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Comfort, Safety and Daily Care

Whether you are a family member or a paid caregiver, caring for someone with advanced dementia can be difficult, but also rewarding. Each day can bring new challenges.  As the patient’s abilities change over time, the caregiver must change approaches. People with dementia seem to function best in a familiar, structured setting with a definite daily routine.

Preventing Skin Problems

  • Keep skin clean, dry and moisturized.
  • Change wet disposable briefs immediately. (The terms “disposable briefs” or “adult briefs” are more dignified for adults than saying “diaper.”)
  • Hospice staff can provide moisture-resistant “barrier” creams to help protect the skin from urine, stool, or sweat.
  • Unless they turn over on their own, patients should be turned or placed in a new position every two hours. This relieves pressure that may cause bedsores.
  • Pay special attention to bony areas such as the tail bone, hips, heels, or elbows.

Bowel and Bladder Function

  • Set a regular schedule for going to the bathroom if the patient is able to use a toilet; many choose shortly after meals and every two hours.
  • Limit fluids before bedtime and avoid caffeinated drinks.
  • Keep track of how often the patient has bowel movements. If needed the hospice nurse will order laxatives and stool softeners.
  • Expect that bowel and bladder accidents may happen — stay calm.

Bathing and Dressing

  • Try to make bath time a “spa” experience. Try scenting the water, giving a massage, and providing a snack. These will become pleasant association and the patient is more likely to enjoy the bath.
  • Schedule bathing at a time of day when the patient is most likely to be calm and cooperative, and feeling strongest.
  • People with advanced dementia can be very sensitive to temperature. Make sure the bathroom and water are at comfortable temperatures.
  • Get everything ready before you begin.
  • A shower bench and hand-held shower can make the job easier.
  • A bath or shower may not be needed everyday; a sponge bath may be enough.
  • Lay out clothes before beginning the bath.
  • Allow the patient some limited choices of what to wear.
  • Comfortable clothing with elastic or Velcro closures work best.

Arm and Leg Exercises

  • Pathways staff can show you stretching exercises that may help keep arms and legs flexible. These are called “range of motion” exercises and may help prevent pain. These are commonly done once or twice a day.
  • If moving causes discomfort and the patient has pain medication available, you may want to give the pain medicine an hour or so before you plan to exercise the patient.
  • Don’t try to do exercises if the patient will not cooperate.
  • Exercises can be done in bed, on a couch, or in a chair. The patient does not need to be lying flat.
  • Keep in mind that older people often cannot completely stretch out their arms and legs.
  • Begin by gently raising one arm. Watch the patient’s face for signs of discomfort. Stop if the exercise appears to cause pain. Repeat several times. Then slowly bend and straighten the elbow several times. Do the same thing with the other arm.
  • Gently raise and bend one knee, supporting the leg with one hand under the knee and the other under the foot, then straighten the leg. Repeat several times, then do the same on the other leg.
  • Gently massage hands and feet with lotion.
  • If arms and/or legs are contracted, do not try to straighten them—this will cause pain.

Preventing Falls

  • Make sure you know the proper use of equipment like walkers, commodes, or electric beds. Ask the hospice staff if you are not sure.
  • Remind the patient as often as needed to use equipment (such as the walker).
  • Remove throw rugs, low tables, and electrical cords – anything the patient may trip on.
  • Have grab bars installed in the bathroom.
  • Keep the patient’s eye glasses clean.
  • Don’t let robes, pajamas, sheets, or blankets touch the floor.