Caring for Someone with Dementia

A Five-Part Fireside Village Series

Part 2 of 5: Everyday Care, Safety and the Changing Home

A quick note: this article is educational information for Fireside Village members. It does not replace medical, legal, or financial advice from qualified professionals. If you have questions about a specific diagnosis, treatment, or safety concern, please consult the appropriate professional directly.

Chapter 1: Building a Day That Still Works

Dementia changes everyday life in strange ways.

Things that used to happen without anyone thinking about them can suddenly become difficult.

Getting dressed.

Making breakfast.

Taking a shower.

Going to the grocery store.

Watching television.

Helping fold laundry.

Sitting down for dinner.

A caregiver can gradually find themselves doing more and more for the patient because doing it yourself is faster.

Sometimes that is necessary.

But there is another goal worth remembering:

Help the patient keep doing what they can still do.

The goal is not to make every day perfect.

It is to build a day the patient can still participate in.

Routine can make life easier

Most of us live with routines without realizing how much we depend on them.

Coffee in the morning.

Shower after breakfast.

Lunch around noon.

A favorite television program in the afternoon.

Dinner at six.

Bed around ten.

Dementia gradually makes it harder to figure out what comes next.

A familiar routine can remove some of that work.

The patient may forget what day it is while still responding well to a familiar sequence of events.

Wake up.

Bathroom.

Get dressed.

Breakfast.

Medication.

Sit on the porch.

The routine itself becomes a kind of guide.

That still leaves room for flexibility rather than a military schedule.

It means familiarity can help when memory and reasoning become less dependable.

Watch what already works

Before rebuilding the patient's entire day, watch it.

When is Mom usually at her best?

Does Dad become tired after lunch?

Is bathing easier in the morning?

Does the patient become restless when sitting too long?

Are evenings harder?

Does a certain television program calm them?

Does music help?

Does a crowded room make things worse?

You are looking for patterns.

Then build around those patterns when you can.

If Mom is usually clear and cooperative in the morning, that may be a better time for bathing or an appointment than late afternoon.

If Dad becomes exhausted after lunch, scheduling three errands at two o'clock may create problems that have little to do with the errands themselves.

Work with the patient's better hours instead of fighting them.

Familiarity matters

Dementia can make the world increasingly confusing.

Familiar people, places, objects and activities can make that world easier to navigate.

The same chair.

The same coffee cup.

The same morning radio station.

The same route through the house.

The same place at the dinner table.

These things may seem insignificant.

For someone whose brain is working harder to understand the environment, familiarity can reduce the amount of figuring-out required.

This is one reason unnecessary changes can sometimes create more confusion than families expect.

If something already works, there may be value in leaving it alone.

Keep meaningful activities in the day

A patient with dementia still needs something to do.

Sitting in a chair for 12 hours while everyone else manages life around them is technically safe.

It is also a very small life.

Meaningful activity can be simple.

Fold towels.

Water plants.

Sort photographs.

Sweep the porch.

Listen to music.

Walk to the mailbox.

Help prepare vegetables.

Brush the dog.

Sit outside.

Attend church.

Work a simple puzzle.

Watch birds.

The right activity depends on the person.

Ask yourself:

What did this person enjoy before dementia?

Then figure out whether some version of that activity can still exist.

A woman who cooked family meals for 50 years may eventually be unable to prepare dinner safely.

Maybe she can still stir something in a bowl.

Maybe she can snap green beans.

Maybe she can sit at the kitchen table while someone else cooks.

The old activity may need to change.

The connection to it can remain.

Activity can also have a purpose

People often respond differently when they believe they are helping.

Instead of:

“Here's something to keep you busy.”

try:

“Can you help me fold these towels?”

That small difference can matter.

The patient is contributing.

The task has a reason.

A person who spent a lifetime caring for a home, raising children, working, building things or helping other people may still respond to being useful.

The towels may end up folded badly.

That is okay.

The point was bigger than the towels.

Boredom can look like a behavior problem

Sometimes a patient becomes restless because there is simply nothing happening.

They pace.

Open drawers.

Follow the caregiver from room to room.

Ask the same question repeatedly.

Try to leave the house.

Become irritated.

Dementia itself can contribute to all of these behaviors, and medical or physical causes sometimes need consideration too.

But before assuming every restless behavior is something that needs to be stopped, ask:

What has this person done all day?

A little movement, conversation, music, fresh air or a simple task may help.

The patient still needs a day that contains something besides being cared for.

Preserve independence where it is still safe

Caregivers naturally want to protect the patient.

The danger is beginning to do everything.

Mom takes forever to button her blouse, so you button it.

Dad makes a mess making cereal, so you make breakfast.

The patient struggles with shoes, so you put them on.

Eventually the patient stops trying.

Sometimes assistance is absolutely necessary.

But when time and safety allow, give the patient a chance.

Lay the clothes out in order.

Open the cereal box.

Put the bowl on the counter.

Hand Dad the toothbrush.

Give one instruction instead of five.

Start the task and let the patient finish it.

There is a large difference between:

“Can this person do this exactly the way they used to?”

and:

“What part of this can they still do?”

The second question preserves ability longer.

Simplify before taking over

A task may become too complicated before it becomes completely impossible.

Getting dressed is a good example.

Imagine what dressing actually requires.

Choose appropriate clothes.

Find them.

Figure out which item goes on first.

Orient the clothing correctly.

Work buttons or zippers.

Put on socks.

Choose shoes.

Tie them.

That is a surprising number of decisions.

Instead of taking over the entire task, remove some of the decisions.

Put out one outfit.

Arrange the clothes in the order they are worn.

Use clothing that is easier to manage.

Give one instruction at a time.

Offer help only where help is needed.

The same idea can be used throughout the day.

Simplify the task before removing the task.

Too many choices can become exhausting

A few real choices can preserve independence just as well as unlimited ones.

Opening a closet containing 40 shirts and asking:

“What do you want to wear?”

may be overwhelming.

Hold up two shirts.

“Blue or green?”

If that becomes difficult, choose one and ask:

“How about this one today?”

The patient still has an opportunity to participate without having to sort through dozens of possibilities.

The same principle works with meals, activities and outings.

Reduce the number of decisions while preserving some control.

Adapt hobbies instead of automatically ending them

Dementia can slowly take abilities away.

Many hobbies can continue well past the day of diagnosis, often in an adapted form.

A gardener may eventually need help using tools safely but can still water plants.

Someone who loved woodworking may no longer safely operate power equipment but may enjoy sanding a piece of wood by hand.

A lifelong baker may still measure ingredients that someone else organizes.

A card player may eventually need a simpler game.

A reader may move from novels to shorter stories, magazines, photographs or audiobooks.

Look for the part of the activity the patient still enjoys and can still manage.

Sometimes the activity changes several times as dementia progresses.

That is okay.

Outings may need to become simpler too

Going out can remain an important part of life.

But a six-hour shopping trip involving four stores and a crowded restaurant may eventually become exhausting.

Try shorter outings.

Go during quieter hours.

Visit familiar places.

Bring another person when extra help would make things easier.

Know where bathrooms are.

Carry the things the patient commonly needs.

Pay attention to fatigue.

Sometimes a 20-minute ride in the car, an ice cream cone or sitting at a park can be enough.

The goal is participation, rather than proving the patient can still handle the old version of the outing.

Expect abilities to change

Something that worked beautifully six months ago may suddenly stop working.

That reflects the disease, not your effort.

The disease changes.

The routine has to change with it.

Maybe Mom can no longer prepare breakfast.

She may still be able to eat independently.

Later she may need reminders.

Later still she may need someone beside her.

Caregiving becomes a continuing process of asking:

What can the patient do today?

Then building the day around today's answer.

A bad day is just a bad day

Some days dementia simply wins.

The patient refuses the activity they enjoyed yesterday.

Breakfast goes badly.

Nobody wants a shower.

Dad sleeps half the afternoon.

Mom becomes irritated during an outing you thought she would love.

Caregivers can spend enormous amounts of energy trying to create the perfect dementia routine.

There is no perfect routine.

A routine is a tool.

If something is making the day harder, change it.

If the patient is exhausted, shorten the activity.

If everyone is becoming frustrated, try again later.

If today becomes a television-and-pajamas day, tomorrow still exists.

Watch for sudden changes

There is one important exception.

If the patient suddenly stops doing something they could do recently, especially when the change is dramatic, think beyond dementia progression.

A sudden change in walking, alertness, appetite, communication, behavior or ability to perform familiar tasks may deserve medical attention.

As we discussed in Part 1, illness, pain, dehydration, medication effects, infection and other medical problems can cause sudden changes.

Gradual adaptation is part of dementia caregiving.

Sudden decline deserves a closer look.

The routine should serve the people

Eventually caregivers can become prisoners of their own routines.

Breakfast must happen at eight.

Bathing must happen Tuesday morning.

The walk must happen after lunch.

Bedtime must be nine.

Then the patient changes and the schedule becomes a daily battle.

The schedule is there to help you.

You are not there to serve the schedule.

Keep the pieces that create familiarity.

Change the pieces that create unnecessary conflict.

Build a life around what remains

Dementia forces families to spend a lot of time thinking about what has been lost.

Memory.

Judgment.

Independence.

Language.

Skills.

That loss is real.

But caregiving also requires noticing what remains.

Can Mom still sing?

Let her sing.

Can Dad still make coffee with a little help?

Let him help.

Can your spouse still walk around the block?

Go together.

Can the patient still laugh at an old television show?

Watch it.

Can they fold a towel badly?

Give them the towels.

You are going to spend plenty of time adapting to things the patient can no longer do.

Make room for the things they still can.

A good day with dementia can look different from the old days and still count.

It needs to be a day that still belongs, at least partly, to the person living it.

Chapter 2: Eating, Drinking and Swallowing as Dementia Progresses

Food carries a lot of meaning in families.

We cook for people we love.

We celebrate with food.

We gather around the dinner table.

We worry when someone stops eating.

So when dementia begins changing the way a patient eats or drinks, caregivers can become frightened very quickly.

Mom leaves half her dinner untouched.

Dad says he already ate when he has not eaten all day.

The patient forgets how to use a fork.

Someone who loved coffee for 50 years suddenly refuses it.

Later, chewing and swallowing may become difficult.

The caregiver's natural reaction is:

“I have to get them to eat.”

Sometimes that determination helps.

Sometimes it turns every meal into a battle.

Understanding why eating changes can make those decisions a little easier.

Eating is more complicated than it looks

Think about everything the brain does during one ordinary meal.

Recognize that you are hungry.

Recognize the food.

Understand what the utensils are for.

Choose what to eat.

Pick up the food.

Bring it to your mouth.

Chew.

Swallow.

Remember that there is still food on the plate.

Recognize when you are thirsty.

Dementia can interfere with different pieces of this process at different times.

The patient may still be physically capable of eating while having trouble understanding what to do.

That distinction matters.

Make the meal easier to understand

Sometimes simplifying the environment helps.

A table covered with several dishes, decorations, medications, napkins and utensils may become visually confusing.

Try removing unnecessary items.

Serve one or two foods at a time.

Make the food easy to see.

Use familiar dishes and utensils.

Reduce television noise and other distractions if they make eating harder.

Sit with the patient when possible.

Sometimes seeing another person eat provides a useful cue.

The goal is simple:

Make eating require less figuring out.

Give the patient enough time

Meals may become slower.

Very slow.

A caregiver can finish eating while the patient has taken three bites.

Then comes the temptation:

“Come on, Mom. Take another bite.”

“Hurry up, Dad.”

“Your food is getting cold.”

The patient may simply need more time to process each step.

If the patient can still eat safely and independently, allow extra time when you can.

A meal can run on its own schedule now.

Finger foods can preserve independence

Utensils may eventually become difficult.

The patient may still be able to eat independently with the right foods.

Try foods that can be picked up easily.

Small sandwiches.

Cut fruit.

Pieces of cheese.

Toast.

Chicken pieces.

Vegetables that are easy to hold.

Other foods the patient enjoys and can safely manage.

Finger foods can sometimes allow a patient to continue eating independently after forks and knives become confusing.

That small piece of independence can matter.

Appetite may change

Some patients eat less.

Some forget they have eaten and ask for food repeatedly.

Some develop strong preferences for sweets.

Some lose interest in foods they loved for decades.

Taste and smell can change.

Activity levels change.

Medications can affect appetite.

Illness, constipation, mouth pain, dental problems, depression and other conditions can also affect eating.

If appetite changes suddenly or dramatically, tell the healthcare professional.

A gradual change and a sudden change deserve different kinds of attention.

Check the mouth

This is easy to overlook.

A patient may refuse food because eating hurts.

They may be unable to explain:

“My tooth hurts.”

“My dentures don't fit.”

“My mouth is sore.”

Instead, they push food away.

Chew only on one side.

Grimace.

Stop eating certain textures.

Become irritated at meals.

If eating suddenly becomes difficult, consider whether there could be a dental or mouth problem.

Hydration can become difficult too

A patient may gradually lose the ability to recognize thirst or remember to drink.

Simply placing a glass of water on the table may accomplish very little.

Offer drinks throughout the day.

Put the drink where the patient can easily see and reach it.

Offer beverages the patient enjoys.

Foods containing fluid can also contribute to overall intake.

Watch for significant changes in drinking, urination, alertness or physical condition and discuss concerns with the healthcare team.

Dehydration can make an older adult very sick and can contribute to sudden confusion.

Watch for swallowing changes

As dementia advances, swallowing can become more difficult.

This is called dysphagia.

Signs can include:

·        Coughing during or after eating or drinking.

·        Choking.

·        A wet or gurgling voice after swallowing.

·        Food remaining in the mouth.

·        Taking much longer to eat.

·        Difficulty managing certain textures.

·        Repeated chest infections.

·        Weight loss.

·        Trouble swallowing pills.

·        Food or liquid coming back out of the mouth.

Sometimes aspiration occurs without obvious coughing. This is often called silent aspiration.

Aspiration means food, liquid, saliva or other material enters the airway instead of traveling normally toward the stomach.

This can lead to aspiration pneumonia.

Swallowing changes deserve professional evaluation.

Aspiration pneumonia can become part of advanced dementia

As swallowing declines, material entering the airway can contribute to pneumonia.

For some patients, aspiration pneumonia becomes one of the serious complications seen late in dementia.

Families may face decisions about antibiotics, hospitalization and the overall goals of treatment. There is no single answer that fits every patient.

The important thing to understand is that repeated swallowing problems and aspiration can represent progression of the underlying disease. That understanding can help families have more informed conversations with physicians, nurses and eventually hospice professionals when the time comes.

Position matters during meals

A patient who has difficulty swallowing generally needs good positioning for eating and drinking.

Sitting upright can help.

Trying to feed someone who is lying far back in bed can make swallowing more difficult.

The patient's healthcare team may recommend specific positioning, food textures, liquid consistency or feeding techniques based on the patient's swallowing ability.

Those recommendations should be individualized.

What works for one patient may be inappropriate for another.

Ask about a swallowing evaluation

When swallowing becomes difficult, ask the healthcare team whether a swallowing evaluation would be useful.

Speech-language pathologists commonly evaluate swallowing problems.

That surprises some families because they associate speech therapy only with talking.

A swallowing evaluation can help identify what the patient is having difficulty with and what strategies may make eating and drinking safer.

Food textures may eventually change

Some patients may have difficulty with certain foods before others.

Dry foods.

Tough meats.

Foods that crumble.

Thin liquids.

Mixed textures.

The healthcare team may recommend changes based on the patient's specific swallowing problem.

Families sometimes begin pureeing food or thickening liquids on their own because they have heard these approaches help dementia patients.

These changes deserve professional guidance.

The safest texture depends on the individual patient's swallowing ability, medical condition and goals of care.

Avoid turning meals into a wrestling match

This is emotionally difficult.

The caregiver sees an unfinished plate and thinks:

They need the calories.

So another bite gets offered.

Then another.

The patient closes their mouth.

The caregiver tries again.

The patient turns their head.

The caregiver becomes more determined.

Eventually both people are upset.

A patient who is actively refusing food may be communicating something even when they cannot explain it.

Maybe they are full.

Maybe they are tired.

Maybe the food hurts their mouth.

Maybe they cannot understand what is happening.

Maybe swallowing has become difficult.

Maybe they simply dislike that particular food today.

Pause.

Try again later when appropriate.

Try another food.

Look for a reason.

Ask the healthcare team for help if the pattern continues.

Weight loss deserves attention

Weight loss is common in dementia, especially as the disease advances.

Other possible causes deserve a look before crediting dementia alone.

Tell the healthcare professional about significant or unexplained weight loss.

There may be treatable contributors.

Medication effects.

Dental problems.

Difficulty swallowing.

Depression.

Another illness.

Constipation.

Pain.

Problems obtaining or preparing food.

The healthcare team can help look at the larger picture.

Families often ask about feeding tubes

This question usually appears later in advanced dementia, when eating and swallowing have become much more difficult.

Families may understandably think:

“If the patient cannot eat enough, we should put nutrition directly into the stomach.”

The decision is more complicated in advanced dementia.

Major geriatric and hospice guidance generally recommends careful hand feeding rather than routine feeding-tube placement for people with advanced dementia. Feeding tubes have not been shown to reliably prevent aspiration or restore the losses caused by advanced dementia, and they can introduce additional burdens.

This is an important goals-of-care discussion with the patient's healthcare team.

Part 4 of this series will discuss feeding decisions near the end of life in much greater detail.

For now, caregivers should know that a feeding tube is not simply the automatic next step when advanced dementia changes eating.

Eating less can eventually become part of the disease

This may be one of the hardest things for families to accept.

In advanced dementia, the brain gradually loses the ability to coordinate many basic functions.

Walking changes.

Speech changes.

Swallowing changes.

Eating changes.

Eventually the patient's interest in and ability to take food and fluids may decline significantly.

Earlier in the disease, poor intake should lead caregivers to look for causes and possible solutions.

Near the end of advanced dementia, decreasing intake can become part of the natural progression of the illness.

Those are very different situations.

Understanding where the patient is in the disease matters.

We will return to this carefully in Part 4 when we discuss hospice and the end of life.

Food should still be food

Caregiving can turn meals into medical procedures.

Calories.

Protein.

Ounces of water.

Weight.

Supplements.

Swallowing precautions.

All of those things can matter.

But food is also pleasure.

A favorite flavor.

A warm cup of coffee.

Ice cream.

A family recipe.

Something familiar.

When it is safe and appropriate for the patient's condition, leave room for enjoyment.

Sometimes the best meal is the one the patient actually wants to eat.

Watch the patient, rather than the empty plate

Caregivers often judge a meal by what remains.

Half the plate is still there.

Only four bites were eaten.

The drink is still half full.

Those observations matter.

But look at the patient too.

Are they comfortable?

Are they coughing?

Are they struggling?

Are they tired?

Are they interested in the food?

Are they able to feed themselves?

Has something changed from their usual pattern?

The plate gives you information.

The patient gives you more.

As dementia changes eating and drinking, the caregiver's job changes too.

At first, you may simply provide reminders.

Later, you may simplify the meal.

Then you may cut the food.

Then provide more supervision.

Eventually you may help feed the patient.

And later still, the family may face difficult decisions about what eating means as the body approaches the end of life.

Take those decisions one stage at a time.

The goal is more than getting food into the patient.

The goal is helping the patient eat as safely, comfortably and independently as their current abilities allow.

Chapter 3: Personal Care Without a Daily Battle

Personal care can become one of the most difficult parts of dementia caregiving.

Bathing.

Brushing teeth.

Changing clothes.

Using the toilet.

Changing a brief.

Shaving.

Washing hair.

These are ordinary tasks.

They are also extremely personal tasks.

A patient who once cared for themselves may eventually need another adult standing beside them, giving instructions, removing clothing or physically helping with intimate care.

The caregiver knows why the help is necessary.

The patient may have no idea.

That difference can turn a simple shower into a fight.

The first instinct is often:

“How do I get them to cooperate?”

A better question may be:

“What is making this difficult for the patient?”

Start by looking for the reason

When a patient refuses personal care, the refusal may make perfect sense from their point of view.

Imagine someone walks into your bedroom and says:

“Take your clothes off. You need a shower.”

You believe you already showered.

You barely recognize the person standing in front of you.

You are cold.

You do not understand where you are going.

Then the person begins pulling at your clothing.

You might resist too.

Dementia can remove the context that makes caregiving actions understandable.

What looks like stubbornness may actually be confusion, fear, embarrassment, pain or loss of privacy.

Understanding that changes how you approach the task.

Bathing is a common battleground

Families talk about shower problems constantly.

Mom refuses to get in.

Dad says he already showered.

The patient becomes angry when clothing comes off.

Someone who once showered every morning now insists they do not need one.

There can be many reasons.

The bathroom may feel cold.

Running water may sound frightening.

Stepping into the shower may feel unsafe.

The patient may have trouble seeing the edge of the tub.

Water hitting the skin may feel unpleasant.

The patient may be embarrassed.

They may be afraid of falling.

They may simply have no memory of how long it has been since the last bath.

Before assuming the patient is being difficult, look at the experience you are asking them to have.

Change the approach before forcing the issue

If showers consistently create distress, experiment.

Try a different time of day.

Warm the bathroom first.

Have towels and clothing ready before beginning.

Use a shower chair when appropriate.

Use a handheld showerhead if it makes bathing easier.

Keep the room calm.

Give one instruction at a time.

Cover parts of the body that are not being washed when possible.

Preserve privacy.

If a full shower becomes too difficult, ask the healthcare team about other safe ways to maintain hygiene.

A difficult shower at 9:00 can simply end, rather than escalate into a bigger fight at 9:15.

Sometimes the best decision is to stop and try again later.

Pick the battles that actually matter

Caregivers can become trapped by the old schedule.

Mom always showered every morning.

Dad always shaved daily.

Hair was always washed Tuesday and Friday.

Then dementia arrives.

Now Tuesday's hair washing creates an hour-long confrontation.

Ask yourself:

What actually needs to happen today?

The patient needs reasonable hygiene.

Skin needs to stay clean and dry.

The mouth needs care.

Soiled clothing needs changing.

But old grooming habits can shift in form or schedule and still count as care.

Caregiving is difficult enough without creating unnecessary battles over routines that can safely become flexible.

Dressing can become confusing

Getting dressed requires more thinking than it appears to.

Choose clothes.

Find them.

Know what goes on first.

Know which side is front.

Put arms and legs through the correct openings.

Work buttons and zippers.

Choose shoes.

Dementia can interrupt that sequence.

The patient may put several shirts on.

Wear clothing backward.

Put pajamas over daytime clothes.

Choose a winter coat in hot weather.

Forget underwear.

Become frustrated halfway through dressing.

Simplify.

Lay out one outfit.

Put clothing in the order it will be worn.

Choose comfortable items that are easier to manage.

Give one instruction at a time.

Allow the patient to do whichever pieces they can still do safely.

Sometimes unusual clothing choices are harmless

Dad wants to wear two shirts.

Mom insists on wearing the same sweater again.

The colors do not match.

The socks are different.

Before correcting it, ask:

Does this matter?

If the clothing is safe and appropriate for the temperature, the caregiver may decide that mismatched socks are a very small problem.

Dementia caregiving gives families enough serious problems.

You do not need to turn every harmless difference into another one.

Toileting problems often appear gradually

The patient may first need help finding the bathroom.

Later they may need reminders to use it.

Then help with clothing.

Then help cleaning themselves.

Eventually urinary or bowel incontinence may develop.

This progression can be embarrassing for the patient and exhausting for the caregiver.

Try to preserve independence as long as possible.

Keep the route to the bathroom clear.

Make the bathroom easy to identify.

Consider simple signs or visual cues if they help the patient.

Use clothing that can be removed easily.

Offer regular bathroom opportunities when the patient can still toilet with assistance.

Watch for patterns.

If accidents frequently happen at a certain time, you may be able to get ahead of them.

A new accident deserves attention

If a patient who has been reliably using the toilet suddenly begins having accidents, look beyond dementia progression.

Constipation.

Diarrhea.

Medication changes.

Mobility problems.

Pain.

Urinary problems.

Infection or another illness.

Difficulty finding the bathroom.

A sudden change deserves a closer look, especially when other symptoms appear with it.

Tell the healthcare professional what changed and when.

Incontinence is a care problem, rather than a character problem

This can be hard for families.

A spouse may think:

“He knows better than this.”

A caregiver may become frustrated when the patient removes a brief or has an accident shortly after being taken to the bathroom.

Dementia can eventually affect the patient's ability to recognize the need to toilet, find the bathroom, manage clothing, clean themselves or understand what happened.

The patient may feel embarrassed even when they cannot explain it.

Respond as calmly as you can.

Clean the patient.

Protect the skin.

Change clothing or bedding.

Move on.

Shame does not restore bladder control.

Skin care becomes increasingly important

Urine and stool against the skin can cause irritation and contribute to skin breakdown.

Check the patient regularly when they can no longer reliably tell you they need changing.

Keep the skin clean and dry.

Follow healthcare guidance for barrier products or other skin protection when appropriate.

Watch for redness, sores, broken skin or areas that are becoming worse.

As mobility decreases later in dementia, pressure injuries also become a greater concern.

A patient can receive excellent care and still develop skin problems as illness and frailty progress.

The goal is careful observation and early attention.

Oral care still matters

Dental care can quietly become difficult.

The patient may forget to brush.

Forget what the toothbrush is for.

Swallow toothpaste.

Refuse to open their mouth.

Become frightened when someone approaches their face.

Yet mouth problems can cause pain, difficulty eating, infection and significant discomfort.

Keep oral care as familiar and simple as possible.

Hand the patient the toothbrush if they can still use it.

Demonstrate brushing.

Try brushing your own teeth beside them.

Give simple cues.

If dentures are used, make sure they remain clean and fit comfortably.

Watch for broken teeth, swelling, bleeding, sores, bad breath that is unusual, or signs that chewing hurts.

Dental pain may appear as a behavior change long before the patient can tell you what hurts.

Resistance during care can be communication

The patient pushes your hand away.

They yell.

Grab.

Kick.

Try to leave.

The caregiver experiences aggression.

Sometimes that is exactly what is happening.

But also ask what the patient may be communicating.

“I'm scared.”

“That hurts.”

“I'm cold.”

“I don't understand.”

“Stop touching me.”

“I need a break.”

Look at what happened immediately before the resistance.

Did you approach from behind?

Was the patient asleep?

Did you move too quickly?

Did something hurt when you lifted an arm?

Was the room noisy?

Were several people giving instructions?

Did the patient understand what you were doing?

Behavior often contains information.

Slow down the interaction

Caregivers are usually trying to get things done.

There are medications to give.

Laundry waiting.

An appointment at ten.

Breakfast dishes everywhere.

The caregiver thinks:

We need to get this shower done.

The patient has no understanding of your schedule.

Rushing can increase confusion.

Approach from where the patient can see you.

Tell them what you are doing.

Use short sentences.

Give one step at a time.

Pause long enough for the patient to process the instruction.

When possible, let the patient participate.

“Lift your arm.”

“Here's your shirt.”

“Let's wash your face.”

One step.

Then the next.

Protect dignity during intimate care

Imagine needing your adult child, spouse or stranger to help clean your body.

Dementia may affect memory.

Understanding the reason still leaves the embarrassment real.

Close doors.

Cover the patient when possible.

Explain what you are doing.

Avoid discussing the patient's accidents or body as though they are absent.

Use adult language.

Preserve privacy.

Personal care may become mechanical for the caregiver because it happens every day.

For the patient, it is still their body.

Caregiver safety matters too

There may be situations where the patient becomes physically aggressive during personal care.

A caregiver can be hit, kicked, scratched or bitten.

You do not have to continue an ordinary care task while someone is actively hurting you.

Create space when you safely can.

Allow the situation to calm.

Look for triggers.

Try another approach later.

If aggressive behavior becomes frequent, severe or dangerous, involve the healthcare team.

A sudden increase in aggression can also deserve medical evaluation because pain, illness, medication effects, delirium and other problems may contribute.

The patient needs safety.

So does the caregiver.

Personal care will change with the disease

Early on, the caregiver may only leave clean clothes on the bed.

Later, the patient needs reminders.

Then help with buttons.

Then help dressing.

The same progression can happen with bathing, toileting, grooming and oral care.

Try to stay one step ahead without taking over too early.

Ask:

What can the patient still do?

Then help with the rest.

As abilities change, change the routine.

Good care meets the patient where they are

There will be missed showers.

Mismatched clothes.

Messy bathrooms.

Arguments about brushing teeth.

Accidents.

Days when the patient refuses almost everything you planned.

That can feel like failure when you are trying very hard to provide good care.

It is usually evidence that you are caring for someone with a progressive brain disease.

Keep the important things important.

Safety.

Cleanliness.

Comfort.

Skin protection.

Oral health.

Dignity.

And enough flexibility to get both of you through the day.

Personal care works better when it becomes something you do with the patient as long as possible, rather than something you simply do to the patient.

Chapter 4: Sleep, Sundowning and Difficult Nights

Nighttime can become one of the hardest parts of dementia caregiving.

During the day, the caregiver may already be managing meals, medications, bathing, appointments, household chores and constant supervision.

Then evening arrives.

Instead of settling down, the patient becomes restless.

Mom starts pacing.

Dad wants to leave the house.

The patient insists it is morning.

Someone who was fairly calm at three o'clock becomes anxious, suspicious or agitated at six.

Then bedtime comes and nobody sleeps.

A caregiver can handle a lot during the day when there is at least some hope of sleeping that night.

When dementia begins taking the nights too, caregiving becomes much harder.

What is sundowning?

Caregivers often use the word sundowning to describe confusion, restlessness, anxiety, agitation or other behavior changes that become worse later in the day or during the evening.

It can look different from one patient to another.

A patient may:

·        Pace or wander.

·        Become increasingly confused.

·        Ask to go home.

·        Become suspicious.

·        Follow the caregiver constantly.

·        Become irritable or angry.

·        See or hear things.

·        Repeatedly ask the same questions.

·        Try to leave the house.

·        Resist getting ready for bed.

·        Become frightened as the room gets darker.

The pattern matters.

If the same problems regularly appear in late afternoon or evening, the time of day may be part of what is happening.

Sundowning is different from a sudden medical change

This distinction is important.

A patient who regularly becomes more confused every evening may be showing a familiar dementia-related pattern.

A patient who suddenly becomes dramatically confused for the first time deserves a different response.

Think back to Part 1.

Sudden changes can be caused by illness, pain, medication effects, dehydration, delirium and other medical problems.

The caregiver should avoid automatically labeling every evening crisis as sundowning.

Ask:

Is this the patient's usual pattern, or is something different tonight?

That one question can matter.

Look for what happens before the difficult period

Sometimes caregivers begin to recognize a pattern.

Mom does fairly well until four o'clock.

Then she becomes restless.

What happens around four?

Maybe she is tired.

Maybe the house gets darker.

Maybe the caregiver begins preparing dinner and becomes less available.

Maybe the television gets louder.

Maybe several family members come home.

Maybe the patient is hungry.

Maybe pain medication is wearing off.

Maybe she needs the bathroom.

Maybe she has simply reached the end of what her brain can comfortably process that day.

Watch the hours before the behavior begins.

You may find clues.

Fatigue can make everything harder

Think about your own brain when you are exhausted.

You become less patient.

Thinking takes more effort.

Small problems feel bigger.

Someone with dementia already has difficulty processing information.

By late afternoon, fatigue can make that work even harder.

This is one reason demanding activities may work better earlier in the day.

Appointments.

Bathing.

Shopping.

Visitors.

Complicated tasks.

If evenings are consistently difficult, try protecting the later part of the day from unnecessary demands.

Light can matter

As evening approaches, shadows appear.

Rooms become darker.

Objects can become harder to recognize.

A coat hanging over a chair may look like a person.

A reflection in a window may look like someone standing outside.

For a patient already having difficulty interpreting the environment, changing light can add confusion.

Turn lights on before the house becomes very dark.

Reduce confusing shadows when possible.

Close curtains or blinds if reflections in windows cause distress.

Keep pathways and bathrooms easy to see.

A simple change in lighting can sometimes make the environment easier to understand.

Keep evenings calmer

If evenings are already difficult, this may be the wrong time for extra stimulation.

Several visitors talking at once.

A loud television.

Vacuuming.

Complicated conversations.

Arguments.

A trip to a crowded store.

These things may overwhelm a patient whose brain is already tired.

Try creating a quieter transition into evening.

Dinner.

A familiar television program.

Soft music.

A simple activity.

Sitting together.

Whatever fits the patient.

The goal is less about creating a perfect bedtime ritual and more about reducing unnecessary confusion.

Daytime activity can affect nighttime sleep

A patient who sleeps much of the day may naturally be awake more at night.

That sounds simple.

Changing it can be difficult.

Dementia patients may become tired easily.

Some medications cause sleepiness.

Advanced disease itself can lead to increased sleeping.

Still, when appropriate for the patient's health and abilities, daytime movement and activity can help create a clearer difference between day and night.

A walk.

Sitting outside.

Simple household activity.

Conversation.

Music.

An adult day program.

The activity can be gentle.

The goal is to give daytime some structure.

Naps may need some attention

Some patients need naps.

The goal is rarely to keep an exhausted older adult awake simply because the caregiver wants better nighttime sleep.

But if Dad sleeps for four hours every afternoon and then stays awake half the night, the pattern is worth discussing.

A shorter or earlier nap may help some patients.

For others, sleep patterns are being driven by the disease or another medical issue.

Watch the pattern before trying to change it.

Build a bedtime routine

The same ideas that help during the day can help at night.

Familiarity.

Predictability.

Simple steps.

Bathroom.

Wash face.

Change clothes.

Medication if prescribed at that time.

Quiet activity.

Bed.

The routine can shift by a little each night and still work.

It simply gives the patient familiar signals that the day is ending.

The patient may no longer understand bedtime

A caregiver says:

“It's time for bed.”

The patient says:

“I just got up.”

The clock says 10:00 p.m.

That fact may mean very little to the patient.

Arguing about the time rarely makes someone sleepy.

Instead of trying to prove that it is nighttime, guide the patient toward the routine.

“Let's get comfortable.”

“Let's put your pajamas on.”

“Come sit with me for a while.”

Sometimes the body can follow a familiar routine even when the brain no longer understands the clock.

Nighttime wandering creates real safety concerns

A patient who gets out of bed at night may simply need the bathroom.

Or they may begin walking through the house.

Opening doors.

Going into the kitchen.

Trying to leave.

Searching for someone.

Nighttime wandering becomes especially dangerous when the caregiver is asleep.

Home safety needs to change as this risk changes.

Door alerts, appropriate locks, motion alerts, clear pathways, nightlights and other safety measures may become useful depending on the patient and home.

The goal is to create layers of safety without making the home feel like a prison.

Falls become more dangerous at night

A sleepy patient with poor balance walking through a dark house is at increased risk.

Keep pathways clear.

Remove clutter.

Use appropriate lighting.

Make commonly used routes easy to navigate.

Consider whether the patient needs help getting to the bathroom.

Ask the healthcare team about mobility concerns and appropriate equipment when needed.

A bedside commode may be useful for some patients.

For others it may create additional confusion.

The right solution depends on the individual.

Sometimes the patient wakes the caregiver repeatedly

“Are you awake?”

“Where are we?”

“I need to go home.”

“Where is my mother?”

“I need the bathroom.”

“Is it morning?”

Once is manageable.

Twenty times in one night is something else.

The caregiver may become angry.

Then guilty for becoming angry.

Then exhausted.

Then morning arrives and caregiving starts again.

Chronic sleep loss is more than an inconvenience.

It can affect the caregiver's judgment, patience, health and ability to provide safe care.

If nighttime problems are repeatedly preventing the caregiver from sleeping, the healthcare team needs to know.

Look for physical reasons the patient is awake

Before assuming dementia is causing every sleep problem, consider whether something is making the patient uncomfortable.

Pain.

Constipation.

Urinary problems.

Shortness of breath.

Reflux.

Hunger.

Thirst.

Medication effects.

Sleep apnea.

Restless legs.

An uncomfortable room.

Too hot.

Too cold.

A wet brief.

The patient may be unable to tell you what is wrong.

Nighttime restlessness can sometimes be the only clue.

Medication deserves careful discussion

Families sometimes reach a point where they ask:

“Can the doctor give them something to sleep?”

That is a reasonable conversation to have with the healthcare professional.

Sleep medications and medications used for agitation can have significant effects in older adults, including increased sedation, confusion and fall risk. Antipsychotic medications sometimes used for severe behavioral symptoms in dementia carry an FDA boxed warning: clinical trials have found an increased risk of death in older adults with dementia who take them. These medications can still be appropriate in some situations, but the decision should be made carefully with a healthcare professional, weighing the specific risks against the severity of the symptoms.

The answer should be individualized.

Tell the healthcare professional what is actually happening.

How often the patient wakes.

What time the problem begins.

What the patient does.

Whether there are hallucinations or agitation.

How much the patient sleeps during the day.

What you have already tried.

Whether the caregiver is still able to function safely.

That gives the clinician a much better picture than simply saying:

“Dad doesn't sleep.”

Keep a short sleep log

You do not need a complicated chart.

For several days, write down:

What time the patient wakes.

Daytime naps.

Activity.

Meals.

Evening behavior.

Bedtime.

Nighttime awakenings.

Anything unusual.

You may discover a pattern you had never noticed.

The log can also help the healthcare team understand what is happening.

A caregiver needs sleep too

This deserves its own section because caregivers often treat their sleep as optional.

It is not.

If the patient requires supervision throughout the night and the caregiver must function throughout the day, something eventually has to change.

Maybe another family member takes a night.

Maybe paid overnight help becomes possible.

Maybe respite is needed.

Maybe the patient's medical team can help address the nighttime symptoms.

Maybe the overall care arrangement needs to be reconsidered.

There is no prize for staying awake longer than the human body can safely tolerate.

A care plan that depends on one person being awake day and night cannot remain stable forever.

Difficult nights can change the entire care decision

Families sometimes manage dementia at home reasonably well until nighttime becomes unsafe.

The patient begins leaving the house.

Falls repeatedly.

Needs constant supervision.

Becomes severely agitated.

The caregiver sleeps only two or three hours.

At that point, the question may become bigger than:

“How do we fix bedtime?”

It may become:

“Can this level of care still be provided safely in this home?”

That is a painful question.

It is also a legitimate one.

Later in this series we will talk much more about recognizing when more help or a different care setting may be needed.

Nighttime dementia can make the caregiver feel very alone

There is something different about caregiving at three o'clock in the morning.

The house is quiet.

Everyone else seems asleep.

Friends are asleep.

Family members are asleep.

The patient is awake again.

And so are you.

It can feel like nobody in the world understands what your night looks like.

Many dementia caregivers do understand.

They have walked hallways at two in the morning.

Answered the same question 30 times.

Stopped someone from opening the front door.

Changed sheets in the middle of the night.

Sat beside a frightened parent who had no idea where they were.

You are dealing with one of the genuinely difficult parts of this disease.

Build the safest night you reasonably can

There may never be a perfect solution.

But you can keep asking useful questions.

Is the patient comfortable?

Is the environment calm?

Is the house safe if they get up?

Are there medical reasons for the sleep problem?

Is the daytime routine contributing?

Does the healthcare team know how serious the problem has become?

And one question caregivers sometimes forget:

Am I still getting enough sleep to care for this person safely?

The patient's nighttime needs matter.

So do yours.

The goal is bigger than getting the patient through the night.

It is getting both of you safely to morning.

Chapter 5: Wandering, Driving and Getting Lost

Few dementia symptoms frighten families as quickly as wandering.

The patient who has lived in the same house for 30 years suddenly walks out the front door and cannot find the way back.

Dad leaves to buy milk and gets lost driving home.

Mom wakes at two in the morning and says she needs to go to work.

The patient starts searching for a spouse who died years ago.

Sometimes the caregiver catches it immediately.

Sometimes the first sign is an open door and an empty house.

Wandering and getting lost are different from many other dementia problems because the consequences can become serious very quickly.

This is one area where caregivers need to think ahead.

Wandering does not always look like wandering

The word wandering can make it sound as though the patient is walking around without a purpose.

Often the patient has a purpose.

They may be trying to:

Go home.

Go to work.

Find their children.

Find a bathroom.

Look for a spouse.

Get something to eat.

Leave a place they no longer recognize.

Continue a lifelong routine.

Respond to boredom or restlessness.

The destination may make no sense to the caregiver.

It may make complete sense to the patient.

That distinction can help you respond.

“I need to go home”

This is one of the most common and heartbreaking things caregivers hear.

The patient is standing inside the house where they have lived for decades.

“I want to go home.”

The caregiver answers:

“You are home.”

The patient becomes upset.

“No, I'm not.”

Then comes the temptation to prove it.

“You bought this house in 1987.”

“Look at your pictures.”

“This is your bedroom.”

Sometimes none of that matters.

The patient may be talking about a different home.

A childhood home.

A house from early marriage.

A place connected to safety.

Or “home” may simply represent the feeling that something is wrong and the patient wants to be somewhere familiar.

Instead of arguing over the address, respond to the feeling.

“You want to go home.”

“Tell me about home.”

“Let's sit down for a minute.”

Then redirect when possible.

The goal is to reduce distress, rather than win an argument about geography.

Look for patterns

Wandering may happen at predictable times.

After dinner.

During sundowning.

When the caregiver begins getting ready for work.

When the patient is bored.

After waking from a nap.

In the middle of the night.

When visitors leave.

Keep track of when it happens.

Then ask what might be driving it.

Does the patient need the bathroom?

Are they hungry?

Restless?

Looking for exercise?

Following an old routine?

Trying to find someone?

Uncomfortable?

A pattern does not always reveal the answer.

But sometimes it gives you something you can work with.

Give the patient somewhere safe to walk

Walking itself is not the enemy.

If the patient is physically able, walking can provide activity, exercise and something meaningful to do.

The danger is becoming lost or entering an unsafe area.

If possible, create safe opportunities for movement.

Walk together.

Use a secure yard.

Walk through the house.

Visit a familiar park with supervision.

Give the patient a destination.

“Let's walk to the mailbox.”

“Come help me check the garden.”

Sometimes a person who wants to move needs movement, rather than repeated instructions to sit down.

Home security may need to change

A home that was perfectly safe last year may become unsafe as dementia progresses.

The patient may begin opening doors unexpectedly.

They may leave while everyone else is sleeping.

They may forget how to return.

Caregivers may need layers of protection.

Depending on the patient and home, these can include:

·        Door alarms or chimes.

·        Motion alerts.

·        Appropriate door security.

·        Fencing or secured outdoor areas.

·        Nighttime lighting.

·        Keeping pathways clear.

·        Monitoring systems.

·        Identification carried or worn by the patient.

The best combination depends on the patient's abilities and living situation.

Think in layers.

One safety measure can fail.

Several reasonable layers give the caregiver more chances to notice a problem.

Never assume the patient would never leave

Families sometimes say:

“Mom has never wandered.”

That is useful information about yesterday.

Dementia changes.

A first wandering episode can happen without any history of it before.

If the patient is becoming confused about location, asking to go home, searching for people, walking at night or trying to leave, begin thinking about safety before the first disappearance.

Preparation is much easier when the patient is still sitting in the living room.

Identification can matter

A patient who becomes lost may be unable to tell another person:

Their full name.

Where they live.

Who to call.

What medical condition they have.

Identification can help someone get the patient home.

Families may consider an identification bracelet or another form of identification the patient is likely to keep with them.

A recent photograph is also useful.

Keep one available.

If the patient disappears, you do not want to spend valuable time searching your phone for a good current picture.

Have a plan before you need it

Ask yourself:

What would I do if the patient disappeared right now?

Would you know what clothing they were wearing?

Do you have a current photograph?

Would you know which direction they usually walk?

Which neighbors know the patient has dementia?

Does the patient carry identification?

What places from the patient's past might they try to reach?

Who would you call?

You do not need to live in fear of wandering.

You do need a plan.

If the patient becomes missing

A missing vulnerable adult with dementia can become an emergency.

Search the immediate area right away, including inside the home, the yard, and less-traveled spots like closets or a car in the garage. Most people found after wandering are located close to where they started.

If the patient is not found within about 15 minutes, call 911. Tell the dispatcher the patient has dementia and is a vulnerable adult. This matters: it signals an urgent response rather than the standard waiting period sometimes used for other missing-person cases. Many states also have a Silver Alert system, similar to an Amber Alert, specifically for missing older adults with dementia.

Check places the patient may be drawn to or may have visited in the past.

Provide responders with a current photograph, description, clothing, medical information and known destinations or habits.

Avoid waiting simply because the patient has wandered before and returned.

Weather, traffic, water, falls, dehydration and exposure can turn wandering into a dangerous situation.

Driving creates a different problem

Driving represents far more than transportation.

It represents independence.

Privacy.

Adulthood.

Freedom.

For many older adults, giving up the keys feels like losing part of who they are.

That is why conversations about driving can become explosive.

The caregiver sees danger.

The patient sees someone trying to take away their independence.

Both may be responding to something real.

A dementia diagnosis does not answer every driving question by itself

Dementia affects people differently.

The ability to drive safely depends on the patient's cognitive and functional abilities, the type and progression of disease, and other medical factors.

What matters is whether the patient can safely perform the complicated tasks driving requires.

Driving involves:

Attention.

Judgment.

Reaction time.

Navigation.

Interpreting signs.

Responding to unexpected situations.

Remembering rules.

Tracking several things at once.

Dementia can gradually interfere with these abilities.

Watch the driving, rather than the argument

Families often get stuck debating whether Dad is “still a good driver.”

Look for evidence.

Has the patient:

Become lost on familiar routes?

Returned much later than expected?

Had new dents or scrapes on the vehicle?

Confused the gas and brake?

Missed traffic signs?

Made unsafe turns?

Driven unusually slowly or unpredictably?

Had near misses?

Become confused at intersections?

Received tickets?

Had other drivers honk frequently?

Needed a passenger to give constant directions?

These observations are more useful than arguing over whether the patient has driven for 60 years without an accident.

The question is about driving today.

Getting lost while driving is a major warning sign

A patient may still operate the vehicle mechanically very well.

They can steer.

Brake.

Park.

Use the turn signal.

But navigation begins failing.

They leave for a familiar store and cannot find the way home.

That is a serious change.

Driving requires much more than controlling the vehicle.

A patient who becomes lost can end up hours away, run out of fuel, become stranded or enter dangerous traffic situations.

Getting lost should trigger a serious driving-safety discussion.

Let professionals help when possible

Sometimes the caregiver becomes the enemy because they are the person trying to take away the keys.

The patient's healthcare professional may help assess the situation and discuss driving safety.

In some situations, a formal driving evaluation may be appropriate.

The exact rules regarding medical reporting, license review and driving restrictions vary by state or jurisdiction.

Families should learn the requirements where the patient lives.

The caregiver can share this decision with others.

Plan transportation before taking transportation away

Imagine someone tells you:

“You can't drive anymore.”

Your next thought may be:

Then how am I supposed to live?

How will the patient:

Buy groceries?

Attend appointments?

Visit friends?

Go to church?

Get a haircut?

Go to lunch?

Driving cessation works better when there is an alternative.

Family rides.

Friends.

Community transportation.

Paratransit when eligible.

Senior transportation programs.

Rideshare with assistance when appropriate.

Adult day program transportation.

The exact solution depends on the community and patient.

Losing driving is still a loss.

But losing the keys without any replacement for mobility makes that loss much larger.

Sometimes access to the vehicle becomes the problem

A patient may agree today that driving has become unsafe.

Tomorrow they may forget the conversation.

The keys are on the counter.

The car is outside.

They believe they are perfectly capable of driving.

This can force families to change access to the vehicle.

How that is handled depends on the patient, family and level of risk.

The larger principle is straightforward:

A safety plan cannot depend entirely on a patient remembering a decision that dementia may prevent them from remembering.

Walking away and driving away come from the same larger change

Both situations involve something dementia gradually damages:

The ability to safely navigate the world independently.

Early in the disease, the patient may travel normally.

Then they need reminders.

Then familiar routes only.

Then supervision.

Eventually independent travel may become unsafe.

This loss can be painful for everyone.

It also means the caregiver's role changes.

You become part of the patient's navigation system.

Freedom and safety have to move together

Dementia caregiving constantly creates tension between two good goals.

Preserve independence.

Keep the patient safe.

There is no single line that works for every patient.

Too much restriction too early can unnecessarily shrink the patient's life.

Too little supervision too late can create serious danger.

So keep reassessing.

Can the patient still walk safely in the neighborhood?

Can they find the way home?

Can they cross streets safely?

Can they use transportation independently?

Can they drive safely?

What has changed?

What evidence do you have?

The answer today may be different six months from now.

The goal is safe movement, rather than no movement

A patient with dementia still needs to move through the world.

Walk.

Go outside.

Visit people.

Ride in a car.

See familiar places.

Participate in life.

The answer to wandering risk is rarely to make the patient sit in one chair forever.

The answer is to gradually build more support around movement as the patient's ability to navigate independently changes.

Preserve as much freedom as you safely can.

Then add protection before the patient needs more protection than yesterday's care plan provides.

Chapter 6: Making the Home Safer as Dementia Changes

Most homes are designed for people who can recognize danger.

We know the stove is hot.

We understand that cleaning products should not be swallowed.

We remember to lock the door.

We recognize stairs.

We know how to use appliances.

We understand that a bottle of medication contains medicine rather than candy.

Dementia gradually changes some of those abilities.

That means a home that was perfectly safe for the patient five years ago can slowly become dangerous.

Families sometimes respond by trying to dementia-proof the entire house overnight.

That can create a home full of locks, alarms and restrictions long before they are needed.

A better approach is to keep asking:

What can the patient safely manage today, and what risk is beginning to appear?

Then change the home as the patient's abilities change.

Start with the patient's actual risks

Every patient is different.

One patient wanders.

Another never approaches the front door.

One patient continues cooking safely for quite a while.

Another forgets a pan on the stove.

One patient tries to repair things around the house.

Another has lost interest in tools completely.

Walk through the home and think about the patient who actually lives there.

Where have problems already occurred?

What abilities are changing?

What could happen if the patient became confused?

Safety planning works better when it responds to real risks instead of fear of every possible risk.

Falls deserve early attention

Falls can become increasingly common as dementia progresses.

The patient may develop problems with balance, strength, judgment, vision, depth perception or walking.

Medications and other medical conditions can also contribute.

Start with simple things.

Keep walkways clear.

Remove loose clutter.

Watch electrical cords.

Make sure commonly used areas have adequate lighting.

Consider whether loose rugs create a hazard.

Keep frequently used items within easy reach.

Make stairs easier to see and navigate.

Use appropriate handrails or grab bars where needed.

Encourage properly fitting footwear.

If walking or transfers are becoming difficult, ask the healthcare team whether a physical or occupational therapy evaluation could help.

Bathrooms deserve special attention

Bathrooms combine several risks.

Water.

Slippery surfaces.

Hard floors.

Getting in and out of a tub.

Standing during a shower.

Sitting and rising from the toilet.

Closing and locking doors.

A patient may eventually need grab bars, a shower chair, nonslip surfaces, additional supervision or other changes.

An occupational therapist can sometimes help families evaluate the bathroom and recommend changes based on the patient's abilities.

The goal is to make personal care easier and safer for both patient and caregiver.

The kitchen can change from familiar to dangerous

Someone who cooked safely for 60 years may gradually lose the ability to manage a stove.

They may leave a burner on.

Put something inappropriate into the microwave.

Forget food is cooking.

Place plastic on a hot surface.

Turn on the wrong burner.

Eat spoiled food.

Use a knife unsafely.

The difficult part is deciding when help is needed.

You may begin with supervision.

Later, the patient may prepare only simple foods.

Eventually access to certain appliances may need to change.

Try to preserve whatever kitchen participation remains safe.

The patient may still wash vegetables, stir something, set the table or help with another simple task even after independent cooking becomes unsafe.

Medications need their own safety plan

Medication management can become dangerous surprisingly early.

The patient may forget a dose.

Take it twice.

Mix up morning and evening medication.

Take someone else's medication.

Forget that medication was already taken.

Stop taking an important drug.

As memory and judgment change, medication independence should be reassessed.

Families may use pill organizers, reminders, automated dispensers or direct caregiver supervision depending on the patient's abilities.

The patient's pharmacist or healthcare professional can help when the medication schedule becomes difficult to manage.

Medication safety should never depend on pretending the patient's memory is stronger than it currently is.

Household chemicals can become confusing

Cleaning products, pesticides, automotive fluids and other chemicals may eventually need to be secured.

The patient may have used these products safely throughout adulthood.

Dementia can change recognition and judgment.

A colorful bottle may be mistaken for a drink.

Several chemicals may be mixed together.

A product may be used in the wrong place.

Again, respond to the patient's changing abilities.

As risk increases, move dangerous products somewhere secure.

Firearms and other weapons require serious planning

If firearms are present in a home where someone has dementia, access deserves careful consideration.

A patient who previously handled firearms safely may later become confused, frightened, suspicious or unable to correctly identify another person or situation.

The same principle applies to other weapons.

Families should address secure storage and access before a dangerous situation occurs.

This can be emotionally difficult when firearms have been part of the patient's identity, work, military service, hunting or recreation.

The conversation is still worth having.

Past competence does not guarantee current safety as dementia progresses.

Tools and machinery can become unsafe too

A workshop, garage or yard may contain:

Power tools.

Lawn equipment.

Ladders.

Gasoline.

Sharp tools.

Electrical equipment.

A patient who has spent a lifetime using these items may strongly believe they remain capable.

Some activities may remain safe with supervision.

Others may eventually need to stop.

Look at what the patient is actually doing rather than relying entirely on what they used to be able to do.

Water can be a hidden risk

Pools, ponds, canals, lakes and other bodies of water deserve attention when wandering or confusion develops.

A patient may forget how to return from an area.

They may misjudge a step.

They may enter water without understanding the danger.

If water is accessible near the home, include it in wandering and home-safety planning.

This is especially important because a missing patient may be drawn toward familiar outdoor areas.

Temperature becomes another concern

A patient may eventually have difficulty judging whether the environment is too hot or too cold.

They may wear inappropriate clothing.

Sit outside too long.

Turn the thermostat dramatically.

Forget a heater is running.

Remain in direct sun.

Weather exposure can become dangerous when the patient wanders.

Caregivers may need to pay more attention to temperature as judgment changes.

Phones and scams create a different kind of danger

Home safety includes financial safety.

A patient may still answer the phone independently while losing the judgment needed to recognize a scam.

They may provide personal information.

Give someone a credit card number.

Send money.

Allow a stranger into the home.

Click suspicious links.

Respond to fraudulent mail.

Families sometimes discover this only after money is missing.

Changes in financial judgment are common enough in dementia that families should pay attention early.

Call-blocking tools, financial alerts, account monitoring and other safeguards may become appropriate.

Part 3 of this series will discuss the larger legal and financial planning issues in more detail.

Consider what happens during an emergency

Could the patient safely respond to a smoke alarm?

Would they know how to leave the house?

Could they call for help?

Would they understand instructions from a dispatcher?

Would they know their address?

Could they safely remain alone during a power outage?

What would happen during a hurricane, wildfire, winter storm or evacuation?

The answers may change over time.

Include the patient's cognitive abilities in the household emergency plan.

Keep important information accessible to the caregiver.

Have medications and essential supplies accounted for.

Know where you would go if the home had to be evacuated.

Being home alone needs regular reassessment

This is rarely a single yes-or-no decision for the entire course of dementia.

Early in the disease, a patient may safely remain alone for periods of time.

Later, the risks increase.

Ask practical questions.

Can the patient use the phone?

Can they respond to an emergency?

Do they wander?

Can they prepare food safely?

Do they take medications correctly?

Have they left the stove on?

Do they become frightened when alone?

Can they recognize strangers?

Can they safely use the bathroom?

Would they know what to do if they fell?

The question is less:

“Does the patient have dementia?”

and more:

“What could realistically happen during the time the patient is alone?”

Technology can help, but a care plan still leads

Families now have access to many useful tools.

Door sensors.

Cameras.

Motion detectors.

Location devices.

Medication dispensers.

Smart speakers.

Fall-detection devices.

Remote alerts.

Some of these can be extremely helpful.

But technology has limits.

A camera can show you that Mom has fallen.

It cannot always help her stand up.

A location device can tell you where Dad wandered.

Wandering remains risky no matter what technology is in place.

A medication dispenser can release pills.

It cannot guarantee the patient swallowed them correctly.

Use technology as another layer of support.

Avoid asking technology to replace supervision the patient actually needs.

Make changes without unnecessarily taking over the house

There is a psychological side to home safety.

The patient's home is still their home.

Imagine waking up one day to discover:

The stove disabled.

The doors alarmed.

The tools gone.

The medications locked up.

The car unavailable.

Someone watching every movement.

There may come a time when some or all of those measures are necessary.

But whenever possible, make changes gradually and for a reason.

Preserve normal life where normal life remains safe.

Safety equipment should also work for the caregiver

A safety solution that the caregiver cannot realistically use will eventually fail.

A complicated lock that takes five minutes to open during an emergency may create another problem.

Equipment that requires the caregiver to lift more weight may increase injury risk.

An alarm that sounds constantly may eventually be ignored.

Think about both people.

Can the patient use the environment safely?

Can the caregiver provide care safely?

Good home design should help both.

Ask professionals to look at the home when needed

Caregivers sometimes become so familiar with their environment that they stop seeing risks.

An occupational therapist, physical therapist, home health professional or other qualified professional may notice things the family misses.

They may recommend equipment or changes based on the patient's actual abilities.

That can be especially useful after falls, hospitalization or significant functional decline.

Reassess after major changes

Home safety should be reviewed whenever something important changes.

A fall.

A wandering episode.

A hospitalization.

New incontinence.

A medication change.

A major decline in walking.

A kitchen incident.

A driving incident.

A new behavior.

A change in vision.

A caregiver injury.

Each event may tell you that yesterday's care plan needs adjusting.

The safest home is still supposed to be a home

It is easy for dementia caregiving to become entirely about preventing bad things.

No falls.

No wandering.

No kitchen accidents.

No missed medications.

No unsafe tools.

Safety matters enormously.

But the patient still needs somewhere to live.

A favorite chair.

Photographs.

Music.

A porch.

A pet.

A garden.

A kitchen they can still participate in.

Familiar things.

Familiar people.

A sense that this is their place.

The goal is not to remove every possible risk from life.

That would require removing most of life.

The goal is to recognize when the disease has changed a particular risk and respond before that risk becomes unreasonable.

Keep the home as familiar and independent as the patient's abilities allow.

Then quietly build more safety around them as those abilities change.

Chapter 7: Mobility, Falls and Transfers

Dad used to walk two miles every morning.

Now he holds the wall to get from the bedroom to the bathroom.

Mom stood up from her chair last week and her legs simply did not cooperate.

Walking, balance and safe movement can decline right alongside memory and language. It rarely gets talked about as much, and it can be just as disruptive to daily life.

Why can walking and balance worsen as dementia advances?

Dementia affects the brain, and the brain controls far more than memory.

The same regions that manage thinking and judgment also help coordinate balance, posture and the countless small adjustments the body makes while walking. As the disease progresses, that coordination can break down even when the muscles themselves are still strong.

Other common contributors layer on top of that:

·        General deconditioning from reduced activity.

·        Medication effects, including drowsiness or dizziness.

·        Vision changes that make depth and obstacles harder to judge.

·        Fear of falling, which can itself change how a person walks.

·        Pain the patient may no longer be able to describe.

·        Other medical conditions such as arthritis, past stroke, or Parkinson's disease.

Walking changes are rarely about one single cause. They are usually about several small things adding up.

How do I know when the patient needs more help standing, walking, or transferring?

Watch for the same kind of pattern we have talked about throughout this series: a change from the person's own normal.

·        Holding onto furniture or walls more than before.

·        A wider, shuffling, or unsteady gait.

·        Hesitating or freezing in doorways or on different flooring.

·        Needing more time or more attempts to stand up from a chair.

·        A recent near-fall or a fall, even a minor one.

·        New reluctance to walk distances that used to be easy.

Any of these is a reasonable reason to mention mobility at the next appointment, rather than waiting for a fall to bring it up.

What should I do when the patient keeps trying to stand despite no longer being physically safe?

This is one of the more frightening moments in dementia caregiving. The patient's body may no longer be able to do what the patient's mind still believes it can do.

A few practical approaches can help:

·        Stay close during transitions like standing, sitting, and walking, rather than across the room.

·        Keep a clear, uncluttered path to wherever the patient tends to go.

·        Use a chair with arms and a firm seat, which is easier and safer to rise from.

·        Consider a chair or bed alarm that alerts you when the patient starts to stand unsupervised, if that fits your situation.

·        Address the underlying urge. A patient who keeps trying to stand may need the bathroom, may be in pain, or may simply be restless.

Do not try to physically hold the patient down or block them with your body. That approach tends to increase fear and struggle in the moment, and it puts both of you at risk of injury. Create space when you safely can, and if standing or wandering attempts are frequent, raise it directly with the patient's healthcare team as a safety issue that needs a real plan, not something to manage through physical force.

What is a transfer, and why does it carry real risk for both of you?

A transfer is any move from one surface or position to another: bed to chair, chair to standing, onto and off the toilet, into and out of a shower or tub, in and out of a car. Once a patient can no longer do these movements fully on their own, a transfer becomes something the caregiver's own body has to help support.

This is not a small physical demand. Back, shoulder, and neck injuries from lifting and transferring are among the most common injuries family caregivers experience, and they often build up gradually rather than happening all at once.

Pulling someone up by the arms or shoulders is a common instinct, and it is one of the riskier ways to attempt a transfer. A weak or unsupported arm pulled during a transfer can partially dislocate at the shoulder, which is painful and can further limit what the patient can do. Pulling from the arms also puts the caregiver's own back at risk, since it usually means bending and reaching rather than using the legs and staying close to the patient's body.

When should I stop attempting a transfer alone?

A few signs suggest a transfer has moved beyond what one caregiver should try to manage without help or equipment:

·        The patient can no longer bear any weight on their legs.

·        The patient cannot reliably follow a simple instruction during the move, such as “stand up” or “step here.”

·        A recent transfer nearly resulted in a fall, for either of you.

·        You have started to feel real strain in your own back, shoulders, or knees during transfers.

·        The patient's size or weight makes a safe, controlled transfer difficult for one person.

If any of these describe your situation, that is the signal to bring in equipment, a second person, or professional training, not to keep pushing through on your own. A two-person assist, a transfer belt used correctly, a sliding board, or a mechanical lift can all make a transfer safer for both of you. Needing this kind of help is not a failure. It is matching the right tool to the task.

This article will not walk through a specific lifting or transfer technique step by step. The safest technique depends on the patient's strength, balance, weight, and ability to cooperate, and it needs to be taught hands-on by a professional who can watch how your specific patient moves, not learned from a written description.

When should I ask for physical therapy, occupational therapy, nursing, or equipment guidance?

Mobility and transfer problems are exactly the kind of issue where a caregiver can call in help.

A physical therapist can assess strength, balance and walking safety, and can build an exercise plan suited to the patient's abilities. An occupational therapist can look at how the patient manages daily tasks and recommend adaptive equipment or techniques. Depending on your situation, home health nursing or therapy staff can also help coordinate care and provide hands-on training in safe transfer technique for your specific patient.

Ask the patient's healthcare provider:

“Could a physical therapy or occupational therapy evaluation help with walking and transfers?”

You do not need to wait for a crisis to ask this question. Many caregivers only get this kind of guidance after a fall, when it could have helped well before one.

How can falls change the patient's baseline and care needs?

A fall is rarely just a fall.

Even a fall without an obvious injury can represent a meaningful change. It can reflect declining strength, a new medical problem, a medication effect, or advancing disease. It can also cause a new injury on its own, from a bruise to a fracture to a head injury that deserves prompt medical attention.

Tell the healthcare professional about any fall, including when it happened, what the patient was doing, and how the patient has seemed since. Some falls need more than a mention at the next appointment. Seek urgent or emergency evaluation right away if the fall involves a head injury, any loss of consciousness, severe pain, inability to bear weight or stand, an obvious injury or deformity, new weakness, confusion, or difficulty speaking, significant bleeding, or any other change that concerns you.

A fall can also shift what is realistic at home. A patient who could safely be left alone for twenty minutes before a fall may not be safe to leave alone afterward. Reassessing supervision and safety after a fall is not overreacting. It is responding to new information.

The Big Picture

Mobility changes can be gradual, then suddenly impossible to ignore. Watch for the early signs rather than waiting for a fall to force the conversation.

Bring in physical therapy, occupational therapy, or nursing support when walking or transfers become a concern. That is what those professionals are there for.

And treat every fall as information, not just an accident. It may be telling you something about what has changed and what the patient needs next.

Chapter 8: Keeping Daily Life Meaningful as Abilities Change

Dementia caregiving can slowly become a list of tasks.

Medication.

Breakfast.

Bathroom.

Laundry.

Appointment.

Bath.

Dinner.

Bed.

Repeat.

When care becomes demanding, simply getting through the day can feel like an accomplishment.

But the patient is still living inside those days.

Even as memory, judgment and independence decline, people can still experience comfort, enjoyment, familiarity, connection and purpose.

The question changes from:

“What can the patient still accomplish?”

to:

“What can still make today feel like a life?”

Meaning can happen even if it is forgotten tomorrow

Families sometimes stop activities because the patient will forget them.

Why take Mom to lunch if she will not remember going?

Why play cards if Dad forgets the game afterward?

Why visit if the patient may forget you were there?

Because the experience still happened.

A patient can enjoy music without remembering the song tomorrow.

They can enjoy ice cream without remembering who brought it.

They can laugh.

Relax.

Feel safe.

Enjoy sunshine.

Hold someone's hand.

The memory of an experience and the value of an experience are different things.

Follow abilities instead of old expectations

Activities that once brought joy may become frustrating when they require abilities the patient has lost.

Someone who loved complicated crossword puzzles may eventually struggle with them.

A lifelong cook may become unable to follow a recipe.

A gardener may no longer safely operate equipment.

The interest can still be there, just harder to express.

Change the activity.

The cook can stir.

The gardener can water plants.

The person who loved woodworking can sort familiar objects or sit with someone working in the garage when it is safe.

The goal is participation rather than performance.

Familiar activities often work better

Dementia affects recent memory differently from deeply established habits and memories.

Activities connected to earlier life may remain meaningful long after newer activities become confusing.

Music from the patient's younger years.

Old photographs.

Familiar prayers or spiritual practices when important to the patient.

Folding towels.

Sorting objects.

Gardening.

Watching a familiar team.

Sitting on the porch.

Looking through old magazines.

Helping prepare a simple meal.

Walking a familiar route with supervision.

The best activity is often something connected to who the patient has always been.

Music can reach people differently

Caregivers frequently notice that someone who struggles with conversation can still respond strongly to music.

A familiar song may lead to:

Singing.

Tapping.

Smiling.

Movement.

Relaxation.

Recognition.

Music can also become overstimulating for some patients, particularly when it is loud or unfamiliar.

Watch the patient.

If they relax and engage, continue.

If they become irritated or overwhelmed, change the environment.

The patient's response is the guide.

Let conversation stay relaxed

Caregivers naturally ask questions.

“What did you have for breakfast?”

“Who visited yesterday?”

“Remember when we went to the beach?”

For someone losing memory, ordinary conversation can begin feeling like an examination they keep failing.

Try conversations that require less recall.

Talk about what is happening now.

Comment on something outside the window.

Look at photographs without demanding names.

Listen to music.

Tell a story rather than requiring the patient to tell one.

If a memory appears, follow it.

Either way, the conversation can continue.

Connection matters more than proving what the patient remembers.

Children and grandchildren may need help understanding

Dementia can be confusing for younger family members.

Grandma repeats herself.

Grandpa calls someone by the wrong name.

The patient says something strange.

They may stop recognizing people.

Children can sometimes interpret this as rejection or become frightened by behavior they do not understand.

Explain dementia in age-appropriate language.

Tell them the patient's brain is having trouble remembering and understanding things.

Prepare them for what they may see.

Give them simple ways to connect.

Draw a picture.

Listen to music.

Look through photographs.

Sit together.

Bring a favorite snack when appropriate.

A relationship can change without disappearing.

Pets can provide companionship

For some patients, animals can offer comfort and familiarity.

Petting a dog.

Watching a cat.

Listening to birds.

Helping with a simple pet-care routine when safe.

But consider the needs of both the patient and the animal.

A patient may eventually forget how to interact safely with a pet.

They may overfeed it.

Leave doors open.

Become frightened.

Handle the animal roughly without intending to.

As with everything else, reassess as abilities change.

Going outside can change the day

Dementia can make life increasingly confined.

The same rooms.

The same chair.

The same television.

Day after day.

When safe and practical, time outside can offer a different environment.

A porch.

A yard.

A supervised walk.

A garden.

A park.

Fresh air and a change of surroundings can be valuable even when the patient cannot explain why.

The outing can be simple.

Sometimes sitting outside for 15 minutes is enough.

Social connection may need to become simpler

Large gatherings can eventually become overwhelming.

Too many voices.

Too much movement.

Too many people asking questions.

The patient may do better with one visitor.

A shorter visit.

A quieter room.

A familiar person.

Earlier in dementia, social activities may remain important and enjoyable.

Later, connection may become smaller and more personal.

Adapt the environment rather than assuming the patient no longer wants people around.

Routine can create security

A predictable day can reduce the amount of information the patient has to process.

Wake around the same time.

Meals around familiar times.

Regular bathroom opportunities.

Familiar activities.

A consistent bedtime routine.

Life cannot always follow a perfect schedule.

The purpose of routine is not rigid control.

It is familiarity.

When the brain has difficulty understanding what comes next, a familiar rhythm can make the world easier to navigate.

Give choices the patient can still manage

Independence can mean choosing a few things that matter.

Sometimes independence becomes choosing between two manageable options.

“Would you like the blue shirt or the green shirt?”

“Coffee or tea?”

“Would you like to sit outside or in the living room?”

Too many choices can become overwhelming.

A smaller choice still gives the patient a voice.

Let the patient help

Caregivers become efficient.

It is faster to dress the patient.

Set the table.

Fold the laundry.

Put everything away.

But doing everything for someone can remove abilities they still have.

If the patient can safely participate, allow time.

Hand them the towel.

Let them brush their hair.

Let them carry something light.

Let them wipe the table.

Let them fold the washcloths imperfectly.

The finished task matters less than the participation.

Success needs a new definition

Before dementia, success might mean completing a project.

Finishing the puzzle.

Cooking dinner.

Cleaning the entire room.

After dementia, success may mean ten pleasant minutes.

The patient folded three towels.

Watered one plant.

Sang half a song.

Sat outside without becoming anxious.

Helped stir pancake batter.

Smiled at a photograph.

That counts.

Activities should create engagement rather than another opportunity to fail.

Watch for frustration

Sometimes caregivers keep encouraging an activity because the patient used to love it.

But the activity has become too difficult.

Watch the face.

The hands.

The voice.

Restlessness.

Irritation.

Repeated mistakes.

Withdrawal.

If the activity creates frustration, simplify it or move to something else.

Preserving dignity sometimes means quietly changing the task before the patient realizes they cannot do it anymore.

Rest is also part of the day

Caregivers can feel pressure to keep the patient constantly stimulated.

Activities.

Puzzles.

Exercise.

Conversation.

Television.

Music.

Outings.

People with dementia also need rest.

Advanced dementia especially can bring increased fatigue and sleep.

A quiet afternoon is not automatically a failed afternoon.

Balance activity with the patient's energy and comfort.

Keep your own role realistic

This matters.

You already have enough to do.

Meaningful engagement can come from small, simple moments rather than an elaborate schedule.

Fold laundry together.

Sit outside while drinking coffee.

Play music while preparing dinner.

Look at photographs for ten minutes.

Take a short walk.

Watch an old movie.

Let the patient sit nearby while you work on something familiar.

Ordinary life can provide activity.

Some days will simply be difficult

You can create the perfect routine.

Prepare the favorite music.

Make the favorite meal.

Arrange a quiet activity.

And the patient may still be agitated, tired or uninterested.

Dementia has good days and difficult days.

An activity that flops reflects the day, not your effort.

Try something else.

Try later.

Or let the day be quiet.

Keep the person visible inside the disease

As dementia advances, it can consume everyone's attention.

What stage?

What medication?

How much help?

How many falls?

How much did they eat?

Did they sleep?

Did they recognize me?

Those questions matter.

But somewhere underneath all the caregiving problems is still a person with a history.

A mechanic.

A mother.

A teacher.

A fisherman.

A nurse.

A gardener.

A veteran.

A grandmother.

A musician.

A person who loved baseball, terrible jokes, old movies, dogs, church, motorcycles, baking, dancing or sitting quietly with coffee.

Dementia changes what that person can do.

Who that person has been still matters.

A good day may become something very simple

Families sometimes spend years hoping for improvement.

Then hoping for stability.

Eventually they may begin measuring something else.

Was the patient comfortable?

Did they feel safe?

Was there a smile?

Did we avoid unnecessary distress?

Did we share something pleasant?

Did they participate in something they could still do?

That may become enough.

Caregiving cannot restore every ability dementia takes away.

But caregivers can still help create moments worth having.

A good moment matters today, regardless of whether it is remembered tomorrow.

Sources and More Information

The following organizations and authorities provided background for this part of the series. These sources were also used as authoritative reference points for final accuracy review.

National Institute on Aging: Alzheimer's Caregiving
https://www.nia.nih.gov/health/alzheimers-caregiving

National Institute on Aging: Managing Personality and Behavior Changes
https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/alzheimers-caregiving-managing-personality-and

National Institute on Aging: Care in the Last Stages of Alzheimer's Disease
https://www.nia.nih.gov/health/alzheimers-caregiving/care-last-stages-alzheimers-disease

National Institute on Aging: Helping People With Alzheimer's Disease Eat Well
https://www.nia.nih.gov/health/alzheimers-caregiving/tips-caregivers-helping-people-alzheimers-disease-eat-well

American Geriatrics Society: Feeding Tubes in Advanced Dementia Position Statement
https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.12924

Alzheimer's Association: Daily Care
https://www.alz.org/help-support/caregiving/daily-care

Alzheimer's Association: Wandering
https://www.alz.org/help-support/caregiving/stages-behaviors/wandering

Alzheimer's Association: Preparing for Emergencies
https://www.alz.org/help-support/caregiving/safety/in-a-disaster

National Institute on Aging: Driving Safety and Alzheimer's Disease
https://www.nia.nih.gov/health/safety/driving-safety-and-alzheimers-disease

National Institute on Aging: Alzheimer's Caregiving Home Safety Tips
https://www.nia.nih.gov/health/safety/alzheimers-caregiving-home-safety-tips

Sheltering Arms Institute: The Body Mechanics Guide for Caregivers (Safe Lifting and Transfers)
https://shelteringarmsinstitute.com/rehablogs/the-body-mechanics-guide-for-caregivers/

U.S. Food and Drug Administration: Boxed Warning on Antipsychotic Drugs and Dementia-Related Psychosis
https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treat-agitation-symptoms-associated-dementia-due-alzheimers-disease

A Note from Fireside Village

Thank you for reading. This article and the other articles in this series were created specifically for Fireside Village members. Caregiving questions change as the person and the disease change. If there is a subject you would like us to explore, please share your suggestion with a Fireside Village admin