DEMENTIA CARE IN

THE FAMILY SETTING

By NQOBA M SIBENKE
A/PSY0827
BACKGROUND

Nqoba Maryln Sibenke is a registered Intern

Psychologist with AHPCZ. She holds a Bsc honors in
Psychology, Post Graduate Diploma in Education and
MSc in Counselling Psychology. She is currently
employed as an intern Psychologist at Kahle
Counselling Hub in Bulawayo, she is also a trainer at
Zimbabwe Alzheimer’s and Related Disorders
Association where she trains Primary and professional
care givers in Dementia Care. In her spare time she
enjoys Cooking and baking, reading , poetry, blogging
and travelling. She is not yet Married.
 WHAT IS DEMENTIA?

■ Dementia is the umbrella term for a number of

neurological conditions, of which the major symptom
is the decline in brain function due to physical changes
in the brain.

■ Dementia is categorised as a Neurocognitive Disorder

(NCD) in the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5)
TYPES OF DEMENTIA
DIAGNOSIS

■ Dementia diagnosis is done by health professionals particularly,

Geriatric psychiatrists, neuropsychologists, clinical psychologists and
geriatricians.
■ Diagnosis is important to rule out other conditions which have
symptoms similar to Dementia for example, Delirium, Depression,
Traumatic brain injury, etc
DEMENTIA STAGES
Cntd
DEMENTIA SYMPTOMS

■ forgetting things or recent events

■ losing or misplacing things
■ getting lost when walking or driving
■ being confused, even in familiar places
■ losing track of time
■ difficulties solving problems or making decisions
■ problems following conversations or trouble finding words
■ difficulties performing familiar tasks
■ misjudging distances to objects visually
CAUSES

■ Dementia is caused by damage to or loss of nerve cells and their

connections in the brain. The symptoms depend on the area of the
brain that's damaged. Dementia can affect people differently.
RISK FACTORS

■ Age
■ Family history
■ Mental health conditions
■ Childhood trauma
■ Non communicable diseases
■ Drug and alcohol use
■ Traumatic Brain injury etc
■ Nutritional deficiencies eg B12 deficiency
IMPACT OF DEMENTIA IN THE
FAMILY
■ Caregiving can be draining emotionally .
■ financial constraints of medical and caregiving services .
■ Family conflicts .
■ Caregiver burnout
■ May affect the family routine
■ Result in decrease in family time
■ Lack of social life for care givers
CARE NEEDS IN DEMENTIA

■ Medical needs
■ Assistance with daily activities.
■ Social needs
■ Safety .
■ Emotional support
PREPARING FOR CARE

■ Understand and Accept Your Loved One’s Dementia

Diagnosis

■ Equip Your Home with Assistive Devices

■ Practice Self-Care

■ Research on Care Options

DOs AND DON’Ts IN DEMENTIA
CARE
■ Do
■ Smile and use positive non-verbal communication.
■ Use simple language
■ Listen actively
■ Create a calm environment
■ Support independence
■ Establish familiar routine
■ Respond to feelings and emotions
■ Be patient
■ Be flexible
CNT’D

■ DON’T
■ Disagree
■ Argue
■ Remind
■ Correct
■ Ignore them
COMMUNICATION
■ Keep communicating simple
■ Keep track of non verbal cues from the patient
■ Use positive non verbal communication
■ Maintain physical touch
■ Speak slowly
■ Maintain eye contact
■ Do not interrupt them
■ Give them full attention
■ Pay attention to emotions
 PAIN IN DEMENTIA
■ In Alzheimer’s disease, individuals do feel pain, but the interpretation
and cognitive and emotional evaluation of the pain may be different.
■ In Vascular Dementia, individuals most likely have more pain, because
of white matter lesions that may stimulate Central Pain.
■ As the causes of dementia are progressive neuropathological diseases,
the impact on pain processing is dependent on the stage of the disease.
■ In almost all types of dementia, communication is seriously impaired
eventually in the process.
MANAGEMENT OF PAIN IN
DEMENTIA CARE
■ Music Therapy
■ Art Therapy
■ Play Therapy
■ Exercise
■ Massage
PSYCHOLOGICAL ISSUES

■ Rapid mood swings

■ Poor emotional regulation
■ Depression
■ Anxiety
■ Hallucinations
■ Aggressive
■ Low self esteem
■ Apathy
 MANAGEMENT OF
PSYCHOLOGICAL ISSUES
■ Try to keep a daily routine for the person with dementia. Incorporate daily exercise

• Try to keep a daily routine for the person with dementia.

• Incorporate daily exercise
• Psychotherapy
• Music Therapy
• Reminiscence Therapy
• Mental Exercises
• Physical Exercise
BEHAVIOR ISSUES IN DEMENTIA
■ Repetitive behaviour.
■ Trailing, following and checking.
■ Hiding, hoarding and losing things.
■ Losing inhibitions.
■ Accusing.
■ Agitation including restlessness.
■ Aggressive behaviour.
■ Sundowning.
■ Wandering
BEHAVIOR MANAGEMENT

■ Create a calm environment

■ Manage stress through relaxation techniques, physical activity etc
■ Reminiscence therapy
■ Identify signs of discomfort, hunger, thirst, pain and address them.
■ Keep space safe from dangerous things like knives, guns, pesticides
etc
DEALING WITH DIFFICULT
SITUATIONS
■ Remain calm
■ Practice emotional control
■ Be flexible
■ Negotiate
■ Maintain a positive attitude
■ When situation is beyond you, consider other care options
 WANDERING

Scenario

Most people living with Dementia will want to go out of the house
claiming that they want to go home . Or they feel their independence is
lost so wandering will give them a sense of comfort. It can be a way of
relieving old memories or a result of frustration. Sometimes people
with Dementia wander when they feel disoriented.
RESPONDING TO WANDERING

■ Maintain a calm tone

■ Ask where they are going or what they need
■ Distract them with a new activity eg packing a bag, going through
photos etc
■ They will soon forget that they wanted to leave.
AGITATION AND ANXIETY
Scenario

Patient appears restless and frustrated. They may refuse help

even though they need it . Other signs of agitation include
pacing, irritability, worried, and nervous.
Triggers include;
■ a feeling of loss of control,
■ misinterpretation of actions to help them as threats ,
■ unmet needs
■ inability to communicate clearly,
Continued….

■ frustration due to difficulty executing tasks.

■ Difficulty judging limitations
■ Changes in routine or environment
■ Can escalate to violent behaviour.
RESPONSE TO AGITATION AND
ANXIETY
■ Do not be irritable or frustrated, remain calm.
■ They react according to your approach.
■ Don’t rush them give them time to complete tasks.
■ Use positive body language.
■ Use gentle touch to reassure
■ Do not give orders
Continued…

■ Plan according to their schedule

■ Simplify the environment
■ Allow them to make independent decisions
■ Assure of support
AGGRESSIVE LANGUAGE AND
BEHAVIOUR
Scenario

A Dementia patient may suddenly attack caregiver , throw things around

and punch them. This may be a sign of pain , frustration or depression and
anger. They may display aggressive behaviour when they don’t
understand what is being asked of them. Attacks are not personal
although they seem personal.
RESPONSE TO AGGRESSIVE
LANGUAGE AND BEHAVIOUR
■ Respond calmly to manage the situation.
■ Identify yourself if necessary.
■ Identify emotions driving the aggression and speak to them for
example respond to fear by reassurance, encouragement, distraction
etc
■ Be flexible
■ Ask one question at a time / one instruction at a time.
■ Calm Tone , positive body language,
■ Avoid yelling
DEPRESSION AND APATHY

Scenario

A patient may feel a lack of motivation to wake up and to engage in

everyday activities. This is called Apathy . On the other hand Depression
is characterised by negative feelings, low self esteem, mood swings .
Reluctance to get out of bed, go out , take a bath is a sign of apathy and
depression. If Depression is severe (clinical depression) there might be
need to see a professional .
RESPONSE TO APATHY AND
DEPRESSION
■ Daytime physical activities
■ Involve in chores around the house
■ Time activities according to mood
■ Make them feel useful
■ Use of incentives to promote cooperation for example treats , gifts ,
appreciation.
HALLUCINATIONS

Scenario
Dementia patients may see things that are not there especially when the
area of the brain responsible for sight and sounds is affected. They may
speak to imaginary people or claim to see relatives who are deceased.
These may be triggered by objects for example a hanging coat, shadows
etc
RESPONSE TO HALLUCINATIONS

■ Identify object that trigger and eliminate them .

■ If they persist consult the psychiatrist or psychologist
■ Be calm and reassuring.
■ Do not yell or scold
REFUSAL TO BATH

Scenario

Dementia Patients seem to be afraid of water. (Some) They might become

aggressive when it’s time to bathe .
RESPONSE TO REFUSAL TO BATH

■ Be flexible
■ Baths can be scheduled at a time that they prefer for eg they may not
want to bath in the morning
■ Be creative, make bath time an interesting event for them
■ Use incentives
■ Baths can be skipped sometimes, dry wash instead.
SLEEP DISTURBANCES

SCENARIO

Dementia patients might sleep during the day and be awake at night.
When night time comes they cannot fall asleep and become active. They
also keep everyone awake . They may also experience nightmares and
feel scared . The dark frightens them .
RESPONSE TO SLEEP
DISTURBANCES
■ Maintaining regularity in meal times, sleeping time and time for
waking up.
■ Eliminate blue light before bedtime
■ Sunlight exposure
■ Increase activity during the day
■ Exercise
SUNDOWNING

SCENARIO
They may feel irritated and confused towards sunset or late in the
afternoon.
Anxiety and irritability are common during sundowning.
RESPONSE TO SUNDOWNING

■ Help them calm down through interesting activities

■ Speak calmly
■ Change of environment
■ Introducing light
HOME SAFETY

Scenario

A family member with Dementia may be at risk of danger as they have

poor judgement. For example when handling utensils such as knives,
needles, tools they may harm themselves.
RESPONSE TO HOME SAFETY
ISSUES
■ Remember to respond calmly
■ Child safety locks
■ Keep away dangerous objects
■ Medications and chemicals to be locked away
■ Throw away expired foods
■ Keep emergency contacts close by
MANAGING DEMENTIA
THROUGH LIFESTYLE
CARE OPTIONS

■ Home health care

■ Companions
■ Respite care
■ Day care services
■ Rotating family schedule
■ Facility Options
CAREGIVER BURNOUT
Signs include

■ Exhaustion
■ Lack of sleep
■ Irritability
■ Lack of concentration
■ Health issues
■ Apathy
■ Depression
■ Anxiety
■ Mood swings
MANAGING BURNOUT

■ Seek support through support groups

■ Be an educated Caregiver
■ Find time for yourself to relax
■ Counselling helps to clear your mind
■ Engage in Physical activity
DEMENTIA SUPPORT AND
RESOURCES
■ Alzheimers Disease International- https://www.alzint.org/
■ ZARDA- https://zarda.org
■ Alzheimers Association -https://www.alz.org/help-support/caregiving
THANK YOU🙏