Dementia is a progressive disease, mostly affecting older adults, which, in addition to memory loss, can lead to problems with thinking, language, orientation and coordination. Whilst dementia is most classically associated with memory loss, a major part of managing or caring for someone with dementia revolves around BPSD; behavioural and psychological symptoms of dementia. Behavioural symptoms can include physical aggression, restlessness and wandering, which are particularly distressing for carers
Psychological symptoms associated with dementia can include anxiety, depression and even hallucinations. These symptoms can have a serious impact on a someone’s quality of life, and whilst some can be managed with medications, there are an increasing number of additional strategies that carers and health professionals caring for patients with dementia can put in place at home which can give significant benefit for both patients and carers. For example, wandering and getting lost is often a recognised complication for patients with dementia. Recent research looked at putting in preventative methods with a ‘home-based missing incident prevention programme’.1 The programme included strategies such as dementia education, assistive devices, skills training, environmental modifications and redesigning of daily life routine. This programme was found to reduce the frequency of missing incidents (and searching time), as well as significantly reducing carer stress. This is just one example of a non-pharmacological way that dementia can be managed.
Here are 5 top strategies you can implement at home, supported by current research:
Educating yourself about dementia, the progression of the disease and its management can have huge effects on quality of life for both the person you care for and yourself as a carer. As dementia is a progressive disease (i.e. it gets worse and can change over time), having an idea of what is to come can give you both insight and time to prepare for the future, as well as understanding to cope with the current situation. The majority of non-pharmacological management of dementia has carer education at its core and improving knowledge and understanding of dementia has been shown to positively impact both patients and carers in healthcare.2-5 There are a number of excellent sites that provide courses and free resources for carer and patient education:
2. Sleep hygiene
Up to 35% of patients with dementia can have clinical problems with sleep, including reduced sleeping time, poor sleep quality and sleep walking.6 Many older adults experience sleeping problems, and these are often exaggerated by dementia. Whilst there are several medical-based solutions that can help with sleep, these all come with associated risks and side effects (which may be completely outweighed by their benefit), there are several strategies that can be put in place at home to promote better ‘sleep hygiene’.7 This essentially encompasses things that can help you get to sleep more easily and have a better quality of sleep throughout the night.8
- Increasing day time activities and minimising daytime napping
- Regular exposure to natural light during the day
- Keeping to a reasonably regular routine
- Reducing caffeine intake
- Ensure regular toileting to avoid waking up in the night to go to the toilet
- Maintaining a good sleeping environment; a quiet, dark room with a comfortable temperature
- Avoiding going to bed having just eaten a large meal or feeling hungry
It is also worth checking with your GP to make sure there is not an additional underlying cause of sleep disturbance such as heart or urinary problems. Again, research has shown that carer-education is key here, and that there is significant benefit for patients with carers implementing an effective sleep hygiene programme.9
NB: Carers need good sleep too! For more information, the National Sleep Foundation has some great advice.
Physical exercise is already established to have widespread benefits amongst older adults all culminating in improved health.10 However, in the last few years, there has been research looking more specifically at the effects of exercise on patients with dementia, with a particular focus on BPSD. Activities such as aquatic exercises focusing on areas like strength, agility, balance and coordination showed reduced BPSD and an overall improvement in general psychological well-being.11 Exercise-based activity has also been shown to help with carer burden and distress associated with BPSD.12
In addition to helping with dementia-specific issues, exercise activities can have widespread physical and mental health benefits as well as providing a much-needed social platform for both patients and carers who can so often become isolated.
4. Alternative therapies
In addition to exercise, there a number of activities that have shown enough benefit to people with dementia, that they have even been labelled as ‘alternative therapies’. These can include engaging in normal hobbies such as music, arts or anything of personal interest, to alternative medicines like aromatherapy and bright light therapy. These are fantastic adjuncts to include on top of medical treatment, and can be instrumental in improving quality of life. The main areas of improvement seen with music-based activity and aromatherapy showed significantly reduced levels of anxiety and agitation, which can range from mild symptoms to being severely disabling for many patients.13,14
5. Caring for the carers
Caring for someone with dementia is difficult. Whether it be in a healthcare setting or at home, it can be an incredibly stressful role and caregiver burden is a genuine phenomenon seen in carer roles throughout healthcare. All of the strategies above have been shown to alleviate carer burden, and data collected from people who care for someone with dementia showed that those that had higher levels of self-compassion had improved coping strategies resulting in lower levels of burden.15 As a carer, your own physical and mental health can suffer, and in order to continue to provide optimal care to any patient, it is essential that you look after your own health as well. There are several UK-based organisations that provide support, advice and help for carers:
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. myHealthSpecialist makes no representations as to the accuracy or completeness of any of the information in this article, or found by following any link from this article. Please consult a doctor or other healthcare professional for medical advice.
Final year medical student, Kings College London