Promoting Independence for Persons With Dementia

 Background 

Dementia is a broad term used to describe a group of symptoms associated with on-going decline of the brains abilities. These include impairment in:

•  memory
•  intellect
• language
•  insight
• social skills

While over 100 different diseases can produce the symptoms of dementia, it is known that Alzheimer’s disease is the most common cause, accounting for more than 50% of all cases. (link to alzheimers website)

There are currently around 750,000 people in the UK living with dementia, and this is expected to rise to 1.4million by 2039. Dementia mainly affects people over the age of 65 and its incidence increases with age.

To maintain a sound quality of life in individuals with dementia, it is essential to retain their independence as long as possible. However, due to the progressive nature of dementia, family members will often have to assume the role of primary carer for their loved ones to ensure this.

As the figures highlight, dementia affects a large percentage of the population, and as a result family members often have to assume the role of primary carer for their loved ones. Two thirds of people with dementia are currently living at home, and therefore carers require as much assistance as possible. Carers of people with dementia often display poor health when compared to their age-matched peers (Pinquart 2003, physio document).

This leaflet aims to:

1. Help you identify ‘Dementia Danger Signs’
2. Provide you with helpful ideas to promote independence for the individual with Dementia
3. Physiotherapy Advice....
4. Highlight dementia services and resources which can be accessed when required.

 
Noticing Danger Signs;  

In most cases of Dementia there may be certain clues to……

Diagram / Flow Chart to highlight all danger signs ; hyperlink out to sections of Wiki

Danger Signs

Table Format...

Walking more slowly Tense body language
Using smaller, shuffling steps Becoming rigid when moving
Uncoordinated movement Clenching of teeth
Grasping furniture around the house when walking Eyes wide open
Afraid to use stairs Tightly shut eyes
Unsteady on feet and requiring more and more physical assistance/help when walking Loud outbursts
Stutter with feet when starting to move

 
Keeping Active  

Most dementias will at some point in their course affect areas of the brain that are responsible for movement and balance. LINE ABOUT WHY MAINTAINING MOBILITY IS REQUIRED. As the disease progresses problems with mobility will increase. As the caregiver for an individual with dementia there are some things you can do to encourage activity safely.

• Before you consider helping someone walk, make sure they have comfortable footwear, the correct glasses and hearing aids, and that their clothing is secure.
• If giving assistance, do so at the patients side so you are both facing in the same direction and move together.
• Be realistic about how much activity can be done at one time. Aim to cover a short distance, to a seat that the person can see. Provide a resting place, such as a chair or stool, halfway.
• Give the walk a purpose- for example, to eat a meal, watch TV, see a visitor, go to the toilet, or do some exercise.
• Reassure the person about the surroundings – for example, if moving from hard to soft floor coverings.
• Make walking an enjoyable experience by talking to the person and paying them plenty of attention.
• If the patient begins to shuffle their feet when walking, encourage marching so to lift their feet.
Every person with dementia will be different in terms of what they can do for themselves, however it is important to involve them in decision making and make activities specific to what they enjoy. By making activities fun, this might help them remember what they can do. As the carer, you will know their strengths and you can use these to your advantage.

 What Physiotherapy can do to help  

Improve independence with everyday activities such as bed mobility, walking and climbing the stairs as well as advising and supporting family and or carers about help outside treatment sessions.

Benefits of physiotherapy for dementia:

• Improving activity
• Improving function
• Maximising mobility
• Reducing pain
• Relieving stiffness
• Reduces risk of falling
• Maintaining independence

An initial assessment with one of our neurological physiotherapist either at home or in the clinic will look at current level of physical function including movement, balance and muscle strength in order to develop a structured rehabilitation program which may include:

• Active range of movement exercises to keep muscles strong and flexible and make functional activities easier
• Balance training to improve confidence and reduce risk of falling
• Gait re-education with or without support to maximise mobility
• Practicing functional tasks to enhance independence
• Transfer rehab
• Muscle stretching exercises to relieve pain and stiffness
• Advise on mobility aids or equipment for the home to ensure safety and promote mobility and function

Your physiotherapist will ensure that your loved one gets the most out of their treatment by setting treatment goals on a regular basis. Physiotherapy treatment will improve ability with functional tasks and quality of life.

Your Home

Lots of hospital admissions for people with dementia are due to trips and falls. The home can be full of potential tripping hazards for a person with dementia. To prevent falls, try to ensure the home environment is obstacle fee. Some methods to help with this are;

• Assess each part of the house for trip hazards;
o Removing objects which may act as an obstacle or provide distraction
o Removing loose carpets or rugs
o Ensuring cables or wiring are not lying across the floor
o Using signs on doors to provide information; bathroom, shower
o Ensure there is adequate lighting throughout
o Placement of handrails / grab-rails on stairs, entrances and toilet
• Try to ensure the patient wears suitable clothing and footwear that he/she is unlikely to trip over.
• Encourage the patient to keep physically active as this will help strengthen balance and maintain confidence.

If you feel you require more assistance with your home environment or you would like a home assessment then you can request help from a Physiotherapist or Occupational Therapist (OT)

Here’s how the physiotherapist can help
• Provide balance training to improve confidence and reduce the risk of falls.
• Carry out a home assessment and advise on devices which will increase safety and promote functional abilities.
• Increase patient motivation to decrease fear and anxiety.
• Help with exercises for simple everyday things like walking, rising from a chair etc.

 
Recognising Pain  

 People suffering from dementia often have trouble telling their carer or family member that they are in pain.

What the carer can do

Watch out for some of the danger signs listed above e.g. rigid body parts when moving, eyes wide open or tightly close shut.

Arrange an appointment with the patients local GP to see if the patient needs his medications changed or strengthened.

What the physiotherapist can do
Physiotherapy can teach carers and family members to encourage patients to do as much for themselves as they can.

Pain can affect the patient’s mind, willingness to do any exercise or treatment.

Physiotherapists are trained to be able to notice if the patient is in pain and can then give the carer or family member help and information on this.
Physiotherapists can liaise with GP's to assess if the patients needs more or less pain medication.

With some dementia patients who cannot communicate if they are in pain or not, there is the problem that their pain can be under-treated. This may be because:
• There is a myth that pain is a normal and expected part of getting old.
• The myth that dementia patients can’t feel pain.
These are both untrue and pain can be treated with dementia patients through a good working relationship between both the carer/family member and the physiotherapist/GP.

The Coloured Analogue Scale is often used by both physiotherapists and carers. It is a scale to measure the amount of pain that the patient is feeling. The scale goes from 0-10 and the colour changes as the amount of pain changes. The patient is asked to use a sliding bar to tell the carer or physiotherapist what level of pain they are feeling. The physiotherapist can explain this to you the carer/family member and if you feel confident, you can use this to find out if the patient is feeling any pain at that time.

 
Caring For Yourself  

As a caregiver, it is important you learn to look after your own needs. Here are a few recommendations to help you cope with the demanding role of looking after someone with Dementia.

Look for support - join a support group where you can learn from others through sharing of experiences

Take care of yourself – make sure to get enough sleep and eat well

Don’t be afraid to ask other family members and friends for help. Take breaks from care-giving as often as possible by asking other family members to help. People will be happy to help but may feel nervous around the person with dementia.

People can help you best if you:
• Give them specific tasks and tell them exactly how you are feeling and what you need.
• Be specific and positive.
• Let them know you appreciate their help and that it is making your burden slightly less.
• It may be helpful to ask people to help you with everyday tasks such as shopping and cleaning the house. You may think these tasks are unrelated to direct care-giving but every little helps.

Where to Get Help