- Understanding dementia
- The basics of dementia and its misconceptions
- How does dementia affect our elderly parents?
- Common types of dementia
- How can we provide support?
- How will their behaviour change?
- How can we manage their behavioural changes?
- How to help them from day-to-day
- How do we communicate with them better?
- Managing stress and emotions while caregiving
- Useful resources on community support
- Self-help tools for dementia
- Mental health services
Caring for
someone
living
with dementia
Our elderly parents may have retired (or may be retiring) from working life. Unfortunately, it is also at this stage that we may notice them becoming more forgetful, misplacing things, struggling to find words to express themselves, or experiencing mood changes.
These may be signs of dementia — a condition that can affect a person’s day-to-day life. Let’s read on to find out how we can support them through this difficult journey.
What is dementia?
As our parents age, subtle changes in memory may occur naturally. Simple forgetfulness and a delay in recalling names, dates and events can be part of the normal process of ageing. In other words, becoming forgetful does not necessarily mean someone has dementia.
Let’s learn about the common misconceptions about dementia:
- Pursue daily activities and function independently, despite occasional memory lapses
- Make decisions
- Recall and describe significant events
- Engage in conversations with others
- Staying physically active and exercising regularly
- Keeping blood pressure at a healthy level
- Monitoring blood glucose if someone has diabetes
- Eating a balanced diet
- Quitting smoking
- Going for regular health screening
- Refraining from heavy alcohol intake
- Being socially engaged
- Staying mentally engaged by playing strategy games and puzzles
- Learning something new such as taking up a new hobby, practising a musical instrument, reading a good book
- Breaking old habits such as eating with a non-dominant hand or taking a new route home
- Sleeping well
How does dementia affect our elderly parent?
Dementia is the name for a group of brain disorders that results in the loss of intellectual abilities such as memory and reasoning.
Dementia can affect adults of any age. Based on the Well-being of the Singapore Elderly (WiSE) nationwide study by the Institute of Mental Health (IMH), 1 in every 10 people aged 60 years and above has dementia.
A person with dementia may gradually find the following abilities challenging:
Thinking and reasoning
Problem-solving and making
judgements or reasoning
Remembering new information
or recalling recent events
Learning new
information and skills
Recognising familiar
faces and items
Finding the right words
to communicate
There are different types of dementia, some common ones include:
Supporting someone with dementia
Caring for someone with dementia can be intensive and challenging. To support our elderly parents living with dementia:
Dementia has several stages ranging from mild to severe. It is important for us to understand what stage our parents are in before deciding which supports to use. The more we understand dementia, the better we can support them.
Caregiving through the stages:
At this stage, our elderly parents can most likely be independent in most daily activities. However, they may need reminders to help with memory.
- Maximise their independence in daily activities as much as possible. Discuss with them about the things they can do on their own, and those that they need support with.
- Talk to them about their emotions. It is not easy to find out that one has dementia. Discussing their feelings with them can help them through these difficult times.
- Encourage them to remain physically and mentally active through exercises and social interactions with family and friends.
At this stage, our elderly parents will likely show changes in behaviour, mood, and personality, and will require additional support in daily activities.
- Establish daily routines for them. Routines can help provide a form of structure during the many changes they are going through.
- It is also good to remain flexible in these routines and adjust them as our parents’ dementia progress.
At this stage, our elderly parents will likely be totally dependent on us for daily living. Chances are they will require intensive physical care around the clock and along with additional support and assistance at home.
- Engage and stimulate them through their senses as they still can experience sights, sounds, smells, tastes, and touch vividly.
- Gather with other family members and caregivers to discuss alternative care arrangements for them to ensure they get the appropriate care that they need.
By identifying what might trigger challenging behaviours in people living with dementia, it may be slightly easier to figure out ways to prevent or minimise the behaviour from happening again.
Some examples of triggers and ways to cope with them can include the following:
Possible triggers:
Fatigue
Hunger or thirst
Sleep deprivation
Physical discomfort such as pain, fever
Impaired vision or hearing causing misinterpreted sight and sounds
Illness
Boredom
Trying to express emotions
Needing to urinate or constipation
Excessive noise such as TV, radio or too many people talking at the same time
Some tips to overcome sources of triggers can include:
Encouraging short periods of rest to minimise fatigue
Serving snacks and fluids in between meals
Looking out for non-verbal cues of pain and/or discomfort (e.g. frowning)
Promoting regular toileting and monitoring bowel habits
Increasing comfort by doing frequent check or change of diapers
Lowering the volume of the TV or radio to minimise noise which can trigger agitation
Not forcing them to do something they dislike
Reducing clutter to give them space to move around
Improving communication e.g. speak slowly and in short sentences especially to those with hearing impairment
Managing personality behavioural changes
Often, families may find it difficult to accept the personality change that comes with dementia. As the disease causes changes in the brain, the person they once used to know may seem to have become a different person. It is important to understand that the change is not deliberate.
Depression can also be more common among people living with dementia which might make any changes in their personality/behaviour worse. Learn more about depression here.
- Showing physical aggression
- Buying the same things repeatedly
- Getting upset more easily
- Wandering away from home
- Imagining things that are non-existent
- Displaying inappropriate social behaviour such as spitting in public
Tips to overcome some of the changes
We can practise these tips to overcome some of the changes:
Reassuring them that they are safe
Being genuine and sincere when approaching them
Having a daily routine and structured activities
Using music, songs, or other activities they used to enjoy to soothe and comfort them when they are upset
Holding and comforting them when they appear anxious or afraid as a gentle touch or hug can help convey we care
Learning communication skills such as keeping things simple by saying one thing at a time, avoid arguing or trying to reason with them even if they end up making a few wrong accusations
Here are some things we can do:
If they get aggressive and/or agitated
Remain calm. Displaying our fear, anger, or anxiety can make the situation worse.
Be patient and listen to what they are saying.
Validate their feelings. This means reassuring them and acknowledging how they are feeling.
Being clear in communicating with them.
- Explain our actions in short, simple sentences to help them understand our intentions, such as “I am here to help you.”
- Ask them specific questions like “What do you need now?”
Help them in managing their emotions and needs.
If they are feeling particularly aggressive or agitated, we can give them time and space to calm down and return afterwards to try again.
If possible, identify the signs or behaviours of agitation or aggression. Before their anger surfaces, we can redirect their attention towards other activities that can soothe them (e.g. listening to calming music or showing them photos to reminisce with them).
As much as possible, their basic needs (hunger, thirst, and sufficient sleep) must be met in a timely manner. The lack of these needs could sometimes be the cause of their agitation or aggression.
Finding out and eliminating their physical discomfort such as a wound, infection, and/or physical aches, can help suppress their aggression and agitation.
If they get physically abusive
A one arm-length should be maintained between us and them to protect ourselves from getting injured.
Their anger should not be restrained or restricted unless they are causing harm to others.
We can also help ensure the environment is free from dangerous objects such as scissors or knives.
We can get help from other family members, neighbours, or friends if needed.
If they experience sundowning
Sundowning occurs when there are changes in their behaviour during the evening. These can include being aggressive, agitated, confused and/or restless.
To manage sundowning, we can:
- Provide them with a consistent daily routine
- Occupy them with a familiar activity
- Reduce sources of discomfort such as loud noises and bright lights
Watch this video to understand how to manage changes in the behaviour of people living with dementia.
Supporting someone with dementia on a day-to-day basis:
Design a daily routine with activities to engage our elderly parents
Mealtime behaviours
Address safety issues
Prevent them from wandering
Taking public transport
Make their home dementia-friendly
Be with our elderly parents in their help-seeking journey
Medication management
Obtain some inspiration and gain helpful tips by watching this video on how to manage the daily activities of someone living with dementia.
Learn communication tips
When communicating with our parents with dementia, it is useful to take note of the following:
Avoid testing their memory
Due to their dementia, they are likely unable to remember many things. When encouraging them to recall certain things, it is best not to test their memory by asking them what they remember as this can make them feel frustrated due to the difficulty they may face in remembering.
Instead, we can use memory aids such as notes, diaries, clocks or calendars to help jog their memory.
Be mindful of our tone and volume
Speak slowly and clearly. The tone of our voice should be gentle and calming. We should also avoid speaking loudly and/or with a high-pitched voice as that might be distressing for them.
If they have trouble hearing, we can consider getting them hearing aids or making use of visual aids to facilitate conversations.
Use different forms of communication besides verbal ones
If we do not understand what they mean, we can ask them to point or gesture. Visual cues can be useful in helping them convey what they want. Alternatively, we can try writing notes too.
Simplify what we say
We should avoid lengthy conversations that require complex thinking. We can break down tasks with clear, step-by-step instructions.
Speaking slowly and in short sentences can be helpful as well. Asking close-ended questions that can be answered with a “yes” or “no” can also be helpful.
Avoid arguing with them
They may not be able to understand what others are saying or convey what they want clearly. Arguing about that will not help us understand each other better.
Be patient
Taking time to listen to their feelings, thoughts, or needs can be helpful. We can give them the space and time to respond and express what is on their mind.
Sometimes, the only way to get someone with dementia to stop repeating themselves is to distract them with something they enjoy. For example, we can offer them their favourite snack or beverage or have them do their favourite activity.
Be supportive
Offering comfort and reassurance can encourage them to open up their thoughts to us. We can look out for the intentions behind words or sounds and observe their body language.
Treat them with respect
This means maintaining eye contact as much as possible and acknowledging what they are trying to convey. We should avoid excluding them from conversations involving others.
Engage in conversation and activities together
Watch this video on how to communicate with someone living with dementia.
Learn some tips and guides from dementia.org.sg and download the language guideline resource kit that were developed and localised in the four languages to remind yourself on the use of appropriate language.
Self-care matters too
Caring for people living with dementia can be tiring, frustrating, and upsetting at times. We may need some time to recharge ourselves; otherwise, it could take a toll on our physical and mental well-being.
Practising and prioritising self-care will put us in a ready state to provide them with the support they’ll need. Hence, there isn’t a need to feel guilty to rest or attend to our needs as it’ll help us take better care of them.
Some ways of taking care of ourselves include:
Taking breaks and enjoying what we do
This can mean heading out for a short walk or for a bike ride, losing ourselves in books, movies, spending time with those we care for, or simply taking a relaxing nap.
Exercising
Exercise keeps us fit and releases endorphins and serotonin. These are known as ‘happy hormones’.
We can start small, like a short 10-minute walk or dance video; or go bigger and make it a group affair with a family hike or a cycling outing. We can stay active with free workout classes or by signing up for the National Steps ChallengeTM and start clocking our steps.
Getting enough rest
Getting at least 7 hours of sleep can help us handle stress better. Find out how we can sleep well and/or manage our stress.
Managing our emotions
This means learning how to identify our emotions and not brushing them aside. The feelings tracker is a good tool in helping us identify how we are feeling.
Managing our emotions also means accepting our emotions as something natural and finding out how they were elicited.
Most importantly, managing our emotions means that we can talk to people about how we feel anytime. We need not wait for problems to be big or our emotions to be overwhelming before we speak to someone. A trusted friend, family, or colleague can be people we can confide in when we need someone to talk to.
Find out how else we can manage our emotions here.
