cases and less aware of how to judge spaces between distances. This means it’s really important to avoid an environment that is either poorly lit or badly cluttered, or both. Remove loose or worn rugs and other unwanted obstacles. Make sure the stairs, hallways and rooms are well lit (but not overly bright as bright lights can over-stimulate the person and cause anxiety). Try to remove clutter or small items of furniture, like coffee tables that aren’t used, away from the middle of the room and avoid having cramped spaces between furniture and doorways.