The Merck Manual of Geriatrics suggests that those facing memory loss and their loved ones create a safe, comfortable, supportive, and sensory-filled environment that promotes independence. This may encompass providers of support services either in the home or in a care facility and allow the individual as many freedoms over life decisions and actions as possible for staving off further decline and adding quality to life. As care providers, it is necessary to find a balance between safety and independence with interactive and structured support systems in place if needed.
Creating a Safe Environment at Home
When the individual with dementia moves into more moderate stages of the disease, it is critical to take certain precautions if the choice to remain in the home environment is made. The Alzheimer's Association suggests safety as a top priority with the removal of dangerous items (i.e. weapons, sharp instruments, and appliances without an automatic shut-off), installation of handrails, and registry with both Medicalert and Safe Return. Other suggestions include care and maintenance of the home, removal of carpets with frays and other potential hazards, assistive technologies and an evaluation for safeguarding from accidental injuries and falls by an occupational therapy professional would be key.
Wandering can become problematic as conditions worsen. The Better Health Channel suggests that wandering off may be due to non-obvious reasons. Certainly short-term memory loss will factor in there, but this could also be the result of boredom, excess energy stores, feelings of confusion about a change, unfamiliar, busy or otherwise noise-filled environment or simply the desire to seek solace by searching for something in the past, such as more familiar surroundings or loved ones. Exercise programs specifically tailored to those with dementia can help. There are also wander-prevention monitoring systems and door alarms available for homes and daycare and long-term care facilities that not only notify but track the individual, too. Calendars, alarm clocks, and sticky notes around the house may be helpful reminders of appointments, medication times and visits from care providers or meal times.
Caregiver Support
The Merck Manual of Geriatrics posits caregiver support as an integral part of environmental interventions for the progression of dementia. Involvement of others in the base of care and the provision of assistance with daily living activities can prevent possible accidents and injuries. Caregivers can help with medication management, hygiene concerns, dressing, daily activities, maintaining a journal, preparing meals, providing transportation to and from appointments, and most importantly, offer company.
Adult Day Care Settings
An adult day care setting is one in which the basic needs and requirements for socialization are met outside of the home environment. As seen with child day care settings, this is an establishment which provides the care during regular work hours (i.e.,7am to 6pm) and would be considered the same type of licensed facility with the exception of the population served.
The Alzheimer's Association suggests adult day care settings that provide daily interaction and an interactive, supportive environment while home care providers work in other settings, require respite, or keep active in a safe and friendly environment. There is a cost for this service and not all insurances will cover it. It is important to include adult day care into financial planning and care team treatment plans.
End-of-Life Issues
The Family Caregiver Alliance and Americans for Better Care of the Dying: Handbook for Mortals posits that end-of-life issues are extremely important to designate during the milder stages of dementia. The involvement of family members, the care team, an attorney and clergy with any final wishes can make this process easier and ensure that all parties involved are effectively communicating. End-of-life issues include: concerns related to tube feeding, placement in long-term care facilities, financial planning for care, will preparation, and the use of artificial hydration and nutrition. Ventilator use (whether or not life-saving supports should be used in the event the individual becomes incapacitated) and housing arrangements also need to be made well in advance of progressing memory loss.
In the event that these desires are not discussed between the individual with dementia and all other parties involved in care and treatment, alternative arrangements will be made by others (i.e., next of kin, the court) that do not necessarily follow the same steps preferred by the individual who is being cared for.
References
- "Merck Manual of Geriatrics: Chapter 40, Dementia"; 2010
- "Better Health Channel: Dementia and Wandering"; 2010
- "Family Caregiver Alliance: End of Life Issues, Feeding Tubes and Ventilators"; 2003
- "Americans for Better Care of the Dying: Handbook for Mortals, Planning Ahead"; 1999
- "Alzheimer's Association: Type of Care, Adult Day Care"; 2010
