Dementia and cognitive impairment mean that a person’s ability to remember and to think clearly deteriorates. This happens over a period of time, sometimes quite a long period, and although there is no cure for dementia, there are some drugs that may be helpful, particularly in the early stages. Mild Cognitive Impairment (MCI) is a condition where memory and thinking are affected, but not to such an extent that it interferes with daily life. It can be a precursor of dementia: 10 to 15% of people diagnosed with MCI will go on to develop dementia every year. However, mild cognitive impairment can be caused by other conditions, including stress, anxiety, depression, physical illness, or even side-effects of medication. So, having MCI does not inevitably mean going on to get dementia; some people recover completely, once their other health problems have been treated.
People with dementia often also experience changes in mood, becoming more anxious, irritable, or withdrawn. As the condition progresses, they may develop behaviours that are out of character, perhaps constantly pacing, questioning repetitively, being agitated and restless.
The number of people with dementia is growing rapidly, as a consequence of our ageing population. Helping people with dementia or MCI to live well is a challenge that has been taken up by many organisations, leading to development of new products and services to help support independence for those managing with diminished memory and thought processes.
The areas where dementia and MCI have most impact include:
• day-to-day memory – someone with dementia may not remember recent events
• planning and organising – they may find it more difficult to make decisions or solve problems
• language – following a conversation, or finding the right word for an object can become more difficult
• attention – someone with dementia may not be able to concentrate on a sequence of tasks, such as cooking a meal, or follow a television programme
• orientation – they may become confused about the time or date, or whereabouts they are
• visuospatial skills – problems with judging distances, and with seeing objects in three-dimensions
Click the links below to go straight to more information about providing support in these areas:
Dementia Bathroom and Personal Care
The bathroom is one of the most important areas of the home, when it comes to maintaining independence and dignity for someone who is cognitively impaired.
Some of the considerations are just the same as when adapting a bathroom for any type of disability or age-related frailty: ease of access; providing support where necessary; eliminating trip hazards; providing easy-to-use taps, flush levers, etc. You can read more about all aspects of an accessible bathroom here.
There are some additional points to bear in mind, when planning a dementia-friendly bathroom:
• Someone with dementia is much more likely to fall, so a completely level access wetroom is the way to go, if possible, without anything distracting about the floor covering: no colour changes or small patterns, nor high shine, which might look as if the floor is wet.
• Less ability to recognise danger is another factor, so anti-scald taps are important, and any radiator in the room should have a low surface temperature, or be covered, to prevent accidental burns.
• While short-term memory goes, longer term recall can be excellent, so a person with dementia is likely to be happier with familiar rooms and traditional-style bathroom fittings.
• Overhead waterfall-style showerheads can be distressing, as the person can’t see where the water is coming from.
• Mirrors and highly reflective surfaces should be used with caution, as many people with dementia fail to recognise their own image, and believe there is someone else in the bathroom with them.
There is more detailed information about dementia-friendly bathroom design in this PDF brochure from AKW.
Dementia Kitchen, Eating and Food Preparation
Kitchen safety is paramount – we have an extensive section on avoiding accidents when preparing and cooking food here. Consider in particular devices to guard against cookers, hob tops and taps being turned on and forgotten.
• Once again, familiarity is important, so make sure that items are always stored in the same places.
• Buying the same foods, in recognisable packets, is also helpful. Clear, see-through storage jars that let you view the contents are better than those that conceal what is inside.
• Even cupboard doors may be a barrier – you could replace them with glass doors, or remove them altogether.
• Leave items that are needed regularly where they can be seen and remembered – for example, snack foods and drinks. Keep anything hazardous out of sight and reach – ideally locked away.
• There is a wide range of easy-to-use utensils to help with preparing food – you can see more in the Independent Living kitchen section.
• Good colour contrast, for crockery and cutlery, can make mealtimes easier. It was believed that red and white was the most effective combination for people with dementia, but it is now recognised that any clearly contrasting pair of colours is equally effective.
• Colourful, attractively arranged food will be more likely to tempt someone to eat. In particular, avoid presenting only pale and white foods. Our resident nutrition expert, Mary Farmer, has written a helpful article about diet and dementia, which you can read here
• If the person with dementia doesn’t remember to eat or drink, you can prompt them with automatic reminders – see more below.
Time Management and Memory Aids
• Confusion over time of day or night can lead to disruption of daily living routines, with people trying to go shopping in the middle of the night, for example, or missing scheduled appointments.
• You can get clocks that show the day and date as well. One that shows whether it is day or night can also be helpful.
• Assistive technology in the form of reminders can help maintain independence with dementia. The Memrabel shown here, above left, can be programmed with spoken reminders, pictures or video clips, to prompt activities such as eating and drinking; going to bed and getting up; taking medication; going to an appointment.
The simple voice recorder shown on the right has one side for the user, with a single big button which they press at the times they are prompted to do so, in order to listen to a pre-recorded message. For example, at 9 AM, an alarm sounds, and they press the button: “It is nine o’clock, time to take your medicine”.
• Problems with medication management – either failing to take prescribed pills, or double dosing, is a significant issue for the individual concerned, and a cost to the NHS: in 2006-07 the cost of hospital admissions in the UK resulting from patients not taking their prescribed medication properly was estimated to be somewhere between £36m and £197m. A dedicated unit which not only provides a reminder, and dispenses the correct dose, but will also trigger an alert if dose is missed, can make a big difference to living confidently alone, even with cognitive impairment.
Staying in Touch
• The latest development in assistive technology to support independent living, the dedicated respexi tablet helps people to stay in touch with family, friends and carers, as easily as possible.
By touching the screen, the user can make and receive video calls with people anywhere in the world; receive photos; listen to preset radio channels. The unit can also be programmed with appointments, and give voice reminders. If the user fails to dismiss the message, and alert will be sent to predefined person – a local friend or carer, perhaps – so that they can check up on them. Preloaded with software, the dedicated tablet operates via a broadband internet connection.
• Mobile phones are indispensable tools for most of us, but they are often quite complicated and fiddly for someone with dementia or cognitive impairment. Smart phones in particular, may provide lots of functionality, but at the price of a steep learning curve. A phone which just receives incoming calls, and makes them to a few preprogrammed numbers, is much more user-friendly.
OwnFone is set up with between two and 12 buttons to make phone calls: these can be labelled with text, Braille or a picture of the person to be called. Small and simple, this sort of phone is less attractive to thieves, as it can’t be used to make any other phone calls, and as no information is stored on it, the risk of identity theft is removed.
• Another very neat solution to the challenge of using a mobile phone with dementia is Fuss Free Phone’s operator service. A button on the back of the phone connects you to a friendly UK-based telephonist, who has your phonebook, so you just have to ask for the person you want to speak to by name.
The telephonists can type out text messages, ring back and read out text replies, or look up things for you on the internet.
Screening nuisance calls and scams is another part of the service. Anyone who is in your phonebook will be able to get straight through to you; other callers will be checked by the telephone operator.
Telecare and Wander Alarms
• In-home telecare systems are considerably more sophisticated than the early alarm call pendants – although this ability to summon help in an emergency is still a feature.
Additionally, systems can include a range of alerts, such as Smoke ; Floods; Falls and movement ; Temperature extreme ; Property exit sensor; Bogus callers; Carbon monoxide. In this way, an individual with dementia can be supported to live more safely in their own home, protected as far as possible from the consequences of forgetfulness. As well as the sensor to trigger an alert if they leave the property, you can also include an alert if, for example, they don’t go into the kitchen to get something to eat or drink, or the bathroom. Fall and movement sensors worn on the body can detect if somebody has a fall – far more likely with dementia – or if they are moving around more or less than normal.
• Similar support is now available outside the home, with various combinations of mobile phone and GPS technologies.
A tracker device which can be programmed with a safe area, will raise an alert if the person carrying it strays too far. This could be fixed to a mobility scooter, or slipped into a pocket.
The micro tracker shown here also provides more overt support: as well as GPS tracking, the user can get help at the press of a button, make and receive voice calls, and keep records of habitual behaviour, so anything untoward can also be identified.
This is an overview of some useful products and services to support independent living with dementia or cognitive impairment. For the latest scientific research and insights into the condition, Mary Jordan’s book, The Essential Guide to Avoiding Dementia is interesting and instructive. You can read more about it here.