Nursing care, home care of patients with dementia

1. Mr. Premnath R
Lecturer, Govt. College of Nursing
Thiruvananthapuram
CARE OF PATIENTS WITH
DEMENTIA

4. • 30 million people with dementia worldwide
currently, and this is likely to double every 20
year.
• There are about 1.5 million people with dementia
in India and this number is likely to increase by
30% in the next four decades.
• In Kerala the prevalence of dementia was 34 per
1000 .

5. Dementia
Dementia is defined as a progressive
impairment of cognitive functions occurring in
clear consciousness. It is often associated with
language difficulty, memory lapses,
disorientation, poor judgment, and difficulty
completing daily care routines such as dressing,
eating, or hygiene tasks.

6. CAUSES OF DEMENTIA
• Many diseases leads to dementia .It can be either
treatable or non treatable.
• Common treatable causes are depression, vitamin
deficiency, head injury etc.
• Untreatable causes are Alzheimer’s dementia,
Multi infarct dementia ,AIDS complex dementia
etc.

7. WARNING SIGNS OF DEMENTIA
• Memory loss that disrupts daily life.
• Challenges in planning or solving problems
• Difficulty completing familiar tasks at home, at work or at leisure
• Confusion with time or place
• Trouble understanding visual images and spatial relationships
• New problems with words in speaking or writing.
• Misplacing things and losing the ability to retrace steps.
• Decreased or poor judgment
• Withdrawal from work or social activities
• Changes in mood and personality.

8. MAIN RULES :
Don’t Argue
Never Say “No”
Maintain Independence
Improve self esteem and
confidence.
Never ask leading
questions.
CARE OF A DEMENTIA PATIENT

9. Eating
• Ensure that the patients ate food.
• Provide well balanced diet.
• Cut down food into smaller pieces.
• Mix food and give it to them.
• Encourage soft and liquid diet and ensure that
client drink enough water.
• Diet supplements like calcium and vitamins

10. Communication
• Use simple sentences with simple words.
• Speak clearly and slowly.
• Stand in front of the client and look into his face and talk.
• Give the patient time to understand before continuing with
the next sentence.
• Observe clients verbal and non verbal responses.
• Don’t argue with the client.
• Use gestures, such as pointing to an object, or
demonstrating the action to be done.
• Avoid distractions while talking to client.

11. Wandering
• Make sure that the person carries identity bracelet
with name, address and telephone number.
• Relocate door locks to positions where the person will
not look for them.
• Install bells and buzzers that sound when external
doors are opened.
• Make the door less visible by painting it the same
color, or covering it with a curtain
• Put a large stop sign on the door.

12. Prepared for wandering
• Ensure patient carries identity
• Relocate door locks
• Door bells
• Stop sign

13. Bathing:
• Never leave patient alone.
• Encourage hygiene and avoid dependency on the
caregiver
• Provide bath stools and grab rails inside the bathroom.
• Keep bathroom clean and dry.
• Check the temperature of water before bath.
• Keep familiar soaps, hair oils, shampoo to remind the
patient about bathing.
• Observe for any injuries or sores while bathing.

14. Toileting
• Monitor for signs of constipation and dehydration
• Assist the patient to toilet at scheduled intervals
• Use signage or symbols leading to toilet.
• Use night lights ,or grab rails in the toilet
• Provide easily removable garments
• Keep the toilet clean and dry.

15. Dental care
• Monitor dental hygiene ,check for halitosis
• Assist with brushing daily
• Use soft bristled tooth brush
• Check mouth for any sores or ulcers
• Use correct fitting dentures
• Use emollients to prevent drying of lips

16. Grooming
• Assist with grooming, cutting and filing nails
• Never cut nails closely to avoid injuries
• Apply moisturizers and deodorants to avoid
body odour.
• Comb hair properly.

17. Dressing
• Provide appropriate sized loose cotton
clothes.
• Avoid zippers and complicated buttons in
the clothings.
• Assist with wearing and removing clothes.
• Reduce the choices for clothing

18. ADAPT THE HOME FOR
DEMENTIA PATIENTS
For reality orientation:
• Place large clocks with the numbers
clearly written
• Place a large calendar, date display, so
that the patient can see the date, day,
and month/year

19. Reminder lists:
• Prominently placed stickies or whiteboards
can help.
• Place the reminders close to where the
patient will need them
• Messages about the food, Important phone
numbers, such as emergency numbers, can
be sticked .

20. Make it easy for the patient to make notes
• Leave notepads and pencils near the phone.
• Tie the notepad and pencil to some fixed object
so that the notepad is not lost
• Label articles

21. Reduce chances of hurting
• Have fewer objects on the floor.
• Remove sharp objects like knives
(keep them locked)
• Remove carpets and wires that can
cause tripping
• Ensure all electric connections are
safe and that there are no exposed
wires

22. Reduce chances of confused
interpretation
• Remove mirrors if patient gets frighten
by reflection.
• Remove pictures ,masks and
decorations which may haunt or
frighten the patient.
• Use simple coloured bedsheets linen
etc.
• Avoid bright or dark paint inside rooms.

23. For problems in handling things.
• Have large, prominent handles on doors
• Use bigger spoons, and plates with blunt edges
• Use mugs with large handles.

24. For problems in getting up and in walking:
• Use stable, heavy furniture.
• Provide chairs with arms.
• Avoid sharp edges using tie cushions, stick
foams etc.
• Install grab rails along the walls, bathrooms
etc.

25. • Provide room and bathroom facilities at the
ground floor.
• Place a safety gate at the entrance of the stairs.
• Provide walking sticks and walkers and
wheelchairs, if needed.

26. General Safety
• Replace door bolts and locks with simple latches
and hooks which can be opened from outside
• Keep all medicines, poisonous liquids, sharp
objects out of reach/ locked
• Keep all electric outlets covered.
• Make sure all switches are safe.

27. • Keep the kitchen locked so that the patient cannot use it
when alone.
• Switch off the gas regulator when not in use and position
the gas such that the patient cannot reach the regulator.
• No match boxes or lighters visible in the house
• Install locks on all doors and windows leading outside.

28. Can you put a name to these faces? Those who struggled to remember
famous faces could have dementia, Northwestern University Feinberg
School of Medicine in Chicago