A Safe and Nurturing Environment

Maintaining a Safe and Nurturing Environment

Stimulation

Creating an environment with adequate amounts of stimulation without overwhelming or confusing an individual with dementia can be very helpful. People with dementia have a limited capacity to process incoming information. This, environments with too much stimulation can be overwhelming and lead to agitation and possibly aggressive behavior. Imagine trying to concentrate enough to read this book while your spouse and your sister are each talking to you simultaneously, your children are playing a spirited game next to you and the radio is on. This is what it might feel like for an individual with dementia to attempt to hold a conversation in a room with the televisions on.

For persons with middle- and late-stage Alzheimer’s disease it is important to avoid very loud or bustling settings with too much stimulation (e.g., busy shopping malls, crowded streets).

Wandering

People with dementia may wander because they feel lost or are looking for something or someone they believe they have lost. Other reason for wandering includes medication side effects, disorientation, curiosity, boredom, restlessness, or memories triggered by routines or stimuli. Wandering does not have to have dangerous consequences, and does not have to be prevented. In fact, attempts to prevent wandering can result in agitation and conflict. To maintain safety, families can obtain alarms that sound when a door is opened or doorstoppers that prevent doors from opening completely. Locking doors that cannot be opened from the inside can be a fire hazard.

Housing

If family members are unable to maintain a safe environment at home, they may consider employing an aide to provide supervision, placement in a specialized adult day program, or relocation to a long-term care facility. When new living arrangements are being considered, families must be sure to choose housing facilities whose resources match the level of disability. In addition to being attentive to physical well-being (e.g., minimizing risk of falling, being alert to wandering) and behavioral disturbance, quality facilities also address emotional, social, and spiritual needs of residents).

Family and professional caregivers face a significant challenge in providing adequate supervision to prevent unsafe activities while maintaining the dignity and freedom of an individual with dementia. There may be a tendency to infantalize the person with dementia by using speech and setting limits as one might with a child. The individual with dementia is an adult, deserving of respect. With creativity and patience it is possible to be respectful and prevent unsafe activities.

What to do about seniors with deteriorating ability to drive is an awkward issue for families and service providers. Driving facilitates feelings of independence, competence, and convenience for many seniors. The end to driving can be devastating.

Recall that normal aging includes a decline in the speed of processing information. People with dementia are more compromised and are often unable to judge, observe, or respond quickly enough to stimuli around them. It has been suggested that drivers in t early stages of dementia are impair at approximately the same level as someone with a blood-alcohol lever of .08 (the legal limit in most states).

Warning signs signifying that it may be time to stop driving include the inability to locate or recognize familiar places; poor judgment and slow decision-making in traffic; anger, confusion, or frustration while driving; and failure to observe and follow traffic signs and speed limits. As progression of the disease varies considerably, ability to drive should be assessed individually. If driving skills appear questionable, agencies are available to administer driving tests, including the motor vehicle bureaus in some states.

Communication

People with dementia experience increasing difficulty expressing their needs, concerns, and even memories. They may use incorrect or inappropriate words or say the first thing that comes to mind. When inappropriate remarks are made, caregivers should remember that such remarks reflect a disease process.

Caregivers and professionals must also be attentive to nonverbal signals given by people with dementia. Although people with dementia may not be able to say that they are cold, tired, hungry, or in pain, there are nonverbal ways that they may convey this information. Look for shivers or grimaces of pain, for example.

Nonverbal communication by the caregiver to the persons with dementia is also important. The way an individual with dementia is approached can positively or negatively affect interaction. For example, approaching someone in the late stages of dementia with a smile and a soothing voice increases the likelihood that they will be relaxed and open to communicating. Appearing or sounding angry can be very threatening and lead the individual with dementia to become frightened or agitated. Thus, even if a behavior is frustrating to the caregiver, remain calm and express anger elsewhere. Other helpful techniques include the following:

  • Approach the person from the front and maintain eye contact at all times
  • Speak and move slowly
  • Tell the individual who you are and why you are there
  • Particularly in the early stage of dementia when deficits are minimal (and for some, well into the middle stage), speak directly to the individual with dementia rather than directing questions to the caregiver only. This helps to maintain dignity and demonstrates respect for the older adult. Directing questions to the person with dementia in the presence of the caregiver will give the caregiver the opportunity to clarify any misinformation
  • Minimize distractions, particularly when giving instructions
  • Use few words, and words that are familiar to the individual
  • Ask one question at a time or give one step of instruction at a time
  • Ask questions that don’t require memory or complicated reasoning
  • Ask yes/no questions when possible
  • Repeat questions using the same words. If there is still no response, try rephrasing
  • Remain calm, particularly if the individual becomes agitated. Responding to agitation with upset only escalates the situation
  • Use nonverbal communication such as smiles, nods and gestures. Be careful with touch. Individuals with dementia need touch as much as before the onset of illness, but cultural traditions and personal preference, along with fears of strangers, may limit the amount of touch that the individual with dementia can tolerate
  • Use distraction to minimize inappropriate or unwanted behavior.

The above information was provided by the Society of Certified Senior Advisors (SCSA).