, Author at ReaDementia

Cognitive Stimulation Therapy for Dementia

If you would like to understand the link between cognitive stimulation therapy and dementia, I cover it all in this extensive article.

What if there was a treatment for mild to mid-stage dementia that could improve cognitive functioning as effectively as dementia medications, but without side effects? What if it was inexpensive, accessible and enjoyable for the person with dementia? In fact, what if there already is?

If you live in England, chances are you’re already familiar with Cognitive Stimulation Therapy.

Cognitive Stimulation Therapy and Dementia

It is considered a standard of care in the UK, and it is recommended and provided for most or all British individuals with dementia who choose to participate.

The word — and research — on CST is getting out to other countries, and cognitive stimulation therapy programs are growing around the world.

At least, that is, they were growing until the pandemic put a stop to group gatherings, especially for older adults.

However, there are adaptations being developed for this exciting therapy as scientists, experts, and group leaders explore how to best translate the program to an online format.

What is Cognitive Stimulation Therapy?

Cognitive stimulation therapy is an evidence-based group treatment modality designed for people with mild to moderate dementia.

It was developed in the United Kingdom by Dr. Aimee Spector and a team of dementia specialists after rigorously researching the efficacy of various non-drug dementia interventions.

Since its inception in 2003, an abundance of evidence has shown that CST significantly improves participants’ cognitive functioning, mood and quality of life.

CST Aims to Improve Cognitive Functioning

The evidence shows that CST is as effective as dementia medication for improving cognitive functioning.

CST is the only non-medical intervention that the British government for the treatment of dementia endorses.

In fact, it is considered a standard of care in the UK to be referred to a CST group upon being diagnosed with dementia.

Few barriers interfere with the implementation of cognitive stimulation therapy. CST groups can be led by essentially anyone who works with people with dementia.

It’s not restricted to highly credentialed medical professionals. There is no extensive training or special equipment necessary, so the cost of the program is low.

All that’s needed is a manual, a modest training program, and a few simple supplies.

Who can Administer Cognitive Stimulation Therapy?

Cognitive Stimulation Therapy is designed to be successfully administered by anyone who works with people with dementia.

This includes care workers, psychologists, occupational therapists and nurses.

A basic CST training program ensures that facilitators understand the guiding principles of the program. Also to understand how to apply them in a standardized, yet person-centered, and effective way.

Available training manuals offer instruction on how to lead a CST group.

They discuss the key principles of the therapy, include detailed session plans, and other instructions on how to monitor participants’ progress.

What is a CST Session Like?

Traditional Cognitive Stimulation Therapy sessions utilize a group format to capture the benefits of social interaction.

It is a set series of sessions, usually given twice per week over seven weeks.

CST sessions can occur in a variety of settings, from private homes to hospitals, facilities or day programs.

They should take place in a comfortable environment that is conducive to learning and social engagement.

CST stimulates particular cognitive skills

CST sessions are designed to exercise and stimulate specific cognitive skills. The first session begins by having the members designate a name for their group.

The same participants join throughout the series of sessions.

Attention to consistency throughout the sessions is an important feature. For example, each session begins with the same warm-up activity.

Each session has a different theme, such as “Physical Games”, “Childhood”, “Food”, “Current Affairs” or “Number Games”. Sessions typically last an hour.

A reality orientation board is posted throughout the series of sessions, which displays information about each participant.

As the participants interact with each other, they get to know one another, which contributes to feelings of friendship and support.

What are the Benefits of CST?

The benefits of Cognitive Stimulation Therapy are well documented and include a significant improvement in cognitive functioning.

In order to quantify data, researchers often use tools that measure memory, orientation, language and visuospatial abilities. These tools include:

The Mini-Mental State Examination (MMSE)
The Alzheimer’s Disease Scale-Cognitive Subscale (ADAS-COG)

Because these standardized forms are also often used to measure the efficacy of Alzheimer’s drugs and other modalities, it is easy to directly compare the results.

CST shows an improvement in cognitive areas measured by these tools comparable to anti-dementia drugs.

Other noted benefits of CST include a significant improvement of language skills (such as naming objects, word-finding, comprehension) and quality of life.

Quality of life is determined by the participants using the QoL-AD tool.

Caregivers of CST participants with dementia consistently report an improved quality of life for themselves, as well as for their loved ones.

They report improvements in their loved ones’ moods, confidence and ability to concentrate.

Both the participants and caregivers describe participation in the groups as feeling supportive and positive.

What are the Variations of CST?

As Cognitive Stimulation Therapy matures and becomes more widespread, more variations are innovated to meet more specific cultures or preferences of individual participants.

For example, Saint Louis University’s Geriatric Education Center in Missouri, USA has developed several variations of CST of their own, including an exercise-based group, a spiritual group and a caregiver-assisted group.

Individual Cognitive Stimulation Therapy (iCST)

Individual Cognitive Stimulation Therapy (iCST) is a newer variation of this modality.

It is designed to provide the therapeutic benefits of CST on a one-to-one basis, rather than a group setting.

It can be administered to the person with dementia by a friend or family member with iCST training.

An iCST program includes 75 activity sessions which are intended to be provided over three 30-minute sessions for 25 weeks.

Each iCST session begins with five minutes of orientation information, followed by five minutes of current news and events, and then twenty minutes of the main activity.

The main activity themes include topics such as “Life Story”, “Word Games”, “Art”, “Reminiscence” and others.

In one research study, individuals with dementia participating in iCST programs did not experience the same cognitive gains of the traditional group-based sessions, but there were significant benefits nonetheless.

The individual and their carer reported a much better quality of the relationship. The carers also reported a measurably better quality of life and fewer symptoms of depression.

Both the individuals with dementia and their carers expressed enjoying the program and felt that it ignited an interest in mentally stimulating activities.

Individual Cognitive Stimulation Therapy is an excellent alternative when group sessions aren’t available or practical. During the COVID-19 pandemic, this need has become especially widespread.

It’s also useful anytime those who don’t enjoy group interaction and people who can’t get to group sessions for reasons such as compromised health or mobility.

Maintenance CST

While Cognitive Stimulation Therapy is typically designed as a series that concludes after 14 sessions, an adaptation for ongoing “maintenance” therapy is in the works.

Designed for longer-term treatments, Maintenance CST can extend the period of benefits. One research study concluded that long term benefits of maintenance CST were especially powerful in terms of improved quality of life, with the cognitive improvements tapering off over time.

Virtual Cognitive Stimulation Therapy (vCST)

Virtual Cognitive Stimulation Therapy (vCST) was born in response to an urgent need created by the COVID-19 pandemic. Still in its early stages, vCST is taking shape in various ways.

Adapting group sessions to an online format, providing iCST to an individual online (with in-person support from a family member), and training family caregivers to provide individual CST in-home sessions are areas that have been explored, and are ripe with potential.

Individual cognitive stimulation therapy sessions are now being offered online through Washington University Physicians Occupational Therapy.

Their goal is to train carers to administer sessions at home with their loved ones.

A therapist works with the individual with dementia and their caregiver over seven virtual sessions and supports them as they work through the process.

A binder of material is provided with this program.

Researchers at the University College of London and Hong Kong University have been collaborating to adapt CST into virtual sessions so people with dementia can experience the best possible benefits of the program in the alternate format.

What is Next for CST?

Already being used in at least 33 different countries, scientists are developing ways to introduce and grow Cognitive Stimulation Therapy sessions across different cultures and different socio-economic populations.

International train-the-trainer programs exist in Denmark, Norway, Germany, China, New Zealand and USA.

A three-year study is currently investigating how to best implement CST in low to middle income nations, including Brazil, India and Tanzania.

A similar program, called SAIDO Learning, exists in Japan and demonstrates comparable results.

An adapted model of CST intended for people in the moderate to severe stages of dementia is also currently under development in London.

Where to Learn About Online CST Training

To learn more about CST training opportunities, including access to a series of free online training video modules, visit the Saint Louis University website.

To learn about opportunities for online iCST training visit the iCST website.

Palliative Care: an Underused Support in Dementia

Laura Herman Blog, Prevention March 11, 2021October 16, 2021dementia, palliative care

When speaking about palliative care and dementia, the core focus is improving the person’s quality of life.

Taking care of a family member with dementia can feel incredibly overwhelming at times. There is so much to learn and figure out.

Often it seems that as soon you do get something figured out, everything changes again.

Enter the palliative care team. Specially trained healthcare professionals who focus on improving the quality of life for people with serious illnesses, and their families.

They work hand-in-hand with the person, their doctor(s) and family members to reduce distressing symptoms, enhance communication, coordinate care, and develop a plan to improve quality of life for the palliative care patient and their family.

What can Palliative Care Do for People with Dementia?

The goal of palliative care is to reduce suffering and enhance the quality of life for the ill individual as well as their family.

They are there to help react to problems and discomfort as they occur. However much of what the palliative care team strives to do is to prevent problems from arising in the first place.

By helping the patient and their family understand (to the extent possible) what might lie ahead, they can plan for smoother sailing and navigate around major icebergs, missing most of them altogether.

Assist with Advanced Care Planning

The medical and legal landscape can be confusing and difficult to navigate – all the more so for individuals overwhelmed by emotion, stress or health problems of their own.

Often, this is the case for families that experience dementia.

The palliative care team can help families understand their options.

They can lead conversations about planning for eventualities, such as:

Who is the best choice to advocate for the person as their cognitive abilities decline?
If the person is found unconscious and without a pulse should resuscitation be attempted, or would they prefer to allow nature to take its course?
Should feeding tubes, ventilators or other intensive treatments be considered? Under which circumstances?
What are the person’s beliefs and wishes as they pertain to pain control? Do they want to be kept pain-free at all costs, or would they prefer to deal with some pain, if it means being able to engage positively with family members?

The palliative care team can help ensure that the doctors and medical providers are on the same page with the person in terms of their goals.

Without advanced planning, people often end up spending the last portion of their lives undergoing intensive medical treatments. Spending time in and out of hospitals, rather than remaining comfortable in their own homes.

This can be extremely traumatic or stressful for the person and their family.

This type of advance planning can be especially helpful to undertake with someone in the earlier stages of dementia.

It can enable their voice, preferences and beliefs to be a bigger part of the conversation. Most families find that palliative care support is extremely valuable in this arena.

Minimize Distressing Symptoms of the Disease

People with dementia, and their families, tend to experience a variety of distressing symptoms, such as anxiety and depression.

Pain is not normally a direct symptom of dementia, but because it can impair the person’s ability to recognize and communicate pain from other causes, there is a significant tendency to under-treat pain in people with dementia, according to researchers throughout Europe.

Pain is not only uncomfortable, but it is also exhausting. It can make it harder to think clearly, participate in meaningful activities, or comply with medical recommendations.

For example, it’s hard to comply with exercise recommendations when your feet hurt too much.

Pain is one of the major causes of challenging behavior in people with dementia. These behaviors contribute to their own stress levels, as well as those of their loved ones.

Pain assessment in dementia can be tricky. Even for seasoned professionals in some cases – but it is well worth the effort.

The difference in behavior, functioning and personality in someone with dementia who is hurting, before and after the adequate treatment, can be truly astounding.

The palliative care team can help minimize pain, anxiety, depression, hoarding, paranoid thinking, challenging behaviors, and other symptoms of dementia.

Enable People to Reach their Goals

Palliative care is all about the quality of life, not just medical care. For example, if a person with dementia wants to spend more time with their grandchildren, or figure out how to keep their beloved cat, the palliative care team is passionate about supporting these goals.

They specialize in managing symptoms and overcoming barriers so that people can live their best life.

Palliative Care is Underutilized and Misunderstood

According to the World Health Organization, 40 million people worldwide are in need of palliative care each year as they suffer with physical, emotional or spiritual pain near the end of their lives.

Only about 14% of these individuals currently receive palliative care. The best program availability is located in Europe, North America and Australia.

Most of the lack of utilization is due to the poor availability of palliative care programs. However, some people do have access to it but fundamentally misunderstand its scope.

Patients tend to confuse palliative care with hospice care. They believe that only people with terminal conditions, or those at the very end of life, need or can qualify for palliative care.

Hospice care is indeed for individuals who are expected by their doctor to be in their last few months of life.

However, palliative care is intended for people in any stage of a serious illness – from the time of diagnosis, in many cases – explains Karen Mulvihill, Director of Palliative Care Services at Danbury Hospital in Connecticut, USA.

In fact, palliative care can be most effective when in use as early as possible in the disease. It offers the best chance to prevent problems right from the beginning.

Palliative care can be delivered even while the person undergoes curative treatments, which is another place it differs from hospice.

Other misunderstandings include that palliative care or hospice are in connection to euthanasia or physician-assisted suicide.

This isn’t true.

A key tenant of palliative care holds that the team will do nothing to either hasten or postpone death. They focus on making the best regardless of how much time’s left.

Palliative Care can Improve Quality of Life for People with Dementia and their
Families

For many people living with dementia, palliative care support can alleviate a great deal of physical, emotional and spiritual suffering.

Palliative care can help navigate murky medical terrain, and enhance communication and coordination with medical providers.

Palliative care can help the person with dementia and their families define their goals, and figure out how to reach them.

By achieving these objectives, palliative care can dramatically improve the quality of life for people living with dementia and their loved ones.

For information regarding palliative care programs in your area, contact your doctor, social worker or community resource center.

10+ Best Incontinence Products for Dementia Patients

Laura Herman Blog, Prevention, Resources March 6, 2021September 5, 2023dementia, incontinence, incontinence products

There are numerous incontinence products for dementia patients, and each has dozens of variations.

Different combinations of products may be right for different individuals, and a person’s needs may evolve over time.

Incontinence Products for Dementia

	Product	Features
	Prevail Air plus Daily Brief	Soft & breathable Ultimate absorbency Pack of 4 (18 count) Night & day Skin smart Omni-odor guard
	Wellness Superio Series BriefsBrand: Unique Wellness	Fully Absorb up to 2.6L Wide absorbent core Resealable landing zone for easy adjustment White with a nylon based crinkle-free plastic Value for money Stays dry for 8+ hours Award winner/ Featured on Discovery Channel
	One Piece Waterproof Snap-on Diaper Cover BriefBrand: Salk	Lightweight Softness of cloth 100% waterproof Polyester/urethane outer Brushed polyester inner Super-absorbent pad 3-ply inner layer Waterproof outer layer Washable
	SOSecure Containment Swim BriefBrand: Discovery Trekking Outfitters	Discreet Swimming Undergarment Durable Polyurethane Fabric Fleece Lining Hook and Loop Closure (Easy) Elastic Waist & Legs Machine Washable Latex Free
	Prevail Overnight Bladder Control PadsBrand: First Quality	For Women Dri-Fit cotton enhanced QUICK WICK Layer and cotton Odor Guard
	Depend Men GuardsBrand: Kimberly Clark	Adhesive strips to hold guard in place Individually wrapped Discreet- pocket-sized pouch Easy carrying and disposal Contoured design Cup-shaped protection for men One size fits most
	Medline Incontinence Bed Pads	Underpads 50 count 36"X36" Heavy absorbancy Polypropylene backing (protects against leakage & resists melting) Ideal for overnight use
	Inspire Washable and Reusable Incontinence Chair or Bed Pads	Washable/reusable Solves incontinence problems Safely absorbs & lock in liquids Soft & comfortable Non-irritating
	Bariatric 2X-Large UnderwearBrand: Attends	Improved side panels (better comfort & fit) Acquisition layer Super absorbent polymer Tear-away sides (easy removal) Looks & feels like regular underwear Bag of 12
	Depend Mens Maximum Absorbency UnderwearBrand: Kimberly Clark	Outstanding protection Improved underwear-like fit Brief-like leg opening Heavy incontinence Soft, quiet, breathable material Conforms to the body
	AIRCUTE Washable Absorbent Urine Incontinence Underwear for Women	6 layers High waist Absorbent & leakproof Washable Breathable Comfortable
	Prevail Adult WashclothBrand: First Quality	Super strong & soft fabric (12" x 8") Stay-open & easy-close lid Press 'N' Pull lid Super strong soft fabric Aloe & lanolin Lid closes tightly

Don’t call them diapers

Many people refer to incontinent products for dementia as “diapers,” but the term has a strong connotation with infants.

It is generally considered to be disrespectful, infantilizing and tactless.

It should not typically be used when referring to adult absorbent undergarments (unless the person themselves prefers that term).

Words like “pads” or “briefs” would be an appropriate way to refer to these products.

Products designed to be worn inside, or instead, of underpants

Pantiliners – a very thin pad that adheres to underpants for small leaks
Disposable pads – adhere to underpants, but are thicker and more absorbent than pantiliners
Pull up briefs / disposable underpants
Washable pads, liners or absorbent underpants
Reusable vinyl waterproof underpants covers
Wraparound tab briefs – similar to a traditional “diaper” design
Extended wear – Products designed for extended use keep urine away from the skin
Brief liners – designed specifically for use in a brief to boost absorbance or easily remove if damp
Insert – for use with special underpants designed with a pocket to hold a disposable or washable pad insert
Condom catheter or body-worn urinal – Designed to fit over a penis and collect urine in a bag

Products to protect furniture from wetness

Waterproof bed sheets
Washable bed pads
Disposable bed pads
Waterproof mattress pads

Other supportive equipment

Raised toilet seat with handles – this can make it easier to get on or off the toilet
Portable bedside commode
Urinal

When the Person with Dementia won’t Keep a Brief On

If someone with dementia keeps removing their brief, pay attention for clues to determine a likely reason.

Is the problem specific to briefs or are they pulling at other clothing too? Does it happen mainly at night or after bathing? Understanding the reason behind it is essential for finding a solution.

Common reasons for removing clothing or briefs can include:

Feeling too warm
Ill-fitting brief or pants
Wet, damp or soiled brief

Is the person new to wearing briefs (or wearing a new type or brand)?

Briefs can be bulky or uncomfortable, especially when they feel unfamiliar.

Start with the smallest, thinnest or most comfortable product that will meet their needs. This might mean changing them more frequently.

Be sure to minimize incontinence with a toileting plan.

Try a different style

It is worth experimenting with various brands and styles to find something more comfortable or successful.

Look for patterns

1. Do they remove the brief mainly at night? Try going without the brief if possible, using several bed pads for absorbance instead. It may help to tuck an additional bed pad up between the person’s legs.

2. Does it happen mainly when the brief is damp? It may help to use a brief liner, or alternate style of brief that pulls wetness away from the skin. Allow skin to dry fully after a shower or wash-up to ensure there is no lingering feeling of dampness.

3. Are they removing the brief when they need the restroom? It may be a non-verbal sign that the person needs to use the restroom.

4. Do they seem to have bored or restless hands? Giving them something interesting for their hands, such as super soft fuzzy gloves, or a dementia fidget lap blanket with lots of interesting textures and items for their hands to explore.

Is this a sudden change?

A sudden change probably indicates a problem other than the brief itself.

Look for signs that the person might be uncomfortable, especially in the abdomen or perineal area.

Possible conditions that could cause discomfort include:

Urinary tract infection
Constipation
Hemorrhoids
Dehydration
Rash
Pressure ulcer or skin breakdown

Special clothing for special situations

Although there are specialty clothing designed to prevent people from removing their own clothing – such as a jumpsuit with a zipper in the back – there are ethical concerns about restricting normal access to one’s body. They can cause distress in some cases.

In many places, these types of clothing are considered restraints.

What if the Person with Dementia won’t Change their Brief when Needed?

There are many potential complications of wearing a soiled brief too long. It greatly increases one’s risk of urinary tract infections, rashes, skin breakdown, and pressure sores.

Unfortunately, it’s an all-too-frequent problem in dementia care.

There are dozens, if not hundreds, of unique reasons – and as many potential solutions. A few examples include:

Set them up for independence

Keep pads and supplies easily within sight and reach from the toilet.

Catch them when they’re in the restroom

Getting them onto the toilet in the first place is often the biggest challenge. Once they’re there, it can be much easier to access the brief to change it.

Avoid “taking” anything without giving something in return

Hand them a clean pad to hold while you swap out the soiled one for another.

Spare their pride

Present non-rinse soap, wetness barrier cream, or other appropriate skincare products as a medical treatment, for example, to “prevent infection” or to “protect your skin.”

Not only are these statements true, they also take the focus off of their incontinence, which can spare their pride – and their need to fight for it.

Incontinence can be Embarrassing, Inconvenient and Challenging

Successfully managing it can make a big difference in terms of quality of life, physical health and mental well-

At What Stage of Dementia Does Incontinence Occur?

Laura Herman Blog, Signs March 6, 2021August 13, 2023dementia, incontinence

It is essential to understand at what stage of dementia does incontinence occur to prepare accordingly (in advance).

Up to 70% of people with dementia develop incontinence (urinating or defecating involuntarily).

What Stage of Dementia is Incontinence?

It’s especially common in later stages of dementia due to an assortment of reasons.

Some are directly related to dementia, while others aren’t. Physical changes that occur with other conditions or with the aging process also can contribute.

Why do People with Dementia Become Incontinent?

People with dementia may become incontinent for a variety of reasons – and often, for several at once.

Stress Incontinence

Many older women experience “stress incontinence.”

When the weakened bladder muscles are “stressed” by a sneeze or a laugh, they may leak small amounts of urine.

Urge Incontinence

Urge incontinence is a common condition among elders, characterized by a sudden and intense need to urinate, followed by the loss of a large amount of urine.

Functional Incontinence

Mobility challenges can make it hard to get to the toilet on time.

Difficulty Managing Clothing

Unzipping or unbuttoning pants can become a challenge due to various reasons, including arthritis or cognitive changes.

Communication Deficits

People with dementia may be unable to communicate the need to use the restroom.

Cognitive Changes

A person may forget how to complete the sequence of events needed to successfully remove clothing and use the toilet.

The brain may become less able to recognize the signal from the body that it needs the bathroom.

Difficulty finding the bathroom, recognizing the toilet, or comprehending how to use it can present a major barrier.

Incontinence Products

	Product	Features
	Prevail Air plus Daily Brief	Soft & breathable Ultimate absorbency Pack of 4 (18 count) Night & day Skin smart Omni-odor guard
	Wellness Superio Series BriefsBrand: Unique Wellness	Fully Absorb up to 2.6L Wide absorbent core Resealable landing zone for easy adjustment White with a nylon based crinkle-free plastic Value for money Stays dry for 8+ hours Award winner/ Featured on Discovery Channel
	One Piece Waterproof Snap-on Diaper Cover BriefBrand: Salk	Lightweight Softness of cloth 100% waterproof Polyester/urethane outer Brushed polyester inner Super-absorbent pad 3-ply inner layer Waterproof outer layer Washable
	SOSecure Containment Swim BriefBrand: Discovery Trekking Outfitters	Discreet Swimming Undergarment Durable Polyurethane Fabric Fleece Lining Hook and Loop Closure (Easy) Elastic Waist & Legs Machine Washable Latex Free
	Prevail Overnight Bladder Control PadsBrand: First Quality	For Women Dri-Fit cotton enhanced QUICK WICK Layer and cotton Odor Guard
	Depend Men GuardsBrand: Kimberly Clark	Adhesive strips to hold guard in place Individually wrapped Discreet- pocket-sized pouch Easy carrying and disposal Contoured design Cup-shaped protection for men One size fits most
	Medline Incontinence Bed Pads	Underpads 50 count 36"X36" Heavy absorbancy Polypropylene backing (protects against leakage & resists melting) Ideal for overnight use
	Inspire Washable and Reusable Incontinence Chair or Bed Pads	Washable/reusable Solves incontinence problems Safely absorbs & lock in liquids Soft & comfortable Non-irritating
	Bariatric 2X-Large UnderwearBrand: Attends	Improved side panels (better comfort & fit) Acquisition layer Super absorbent polymer Tear-away sides (easy removal) Looks & feels like regular underwear Bag of 12
	Depend Mens Maximum Absorbency UnderwearBrand: Kimberly Clark	Outstanding protection Improved underwear-like fit Brief-like leg opening Heavy incontinence Soft, quiet, breathable material Conforms to the body
	AIRCUTE Washable Absorbent Urine Incontinence Underwear for Women	6 layers High waist Absorbent & leakproof Washable Breathable Comfortable
	Prevail Adult WashclothBrand: First Quality	Super strong & soft fabric (12" x 8") Stay-open & easy-close lid Press 'N' Pull lid Super strong soft fabric Aloe & lanolin Lid closes tightly

How to Minimize Urinary Incontinence

There are many ways to minimize urinary incontinence. The solution for each individual will depend on the cause, or causes, in their unique case.

A multi-pronged approach, tailor-fit to their situation, will likely be most effective.

Locate the Toilet

Placing signs, or a trail of masking tape on the floor, to help the person find the toilet may help.

Sometimes pictures are easier for the person to understand than written words.

Keep the light on in the bathroom, or place a portable commode, or urinal, at the bedside to help someone who has trouble finding the bathroom during the night.

Replace Troublesome Clothing

Elastic waistbands can make toileting easier for those who have difficulty managing buttons or zippers.

Watch for Non-Verbal Clues

Pay attention to the person’s non-verbal communication. Even if they can’t always articulate that they need the bathroom, people often show outward behavioral signs.

Common signs of needing the restroom include:

Fidgeting with or removing clothing
Pacing, wandering or going in and out of different rooms
Peering around frantically

Toileting Plan

One of the best ways to minimize incontinence is to develop a personalized toileting plan based on the person’s needs.

Initially, the “plan” may be as simple and informal as reminding the person to use the bathroom before leaving the house.

Over time, the frequency and amount of oversight or assistance may increase.

Pay attention to when the person usually needs the restroom and try to anticipate it.

Remind or assist them regularly just before they are likely to need it.

Example:

Larry is a senior with middle-stage Alzheimer’s Disease. He has difficulty recognizing when he needs to urinate, and usually doesn’t get to the toilet on time. He wears incontinent briefs, which used to be wet almost every time he went to the bathroom.

His wife, Roberta, used to ask him if he needed the bathroom, but he would always tell her “no”. Now, however, she doesn’t ask him. Instead, she walks with him to the restroom regularly – when he wakes up, before each meal, after dinner and before bed.

She also wakes him up around midnight and again around 5:00 a.m. If she doesn’t wake him up he will usually wake up on his own around 1:00 and 6:00 in a rush to find the bathroom. Not only is this upsetting to him, it is unsafe because he won’t slow down enough to use his walker.

With this plan, Larry’s brief has rarely been wet at all over the past several months. However, last week he started taking a new diuretic medication to reduce the swelling in his legs, and he immediately started to have accidents again. When Larry went to the toilet before lunch his incontinent brief was soaked.

After a few days, Roberta was able to adjust the plan to the new needs. She started walking Larry to use the toilet after breakfast, and again around 10:30. Larry is back to enjoying accident-free days at this time.

The Importance of Sleep

It’s worth thinking twice about waking up someone with dementia to prevent overnight incontinence. Sleep deprivation can seriously impact both physical and mental health.

It can also worsen the symptoms of dementia.

Depending on the situation, it may be worth considering a quality night brief instead.

These special briefs are designed for extended wear and can absorb large amounts of urine, keeping it away from the person’s skin.

Regular briefs should not be worn if they are wet. Extremely damaging to skin, it also increases the risk of urinary tract infections and pressure ulcers.

Keep Drinking

Some elders avoid drinking fluids because they are afraid of having to urinate more or having an accident.

However, dehydration is a serious concern for elders. It can worsen confusion, contribute to falls, or lead to a medical emergency.

Elders with dementia tend to be at especially high risk for dehydration.

Caffeine and certain medications can cause an increase in urination, which can contribute to both incontinence and dehydration. In general, it’s a good idea to avoid caffeine and to take the diuretic medication in the early waking hours.

Always discuss medications, including what time they are taken, with the person’s doctor.

Talk to the Doctor

There are medications for “overactive bladder”, but beware: this is not the cause of most incontinence in dementia.

Furthermore, some of these medications can worsen dementia symptoms significantly.

There are also other potential treatments for incontinence depending on its cause. Discuss all medications and any concerns about incontinence with the person’s doctor.

Watch for Urinary Tract Infections

Sudden onset or increase in incontinence can be a sign of a medical condition, such as a urinary tract infection.

UTI’s can greatly impact the health and behavior of a person with dementia. Other signs that may indicate an infection could include:

Fever
Increased confusion
Changes in behavior
Dark or odorous urine
Discomfort with urination
Low back pain

If incontinence is new or sudden, talk with the person’s doctor.

Pressure Ulcers, Bedsores and Dementia

Laura Herman Blog March 1, 2021September 7, 2023bedsores, dementia, pressure sores, pressure ulcers

When it comes to bedsores and dementia, it is important to know how to approach with treatment, or even better, have a prevention plan in place.

Bedsores can develop quickly – in as little as a few hours. It’s best to prevent them if possible. If they do develop, it is vital they are tended to promptly.

Prevention & Treatment for Bedsores and Dementia

They can be extremely challenging to treat and can be quite detrimental to a person’s health and quality of life.

What are Bedsores?

Bedsores are also known as decubitus ulcers, pressure sores, pressure ulcers, or pressure injuries. They develop when an area of skin and underlying tissue loses blood flow and starts to die.

This can occur when a shoe, medical device, or other object presses against the skin over an extended period of time.

One of the most common causes of pressure injuries is when skin and tissue are compressed for a sustained period between a person’s skeleton and a surface such as a mattress or a chair.

People who are able to move and reposition normally will adjust their weight frequently enough that blood remains flowing and skin remains healthy.

People who aren’t able to reposition themselves easily, and who spend a lot of time sitting or lying down, are at the greatest risk for developing a pressure ulcer.

Why are Pressure Ulcers a Problem?

While pressure ulcers often develop quickly, they can take an extremely long time to heal.

Factors that contribute to their development – such as limited circulation, impaired mobility, poor nutrition or compromised health – often work against their healing.

Pressure sores are associated with many complications, especially infections.

They often take a great deal of bodily energy to heal – energy which people in poor health usually lack.

Pressure ulcers can be very uncomfortable or painful, detract from quality of life, and in some cases, they can contribute to an earlier demise.

Suggested Products to Assist People with Bedsores and Ulcers

	Product	Features
	HITHINKMED Alternating Air Pressure Mattress, Pressure Pads for Bed Sores	Hospital or home use Mattress pad Ultra quiet electric pump Fits most beds Promotes blood circulation
	Foot Pillows Heel Protectors Heel Cushions Heel Protection Effective Pressure Sore and Heel Ulcer Relief	Swollen feet comfort Heel protection 2 pack
	Skil-Care Heels-Off with Gel Insert	Helps healing ulcers Improves circulation Prevent pressure sores
	Lunderg Bedsore Pillow Positioning Wedge - with 2 Non-Slip Pillowcases & Adjustable Slope - Pressure Ulcer Cushion	Bed sore prevention Stay on side and stay off back Inc 2 non-skid pillowcases 1 year warranty
	MedVanceTM Silicone - Bordered Silicone Adhesive Foam Dressing Size 4"x 12" (2.4"x10.4" Pad) Box of 5 dressings	Promotes healing Easy to apply & remove Semi-permeable Super absorbent Individually wrapped Multi-layered

A Particular Challenge in People with Dementia

People with dementia may have difficulty moving their bodies.

Even if they are painful, they may not recognize that moving would relieve the pressure and pain.

They may not understand the need to reposition themselves to prevent a pressure injury, and may not be compliant with caregivers’ attempts to do so.

For example, a person may prefer to sleep on his or her back all night. He or she may resist lying on the side, or may scoot back to their back shortly after moving off it.

Once a pressure ulcer develops, someone with dementia may not be compliant with the measures needed to heal it.

Aside from keeping pressure off the affected area, bedsores often require painful wound care.

People with dementia may react with uncooperative or resistant behaviors, including pushing, hitting or kicking at caregivers.

In many cases, people with pressure injuries are repositioned every two hours around the clock. Being awakened frequently can cause sleep deprivation and an array of physical and emotional effects for people with dementia, including:

Uncooperative or difficult behaviors
Daytime sleepiness
Withdrawal from social interaction or activities of interest
Decreased physical strength and coordination
Decrease in cognitive function
Increase in emotional volatility
Changes in eating, appetite, nutritional status and weight

Four Stages of Pressure Sores

Pressure ulcers are categorized into four stages based on their severity.

Stage 1

Stage 1 pressure injuries are the first, and mildest, stage. The skin is not yet broken, but it usually looks discolored – usually reddened in light skin, and slightly purple or blue in darker skin. (Dark purple or maroon usually indicates a deeper injury.)

When pressed with a finger the area does not turn white.

A stage 1 bedsore may be warmer, cooler, firmer or softer than surrounding skin. It may or may not be tender or painful.

Stage 1 pressure ulcers are the easiest to heal, but they will progress into stage 2 quickly if the pressure is not relieved.

Consult with the person’s doctor if they don’t resolve within 24-48 hours after relieving pressure.

Stage 2

Stage 2 pressure injuries feature broken skin with pink or red moist wound beds. Blisters may be present, but no underlying tissue is involved.

Stage 3

In stage 3 pressure injuries the tissue beneath the skin is visible. Stage 3 pressure injuries can be very extensive beneath what is immediately visible.

Stage 4

In stage 4 pressure ulcers muscles, tendons or bones may be visible. Black, dead tissue may be present.

Stage 3 and 4 pressure injuries are serious medical issues and require the support and guidance of a medical team to help them heal.

You should consult the individual’s doctor for all pressure injuries. Even Stage 1 pressure injuries should be viewed as a warning taken very seriously.

The doctor should take measures promptly to ensure they don’t worsen or recur.

Sepsis: A Medical Emergency

Pressure ulcers can easily become infected, especially if they are exposed to bacteria from stool or other bodily fluids.

Signs of an infected pressure sore may include:

Redness, soreness or heat in the skin around the pressure injury
Pus or drainage from the wound
Foul odor from the wound
Fever

When you notice signs of infection, notify the person’s doctor promptly.

Because it is easy to miss signs of infection, it’s important to be alert for signs of sepsis in people with pressure ulcers, even if there isn’t a known infection.

Sepsis is a severe reaction to an infection in which the body’s organs shut down.

Without emergency medical treatment, it can rapidly lead to death. Get the person to the emergency room right away and tell them you suspect sepsis.

Look for:

Signs of infection
Temperature changes (high fever or abnormally low body temperature)
Mental changes (increased confusion, extreme sleepiness)
Signs of extreme illness (shortness of breath, discomfort, weakness, pain)

What Contributes to Bedsores?

Pressure sores are especially common in areas over bony prominences that experience sustained contact with a chair or bed.

Areas that are particularly prone include:

Ears
Shoulder blades
Spine
Tailbone
Elbows
Hips
Knees
Ankles
Heels

Sustained pressure

Pressure ulcers can start to develop within a mere two hours when the pressure between the person’s bone and a chair, bed or object has cut off blood flow to the skin and underlying tissue.

Friction

Friction occurs when skin rubs against another surface, such as when a person is pulled up in bed by caregivers.

Shear

Shear occurs when skin stays in one place while bones move. This pinches off blood vessels and restricts blood flow. A common example of shear is when the head of a bed is elevated and a person slowly slides downward.

Poor nutritional status

Dehydration, unplanned weight loss and general malnutrition are known to be significant risk factors for developing pressure ulcers.

Incontinence or wetness

Urine and feces are especially caustic to the skin. Moisture from incontinence, perspiration or other sources can weaken the skin and make it more susceptible to damage.

Immobility

When someone spends a great deal of time in bed or in a chair and doesn’t move or reposition themselves frequently, they are at high risk for developing pressure ulcers.

Can Bedsores Heal?

Bedsores can heal, but it is far easier to prevent one than it is to heal one. Catching and treating it as early as possible makes a huge difference.

Compliance with keeping all pressure off the affected area is extremely important – and often, extremely challenging. It may be necessary to alter one’s sleeping or sitting position for an extended period.

Usually, the pressure ulcer develops in the first place because the person favors that position for some reason. (Such as someone who sleeps on their back due to breathing or discomfort may need to adapt to sleeping on their sides instead).

Refraining from it can be uncomfortable, inconvenient, or present other challenges.

How to Prevent Bedsores

Repositioning

Most people without mobility impairments reposition themselves frequently when sitting or lying.

If someone doesn’t reliably reposition themselves independently, a caregiver should remind and assist him/her to do so.

Many facilities use every two hours as a standard for repositioning, however, the need will vary by individual. Also, there is rising concern about the detrimental effects of sleep deprivation when people are repositioned this often.

The person’s doctor or medical team should determine the frequency of repositioning based on their unique situation.

Repositioning doesn’t necessarily need to be a significant amount of movement.

A shift in weight or a slight turn to one’s side may be sufficient as long as it relieves pressure.

Use pillows under arms or legs, between knees, or behind backs to support their body as needed.

Minimize Friction and Shear

Keep the head of the bed elevated only as much as needed, and elevate the feet to reduce sliding and minimize shear.

When pulling someone up in a bed, lift them fully off the bed, rather than letting them drag against the sheets.

Special friction-reducing sheets designed for this purpose may be helpful.

Nutrition

Wound healing benefits from extra calories, protein, zinc, certain vitamins and amino acids.

Hydration is an extremely important factor in both preventing and healing pressure ulcers.

Different people have different nutritional needs.

For example, people with kidney impairment may need to avoid too much protein or limit fluids. Consult with a doctor or dietician regarding an individual’s nutritional plan.

Keep Skin Clean and Dry

Remaining in a wet or soiled brief is extremely hard on the skin. Ensure to promptly clean all incontinence episodes.

For frequent incontinence, use a barrier cream to protect the skin.

Incontinence products designed for overnight use can help. Such products aim to hold urine away from the skin so it stays dry.

These products tend to be more expensive, but worth the extra cost in some cases.

Minimize episodes of incontinence by following a person-centered toileting schedule when possible.

Mobility

Encourage and assist an individual with dementia to retain their mobility to the extent possible.

When safe and practical:

Move the person out of a wheelchair into a dining chair to eat
Get up to the toilet, move about or switch seats every two hours
While it can feel natural to essentially wait on someone who has difficulty getting up, look for opportunities to allow them to get up and do for themselves. What we don’t use, we lose!

Consult with a doctor, physical therapist or personal trainer regarding ways to keep the individual mobile.

Be sure to find a physical therapist or trainer who has the experience and is comfortable working with dementia.

Because people with dementia may not remember their instructions, it takes a particular skill set to achieve the best benefit.

Finding the right therapist or trainer can make all the difference in the person’s success.

Routine Skin Checks

Make a habit to visually inspect the person’s skin routinely. Pay special attention to their bony prominences including toes, ankles, heels, knees, hips, tailbone, spine, shoulder blades and ears.

The recommended frequency of routine checks will vary based on the individual and their unique health status. Check with their doctor for specific recommendations.

Generally, it’s a good idea to inspect all areas of skin at least daily for high-risk persons.

The coccyx should be inspected with each brief change when incontinence and limited mobility are concerns.

Diabetic Feet

Pay extra attention to the feet of someone with diabetes. The impaired circulation to these lower extremities exacerbates the risk terribly.

Socks and shoes should always be clean, dry and fit properly.

Specialty cushions or equipment

Pressure reduction products, such as cushions and other equipment, are available to help reduce the risk of bedsores.

There are many factors that contribute to pressure injuries, and they vary considerably by an individual.

It is important to select the proper equipment for the person’s needs.

Choosing the wrong product can make the difference between effectively preventing or healing a pressure sore, and not.

Consult with the individual’s doctor or healthcare team to ensure the choice of an appropriate product.

Prevention is Key

Pressure sores can be extremely detrimental to a person’s health, comfort and quality of life, but they can usually be prevented with awareness and precautionary action.

Final Thoughts – Bedsores and Dementia

Older people are more susceptible to bedsores and dementia, especially if they have trouble with mobility. In addition, older people who carry weight, suffer from conditions such as diabetes, incontinence or poor nutrition are at greater risk of developing pressure sores and ulcers.

Bathing And Dementia: Best Practices

Laura Herman Blog February 28, 2021September 7, 2023bathing, dementia

Bathing and Dementia challenge- lots of people with dementia don’t want to bathe – for lots of different reasons.

When you are trying to help someone who doesn’t want to bathe the first step is to figure out why they don’t want to do it.

Only when you know why they don’t want to bathe will you be able to figure out how to overcome the resistance.

Bathing Practices for Someone with Dementia

There are so many unique individuals with multiple reasons for not wanting to bathe. There are quite literally thousands of potential strategy combinations to try.

Common Reasons to Resist Bathing

There are many reasons people with dementia may resist bathing. Often there are multiple reasons at play.

It’s important to investigate the cause, or causes, of each individual’s resistance so that their hygiene needs can be met without causing emotional turmoil or trauma.

Common reasons for bathing resistance can include:

Physical Discomfort

The bathroom is cold, bright or otherwise uncomfortable.
They are in pain.
Bathing is tiring.
Their sensory processing can become hypersensitive, leading to extreme sensitivity – almost pain – to heat, cold, touch, hearing or other sensation.

Emotional Discomfort

They feel embarrassed about needing help.
They’re uncomfortable undressing in front of others.
They are fearful of water in their face.
They are frightened to step into the tub.
Bath mats or drains may look like dangerous holes.
Reflections from the mirror may make it seem like there are many people in the room.
They have traumatic memories that are retriggered by the experience.

Changes in Cognitive Abilities

They believe that they already have showered, or that they will be doing it soon (for example, when they “get home”).
They no longer know how to sequence the steps to complete a shower.
They don’t understand they need help, or what you’re doing to them.
They don’t understand that they need to bathe (even if it seems drastically obvious to you).

How often Should Elders Shower?

Experts tend to agree that traditional showers or baths are the ideal way to achieve cleanliness.

Bathing removes dead skin cells and bacteria that accumulate and lead to rashes, infections and skin disorders.

However, bathing every day can wash away protective oils from the skin.

Elderly people often have dry, fragile skin. Daily showering can actually worsen its condition.

Depending on the individual’s situation, bathing 1 – 3 times per week is generally recommended for elders.

Using a washcloth on the hands, face, feet, underarms and genitals on the other days is ideal.

There is little ideal about dementia care. In reality, we do our best with what we can in each unique situation.

There are many people who can’t bathe traditionally because they are bedbound, or for other reasons.

If someone with dementia won’t get in a bath or shower, a sponge bath using non-rinse soap is a very good substitute.

A careful sponge bath can remove as much dead skin, oil and bacteria as traditional bathing. Furthermore, alternative bathing has been proven to significantly reduce behavioral challenges for people with dementia.

Finding a way to meet the person’s hygiene needs without upsetting them makes a huge difference – on their quality of life, on your relationship with them, and on the safety of everyone involved.

Suggested Products to Assist Bathing People With Dementia

	Product	Features
	Dove Body Love Beauty Bar Soap Dry-Cracked Skin	Hypoallergenic fragrance Instant dryness relief Dermatologist approved Hydration
	Basis Sensitive Skin Bar Soap - Cleans and Soothes with Chamomile and Aloe Vera	Body wash or hand soap No fragrances No dyes Rinses easily
	Nurture Valley Sponge Bath Wipes - Large Disposable Wash Cloths for Adults, Seniors, Bedridden, Home Care	No rinsing Disposable sponge wipes Bath with no soap Ultra thick
	Carousel Sliding Shower Chair Tub Transfer Bench with Swivel Seat	Premium padded Pivoting arms Adjustable space saving design Professional grade Robust
	Bath Bench Seat Suspended, Bath Tub Shower Chair	Heavy duty alloy Adjustable Comfortable Lightweight
	Inflatable Bedside Shampoo Basin kit, Bedridden Shower System for Disabled& Elderly	High quality PVC Holds 2.5 gallons of water Set of 6 Easy and comfortable

Bathing Basics

When helping someone with dementia to bathe it may help to do some of the following:

Cover the person with towels for warmth and modesty.
Help/encourage them to participate – use the washcloth to wash what they can. This can help give them greater control, and can distract their attention from any uncomfortable feelings while someone else washes what they can’t reach.
Set up supplies ahead of time.
Be aware of, and minimize, stimulation where possible. Brains can easily become overwhelmed in a bathroom environment by bright lights, reflections or loud noises.

Mix and Match Tips for Successful Showering

The strategies that will ultimately be effective in successful bathing will depend on the reasons for the resistance.

Be creative and flexible, mix and match approaches, try and err until you find what works for a given individual in the given moment.

Keep in mind that what works may vary from day to day or over time.

Don’t Ask

Generally, you should NOT ask someone with dementia if they want a shower. The answer will be no.

Instead, try walking them to the shower area without talking about it.

Have the shower running already and have everything you need already in place. Towel, washcloths, change of clothing, soaps, shampoo, lotion etc.

Give a Choice

Some people respond better if they have a choice in the matter. Try to offer two options that are both acceptable, such as “Would you rather have a bath or a shower?”

Even if they always make the same decision, having the choice can be important for helping them feel in control.

Choose your Words Wisely

Sometimes it’s a good idea to avoid a specific word, such as “shower” or “bath.” In many cases, avoiding the word itself will avoid resistance.

Simply using different verbiage, such as “Time to wash up”, or “Here’s a warm washcloth,” can make a 100% difference in these cases.

Pay Attention to your Non-verbal Messages

Are you dreading the experience as much as you think they will? Are you inadvertently showing signs of stress, anxiety or tension when it’s shower time?

Most people with dementia pick up on non-verbal messages, such as body language, tension and tone of voice, extremely well.

Relax, open your mind, use a bright, enthusiastic voice – and watch them follow suit.

Who’s Asking?

It can be worth experimenting with who is trying to get the person to shower.

Some people will do anything their son suggests, for example, and seemingly oppose every one of their daughter’s ideas.

Some people respond well to a letter or phone call from the doctor’s office reminding them to take a shower.

Hire a Professional and Work as a Team

Some people don’t want to accept help from a family member, but may be amenable to help from a professional.

On the flip side, other people may be more receptive to a trusted family member.

Professional care staff and family may have to work together to accomplish the task in a way that feels safe and acceptable to the person living with dementia.

Consistency is extremely important when it comes to hiring a professional.

Once you find a good match, use the same person each time to the extent possible. It may take several sessions to build up trust and rapport enough to accomplish the bathing.

Gender may Matter – a Lot

While it doesn’t make a difference to everyone, some people are much more comfortable with members of their same gender.

Others however will tend to do more for someone of the opposite sex.

Play the Part

Other non-verbal cues can include the environment or the outfit that the helper is wearing.

A home bath aide who is wearing scrubs, or a white lab coat, may look more like a nurse and therefore inspire more cooperation.

A home care aide can also come under the guise of a “Nail Care Technician”, “Masseuse” or “Skin-care Nurse”, for example.

One advantage of these options is that they spare the person’s ego.

If the resistance results from being embarrassed or unaware that they need help with bathing, these can be effective approaches. They can meet the person’s hygiene needs while preserving their self-esteem.

Music

Sing or play their favorite music from young adulthood.

Keep their attention wrapped up in song and their mood high. Dance a bit as you help them through the process of changing or sponge bathing and be amazed at what you can accomplish.

Massage

Some people love massages.

Having a massage appointment in which they are massaged using warm washcloths and non-rinse soap can be just the ticket for some.

Beauty Shop

A beauty shop appointment can be very effective for washing hair. Try printing out a “gift certificate” on the computer and presenting it to the person with much ado.

They may just be swept along with the enthusiasm of the moment.

Spa Treatment

Try presenting a bath as a spa treatment. Pamper the person with champagne (or bubbly water) and chocolates in the bath.

Break out the facial mask, cucumber slices, seaweed wraps – or anything else that might sell the experience.

Mani – Pedis

Use manicures as an excuse to provide excellent fingernail care, washing and lotioning skin from the hands up to the elbows, or even beyond.

Likewise, pedicures can provide the perfect opportunity to clean the feet and lower legs up to or even beyond the knees.

Chest, Back and Underarms

Gaining access to this area can be tricky in some cases. Again, presenting the non-rinse soap as a skin treatment can be helpful.

Try to time this for a moment when they are changing their shirt if possible.

Incontinence Care

If the person is amenable to assist with cleaning up after an incontinence episode, this can be a great time to sponge bathe the entire perineal area, thighs and abdomen.

If the person prefers to wash this area independently, provide warm washcloths with non-rinse soap.

It may help to explain that the non-rinse soap is a skin treatment to prevent infections and skin concerns (which is true, after all).

Go for a Swim – or Just Dress Like It!

For people who swim regularly (or may enjoy starting), a pre- or post-swim shower can be a good opportunity to work in a routine shower.

This can be effective because it is an expectation of everyone who swims. There is no singling out, no implications about the person’s needs or detriments, no embarrassment.

If urinary incontinence is a concern, consider adult incontinence briefs made especially for swimming.

Standard incontinence briefs aren’t suitable for submersion underwater.

Wearing a swimsuit in the bathtub can also be effective when modesty is a concern.

Aim for the time that works best for them

This will vary by individual. The best time may be:

What they’re used to.

Have they always liked a bath at bedtime? It might help to keep up that routine.
It may help to have a quick shower or sponge bath every day at the same time, even if it’s not completely necessary for hygiene, it may help them to build that routine so they can thrive with that consistency.

During their best time of day.

If they tend to be more alert during mornings, it may help to aim for a morning shower or sponge bath, even if they used to prefer bedtime baths.
Other people find that midday tends to be when they function at their best, and some (although not too many) even do better cognitively later in the day.

When they’re already changing clothing or using the toilet.

Half the trick is to get them this far. When they’re sitting on the toilet, you can apply their “leg cream” (non-rinse soap). Keep a change of clothes in the room so you can apply the non-rinse soap and change their socks, pants and undergarments quickly, smoothly and without resistance.

Unpredictable.

Sometimes routines are really helpful to those with dementia – but sometimes you just have to be watching for the window of opportunity and be ready to take it when it comes. Have everything ready pretty much all the time, so when they are ready you are too.

Alternative Bathing Options and Products

Sponge Bath

As simple as a warm washcloth in a sink or basin, a sponge bath can be a very effective way of removing old skin cells, bacteria, sweat and odor.

Use soapy water, being sure to rinse well with a clean washcloth afterward, or try using a non-rinse conditioning skin cleansing product for more ease and better skin health.

The general rule of thumb is to wash from cleanest to dirtiest body parts, using a clean washcloth for each body part.

Seven-day Bath

To avoid overwhelming the person, you can break up a sponge bath so that just a tiny portion is completed each day.

Break it up however works best for the person.

One example:

Monday: hands and forearms
Tuesday: elbows, upper arms and underarms
Wednesday: back
Thursday: front torso
Friday: feet and lower legs
Saturday: thighs
Sunday: perineal area and buttocks

Bed Bath

Essentially a sponge bath given in bed, the bed bath can be an effective way to get someone clean while keeping them warm, feeling secure and modest.

It can easily be disguised as a massage and be a very relaxing experience for the person with dementia.

It might be helpful to hire a professional bath aide to assist with this if you find it physically difficult.

Towel Bath

A towel bath is essentially a bed bath where the person is covered in warm wet towels.

The experience is even warmer and more relaxing than a traditional bed bath.

There is a lot of research to back up its effectiveness in maintaining hygiene and reducing anxiety and resistive behaviors in dementia.

Bag Bath

Commercially available bag baths come with 10 disposal cleansing wipes. Pop the whole bag in the microwave and follow the directions for a complete waterless bathing experience.

Bag baths have been proven to be one of the very best options for preventing spread of infections and are used frequently in hospitals, hospices and other organizations.

Non-rinse Soap

Non-rinse soaps often contain lotions or skin conditioners which offer added benefits to skin health.

Non-rinse Shampoo

Available as a powder or a shower cap, this can be a good way to clean hair without getting it wet.

How to Overcome Resistance to Bathing and Dementia

To overcome resistance to bathing in someone with dementia follow these steps:

1. Identify the causes for the resistance.
2. Reframe the goal. It’s not to get them to bathe, it’s to meet their hygiene needs.
3. Consult with the individual’s doctor, if needed, to determine an appropriate bathing frequency. 4. Consider their unique health status and feelings regarding bathing. 1-3 times per week is plenty for most elders.
5. Try a strategy. Try another.
6. Keep trying until something works.
7. Be flexible and keep adjusting the plan as the situation evolves.

Viewing Nature Improves Dementia [Proven]

Laura Herman Blog, Prevention February 23, 2021October 16, 2021alternative treatment, dementia, natural therapy, nature

Now, to be clear, viewing nature will not cure dementia. There are still no cures for most causes of dementia. But is there evidence that viewing nature improves dementia?

But what improves dementia’s symptoms improves dementia.

Science has proven time and again that viewing images of nature improves many factors that worsen dementia’s distressing symptoms.

Factors like pain, anxiety, depression and stress all impact dementia profoundly.

The Importance of Getting Outside, Nature & Dementia

These types of excess disabilities make it harder for people with dementia to function at their best. They can increase confusion, agitation, restlessness and impact sleep.

Unfortunately, when any one of these things falls out of balance it will often disrupt the others as well.

For example, if someone feels anxious it can impact their sleep.

When sleep is disturbed, fatigue increases.
As fatigue increases, the ability to think, function and process information decreases.
This can easily lead to an increase in anxiety, agitated behavior and/or restlessness.
Restlessness can contribute to falls, injuries and pain.
Pain can lead to more restlessness, sleep disturbance, medication, anxiety and greater fall risk.
Medication can lead to constipation which can lead to increased restlessness, sleep disturbance, agitation, anxiety and appetite loss.
Appetite loss can lead to weight loss, weakness, decreased functioning and falls.

Symptoms can quickly spiral out of control and it can be hard to untangle the causes from the effects.

To the extent possible, a key goal in dementia care is to reduce “causes” and minimize effects.

So, when science shows us that viewing plants and scenes of nature can alleviate pain, anxiety, depression and stress we can see how this will effectively improve the symptoms of dementia – although more accurately we’re reducing excess disabilities that worsen dementia’s symptoms thereby allowing the person to function closer to their true baseline capability.

Hospitals are great places to study pain, stress and anxiety

Hospital patients, with their detailed records and controlled experience, are great fodder for study.

Hospital stays and procedures are known to be stressful, and contribute to anxiety. This makes them a great way to study the effects of plants on health outcomes, and there is no shortage of such studies.

View Through a Window May Influence Recovery from Surgery

One of the most cited studies occurred in1984 when Roger Ulrich examined whether the view through the window made a difference to the recovery of post-surgical patients.

Some rooms in the hospital overlooked a grove of trees, while others overlooked a brick wall. The rooms were nearly identical other than the view.

Patients went through the same gallbladder surgery and were matched on multiple factors, including age, gender, and health status.

The findings showed a statistically significant difference in:

1. The frequency and strength of pain medication required

The tree-view group required significantly less, and less potent, pain medication than the control group.

2. Length of hospital stay

The tree-view group was able to leave the hospital an average of a full day earlier than the brick wall-view group.

3. Fewer “negative” experiences

Nurse notes were reviewed for all patients. The group with the brick wall-view had over 3 times as many negative notes (such as “upset and crying” or “needs much encouragement” than the tree-view group who had more positive notes (like “In good spirits” and “moving well”).

Since 1984, thousands of studies have built on and expanded Dr. Ulrich’s research into an enormous body of research.

Although it wouldn’t be possible to cover them all here, we can take a closer look at a sampling of key studies.

Measuring the Benefits of Indoor Plants and Flowers

Live plants enhance health outcomes of patients recovering from surgery

In 2009, this study showed that post-surgical patients in hospital rooms with plants and flowers had a significantly improved physiological recovery response and felt better about their rooms and the hospital staff caring for them.

90 patients recovering from the same hemorrhoid surgery were randomly assigned to similar rooms either with or without live plants.

Researchers measured patients’ vital signs, length of hospital stay, pain medication used, ratings of pain intensity, distress, anxiety and fatigue.

They found that patients in rooms with live plants showed significantly lower systolic blood pressure, and less pain, stress, anxiety and fatigue than the control group.

They also rated their room satisfaction higher and reported more positive impressions of the hospital care staff.

Live plants enhance recovery and mood; reduce pain, anxiety and fatigue

This study in 2016 shows multiple benefits of live plants to post-surgical patients’ mood and recovery.

Patients in rooms with plants reported less pain, anxiety and fatigue than those in the control group.

They also were noted to have increased mood, social activity, friendly behavior towards others, and positive feelings in general.

They described their rooms to be more calming, soothing and satisfying than the control group.

There are hundreds of more studies showing similar effects of plants and flowers on health, stress, anxiety, pain and mood.

A number of studies examine the effect of simply viewing fresh-cut flowers or live plants in a room.

Viewing fresh flowers invokes relaxation and improves mood

Researchers in 2014 confirmed physiological and psychological relaxing effects of cut fresh roses in a room.

This study from 2016 also confirmed that the presence of flowers can positively influence mood as well as perceptions of places and other people.

In another study in 2017 researchers measured a significant relaxation response after participants viewed fresh roses for three minutes. The control group viewed no stimulus.

The physiological and psychological relaxation response was determined by measuring participants’ oxyhemoglobin levels, heart rate and heart rate variability.

A mood profile and semantic differential were also used, which showed a significant elevation in mood and an increase in feeling ‘natural’, ‘comfortable’ and ‘relaxed ’.

And, in case you had any doubt: receiving flowers is actually scientifically proven to enhance mood! It also enhances both social behavior and memory.

Receiving flowers improves mood, social behavior and memory

A series of studies in 2005, showed that people benefit in multiple ways from receiving flowers. People were presented with either flowers or a non-flower gift such as pens, candles or fruit.

The control gifts all had the same economic value, a pleasant odor, similar color variation and were wrapped similarly for presentation.

The results showed that that both women and men, young and old, showed improved mood, positive social behaviors and episodic memory after receiving flowers.

The social behaviors that were measured included initiation of conversations, eye contact, and standing at a more familiar social proximity. Non-flower gifts elicited less or no improvement in these areas.

These improvements were measured both immediately and weeks later, demonstrating a lasting effect on mood, social behavior and memory.

Live plants induce relaxation

In 2016, researchers studied men performing the same task – transferring pots for three minutes – with and without plants present. When live plants were present, the participants relaxed.

This was determined by significant differences in key physiological and psychological measurements, such as prefrontal cortex activity, heart rate variability and mood profile.

Images of Nature on Screens are also Effective

Viewing nature imagery on a screens induces relaxation and positive emotional response

In 2007, researchers found that individuals felt significantly less stressed, more friendly, playful and elated, and less fearful after viewing slide images of nature rather than urban scenes.

In 2018, researchers found significant evidence that viewing forest imagery induces physiological and psychological relaxation. Participants viewed images of either a forest landscape or a cityscape on a high definition television set.

After viewing forest imagery, participants’ oxyhemoglobin levels were decreased and they reported feeling much more “comfortable”, “relaxed” and “natural”.

Awe-inspiring images of nature can be especially potent

In 2014, researchers investigated whether there was any effect, or difference in effect, on people viewing mundane pictures of nature versus awe-inspiring scenes.

Images were shown on a computer screen and were grouped into three categories: awesome nature (such as grand mountain scenes or powerful storms), mundane nature (like grass, foliage or trees) and a control group (featuring objects like buckets, ladders or chairs).

Both types of nature images invoked significantly more feelings of being connected to others, feeling more caring and more spiritual than the control condition.

Both groups of nature images invoked an improved mood, more marked in the awesome images. The awesome images also lead to participants making more prosocial choices.

Photographs and Paintings of Nature can Reduce Stress and Improve Attention

Exposure to natural landscape art reduces anger and stress in males

A study in 2008 showed a significant reduction in anger and stress in males (but not females) when nature landscape art posters were displayed versus abstract art posters.

Participants were asked to perform frustrating tasks on a computer and then report their anger and stress levels.

In the natural landscape settings, the males in the experiment reported less stress and anger – the more natural landscapes were present, the less stress and anger was reported.

Viewing plants, or pictures of plants, reduces stress

In 2012, researchers found that people who viewed real plants and those who viewed images of plants experienced a reduction in stress as compared to the control group, which viewed none.

Viewing pictures of nature improves attention

In 2013, this study showed that viewing pictures of nature significantly improved executive attention in both older and younger adults, as opposed to pictures of urban scenes.

Viewing photos of natural scenery reduces impulsivity

In 2014, researchers concluded that exposure to photographs depicting natural scenery decreased impulsive decision making as compared to viewing photos of a cityscape.

Other Interesting Studies

Virtual reality nature experiences offer relaxation and stress relief

In 2019, researchers studied the effects of seven different simulated forest environments on stress relief and relaxation.

All the virtual reality environments proved to offer relaxing and stress-relieving effects.

The environment which included a prominent water feature was noted to be an especially powerful stress reliever.

Ceilings with sky images may support healthier dreaming and circadian rhythm

This 2014 study examined which differences in brain activity as measured by magnetic resonance imaging would be noted in hospital rooms with traditional ceilings and identical rooms which had sky images painted on the ceilings.

The rooms with sky compositions activated regions of the brain associated with spatial cognition, circadian rhythm, perceived motion and dreaming.

The plain-ceiling rooms activated regions related to facial processing and potential visual hallucinations.

Nature and Daylight Improves Mood and Reduces Stress

This 2018 study established positive effects of exposure to nature and daylight throughout everyday life on one’s mood and level of stress.

Viewing natural scenery promotes relaxation and enhances mood

In 2015, this study added to the body of evidence that seeing a natural forest landscape in person produced physiological and psychological relaxation and enhanced mood as compared to viewing an urban landscape.

Looking at a garden relieves stress and improves verbalization and memory in dementia

In 2018, researchers found that simply seeing a garden relieved physiological stress and improved verbalization and memory in people with advanced dementia.

The Conclusions are Clear: Viewing Images of Nature Improves Dementia

Study after study has added to the body of evidence: seeing plants or images of nature offers substantial benefits to people with dementia.

Whether it’s a photograph, a television program, a view through a window or seeing it live and in person, viewing nature is an effective way to enhance the quality of life for people with dementia.

It can reduce pain, anxiety and stress, promote relaxation, improve mood and enhance mental functioning in many ways.

Adding live plants or images of nature into the environment for someone with dementia is an effective, and low-cost way to help them function at their best.

How to Grow a Therapeutic Indoor Garden for Dementia

Laura Herman Blog, Prevention February 18, 2021October 16, 2021dementia, garden, gardening, therapeutic garden

The healing power of plants and nature has been realized for centuries. The last several decades of scientific research has yielded overwhelming evidence of its efficacy. In this article we look at the benefits of a therapeutic indoor garden for dementia.

Gardening, and interaction with live plants, is very beneficial to the physical, mental and social health of human beings.

It is one of the more effective natural remedies for dementia.

This is happy news for all humans, but it’s especially exciting for people with certain hard-to-treat health conditions, such as dementia.

Therapeutic Gardening for People With Dementia

While there is still no cure for most types of dementia, gardening has been proven to offer a very effective method of relieving some of dementia’s distressing symptoms including:

Furthermore, gardening and interaction with plants has been shown to improve the quality of life for people with dementia by:

Enhancing their general well-being
Improving their level of functioning
Reducing their use of psychotropic medication
Decreasing their incidence of serious falls

Interaction with plants benefits people with dementia

Sensory stimulating interaction with plants has been determined to be therapeutic to people living with dementia.

Tactile stimulation, or touching live plants, has been shown to promote psychological feelings of relaxation along with a physiological calming response in the body.

Meanwhile, olfactory stimulation, or smelling certain natural aromas, has been proven to:

Enhance feelings of calm
Increase alertness
Improve mood
Stimulate memories

Visual stimulation, or viewing images of nature, has been shown in numerous studies to have these health-promoting effects:

Significantly increase feelings of comfort
Significantly increase feelings of relaxation
Reduce biochemicals related to stress

Listening to the gentle sounds of nature is well known to promote feelings of calm and offer these benefits:

Aid in stress recovery
Increase attention
Promote relaxation
Decrease feelings of anxiety
Reduce agitation

Many studies confirm that spending time outside in nature will create a wealth of positive effects on the health, happiness and well-being of people with dementia.

The science confirms these effects occur indoors as well.

Indoor gardening can bring about many desirable health outcomes

Indoor gardening can be especially effective when working with a certified horticulture therapist – but even without one, the benefits of simply interacting with plants can be profound.

A therapeutic indoor garden can be any size. Each garden is as unique as the individual for which it was created.

How to create a therapeutic indoor garden for someone with dementia

Ideally, you can start by selecting an assortment of sensory-stimulating plants. Look for colorful flowers, interesting foliage and pleasant aromas.

However, don’t worry if this isn’t possible or practical – even a single plant can be therapeutic. For some individuals, or in some circumstances, a single plant might be a better choice than a whole garden.

There aren’t too many rules or restrictions when it comes to indoor dementia gardens, but there are a few.

1. Plants and any additives should be non-toxic

Double check every plant for toxicity before including it.

Many people don’t realize, for example, that poinsettias are poisonous. Lilies, ivy, philodendron, jade and oleander are other common poisonous houseplants, and there are many more.

There shouldn’t be much need for insecticides or other additives in an indoor garden.

If you apply fertilizer or any other substance, avoid a potential crisis by taking proper precautions.

Keep all chemicals or substances securely put away when not in use.
Read labels thoroughly to understand any potential dangers associated with anything you use.

Err on the safe side; assume that any part of every plant could be ingested and plan accordingly.

2. Avoid thorns, stickers and other sharp points or edges

Avoid thorny roses, prickly cacti and other sharp plants that may cause injury or discomfort.

Also, be aware of sharp points or edges on the garden tools. It may be okay for an experienced gardener with dementia to use a familiar tool, even if it is sharp.

There is something extremely therapeutic about using familiar items!

However, depending on the person’s situation, it may not be safe or appropriate for them to use particular tools or items.

Use good judgment to determine the risks and benefits of the person using a potentially dangerous item.

Since people who have dementia often experience ups and downs from day to day, it’s possible that using an item could be unsafe one day but not the next.

Re-evaluate the safety of the situation daily or as needed.

In most cases, any sharp tools should be kept secured when unsupervised.

3. Expect interaction and recognize success

Be sure to set up the garden so that the person can interact with it to the extent desired.

This may mean frequent handling, overwatering or other behavior that might actually not be in the best interest of the plants themselves.

If possible, select hardy plants that will tolerate the amount of care – or neglect – they are likely to receive.

Get creative to create success

If the person will be watering the plant or garden, find a small watering can that won’t get too heavy when full.

This can also keep flooding to a minimum if the person enjoys watering the plants frequently.

Another solution to potential over-watering could be to ensure plants have plenty of drainage. Elevate them with pebbles above extra-large drip-trays so they aren’t soaking in overflow.

Alternatively, it could be as simple as putting up a sign that says “Already Watered” – or finding plants that love lots of water!

Opting for a hydroponic system could be another solution.

Knowing the person and their needs, and then tailoring solutions accordingly will lead to the best successes.

It’s important to keep perspective on the goal of this garden: for the person to engage with it.

Don’t worry about imperfection if it would discourage the person with dementia from interacting with the garden.

If the person is engaging with the garden, it is a success!

There are many ways that a person with dementia can interact or engage with the garden.

Depending on their interests and abilities, any of the following activities may be very therapeutic engagement:

Choosing which plants, or types of plants, to grow
Sharing their opinions, experience or thoughts about the garden
Reminiscing about past gardening or plant experience
Using hands or a gardening spade to fill pots with soil
Planting seeds or starts
Watching the plants develop
Simply sitting near the indoor garden
Smelling, touching or looking at the fruit, flowers or foliage
Watering the plants
Deadheading flowers, harvesting, pruning or providing other care
Cutting flowers or arranging bouquets
Cooking or crafting with what they have grown
Picking the plants (even at “non-traditional” or “non-ideal” times)

Any other activity not listed above that allows the person to enjoy, experience or interact with the garden area or individual plants is also considered a success.

4. Find the right light

Find a suitable location to start a garden

A sunny south-facing window is perfect. If that’s not available, adding a grow light can help. Grow lights are designed to simulate sunlight. They can even enable plants to grow year-round.

Consider a countertop hydroponic system for simplicity and ease

Another alternative to consider may be a self-contained countertop hydroponic system. These systems are designed to make gardening extremely easy and successful.

“Hydroponic” means that the plants grow without soil – just water, light and nutrients. Basically, all that is required in many of these systems is to drop a seed into a designated area and then ensure that the device’s water reservoir is kept full.

They usually provide nutrient tablets to drop into the water every couple of weeks or so.

All in all, these systems tend to require very little work for a countertop full of fresh herbs, greens, strawberries, or other lush plant life.

Keep safety foremost in mind

If using a grow light or other electrical devices in a dementia garden, take extra care to be sure that any light bulbs or cords are handled safely.

Look for LED grow lights when possible, which emit less heat than their counterparts.

Be sure cords are kept well out of walkways. Taping them into place may be a good idea, depending on the particular set up.

5. Choose good plant candidates

Select plants that are non-toxic and not sharp. If possible, find plants that stimulate the senses, memories or both.

Most of all, don’t worry too much about getting everything “right.” Just enjoy the experience, and ensure that the person with dementia does too.

That being said, the following is a list of some generally good candidates for an indoor dementia garden.

Lavender

This lovely flowering plant has a pleasant aroma and phytochemicals known to promote relaxation. It needs a lot of heat and light to thrive.

Herbs

Edible, aromatic and purposeful! Using herbs in cooking may even help to stimulate an appetite.
Basil likes its soil to be kept moist while oregano, thyme and rosemary prefer less frequent watering. All of these herbs enjoy warm sunny conditions.
Mint, parsley and chives fare well with lower levels of heat and sunlight.

Jasmine

This pretty vine boasts small white flowers with a strong sweet aroma that can easily fill a room. It can be grown indoors in a partly sunny location where temperatures remain on the cooler side. They prefer growing in moist soil on a trellis or support.

Lemon balm

Lemon balm has a strong sweet lemony aroma. It prefers lots of light and well-drained soil. It can be enjoyed as cuttings in a vase or bouquet. Moreover, lemon balm has long been prized for its medicinal properties. Among other things lemon balm is known for calming the mind, improving mood and enhancing cognitive function.

Spider plant

Appreciated by many for their ability to survive without much sun or attention, spider plants are among the easiest houseplants to grow.

African violet

African violets are popular houseplants due to their velvety leaves and pretty purple flowers. They can blossom year-round under the right conditions. They prefer indirect light and are sensitive to overwatering.

Hoya

Also known as a wax plant, honey plant or wax vine, hoyas are popular hanging or climbing houseplants. They are pretty, hardy and low maintenance. They tolerate various lighting conditions but grow best and produce flowers in bright light. Avoid overwatering.

Baby rubber plant

Another easy to grow houseplant, the baby rubber plant prefers moderate light and somewhat cooler temperatures. It doesn’t like to be overwatered, but it does appreciate humidity. Misting it regularly would make a good activity.

Lettuce, kale or salad greens

These grow quickly and easily in a sunny location.

Scallions

Also known as green onions, these aromatic plants grow quickly in bright sunlight. They take longer from seed, but can be regrown from kitchen scraps within days or weeks simply by placing the roots in water or soil. Cut off the green tops for cooking or eating and the plant will continue to grow.

There are countless more good choices of what to grow in your unique indoor dementia garden.

How will an indoor garden affect your loved one’s life?

There are so many reasons to grow an indoor garden with, or for, someone with dementia.

Science has proven it with countless studies, but what really matters are the effects each individual sees in his or her own life.

Even if you have access to an outdoor garden, having plants indoors as well will only increase the therapeutic benefits.

So, let’s get growing!

Benefits of Horticulture Therapy for Dementia

Laura Herman Blog, Prevention February 14, 2021October 16, 2021alternative therapies, dementia, horticulture therapy

After numerous studies, it shows that horticulture therapy for dementia can bring very positive results.

The term “Horticultural Therapy” is often used to refer to the myriad of beneficial effects that people with dementia (or other diagnoses) reap simply by interacting with nature.

Horticultural Therapy in Patients With Dementia

Interaction with plants and nature creates an astounding array of therapeutic benefits to human health and wellness.

Horticultural therapy is firmly rooted in the past

Although the idea of horticultural therapy may be new to some, the practice is not.

Using exposure to nature to promote healing dates back thousands of years to the earliest known civilizations, including the Mesopotamians and the Persians.

In the 1800’s doctors in the United States and Europe began prescribing time in the garden for certain patients. Florence Nightingale, the founder of modern nursing, was a big proponent of the healing effect of gardens.

By the mid-1900s horticultural therapy was being more widely used to aid the rehabilitation of military veterans. In 1972 the first formal degree programs were established and in 1976 the first PhD in horticultural therapy was awarded.

The benefits of horticulture therapy have been scientifically proven time and again

Scientists have studied horticultural therapy rigorously over the past several decades. This has led to an overwhelming abundance of evidence that interaction with nature leads to a marked improvement in physical, emotional and social health.

These improvements in health have been researched and confirmed for seniors and people of all ages. They have been proven for people with dementia and countless other conditions.

Studies specific to the benefits of horticulture therapy for dementia abound

Many research studies focus specifically on how horticultural therapy affects dementia and its symptoms.

Additionally, abundant research demonstrates profound positive benefits to elders in areas such as relief of pain, stress, anxiety and depression.

Conditions such as pain and anxiety are very common in people with dementia. These conditions tend to exacerbate, or worsen, dementia symptoms such as behavioral changes, restlessness, agitation and confusion.

When these conditions have been relieved or prevented, people with dementia not only feel better, they can also function better. They can enjoy a higher degree of independence, think more clearly and behave more calmly.

Each individual research study tends to focus on one particular area of nature exposure, such as gardening, grounding or forest bathing.

Gardening

Spending time or working in a garden setting is known to be extremely helpful for mental and physical health. It’s even been proven to reduce the risk of developing dementia later in life.

For people with dementia, gardening has been shown to:

Increase feelings of satisfaction, well-being and quality of life
Improve mood
Enhance a person’s connection with community
Improve cognitive function
Reduce stress
Diminish anger
Lower levels of agitation
Relieve depression and anxiety
Increase energy and reduce fatigue
Decrease inappropriate behaviors
Reduce usage of medications for agitation
Reduce number of falls and fall severity

These beneficial effects tend to be noticeable immediately after spending time in the garden setting, and then persist for weeks or months afterward.

Wander gardens

Wander gardens have become increasingly popular in recent years for people with dementia. They can often be found near memory care communities and healthcare facilities.

These gardens are thoughtfully and purposefully designed to provide a safe and calming environment for people with dementia to experience nature actively or passively.

Wander gardens typically feature winding wheelchair-friendly pathways with occasional benches. There are often shaded areas to sit and enjoy the birdsong or soft rustle of leaves in the pleasant afternoon breeze.

There is usually an array of colorful non-toxic plants, which are often aromatic and sometimes edible.

Sometimes there are raised garden beds so elders can dig, plant and actively tend to the garden from a wheelchair or a comfortable height.

Each wander garden is unique, but each provides plenty of sights, sounds and aromas to gently stimulate the senses.

Grounding

Grounding, also known as “Earthing” is the practice of connecting with the earth’s electrical field.

Moreover, grounding exposes the body to electrons which neutralize many of the harmful effects of oxidation on a molecular level. This has a significant effect on how the immune system functions.

Robust scientific evidence shows that grounding:

Reduces inflammation associated with a wide range of chronic diseases, including heart disease, cancer, stroke, chronic obstructive pulmonary disease, osteoporosis, diabetes, asthma, Alzheimer’s disease, arthritis and others
Drastically improves wound healing
Significantly improves immune system function
Markedly reduces pain and swelling
Improves energy and fatigue

Grounding can be accomplished simply by placing one’s bare feet or hands in soil, sand, stone, wood or other natural substance that is in contact with the earth.

There are also products available that can ground a person who would have difficulty getting outdoors.

Forty minutes per day of grounding is sufficient to achieve ideal results.

Forest Bathing

First popularized in Japan in the 1980s, “Forest Bathing” (essentially spending quiet time in forest-like settings) has amassed an amazing amount of evidence for some remarkable results.

Forest bathing has been proven to:

Increase immune system function
Reduce blood pressure and improve cardiovascular health
Minimize symptoms of depression
Reduce feelings of anxiety
Lower feelings of stress and reduce cortisol and other stress biomarkers
Increase mental relaxation
Decrease physical pain
Reduce feelings of psychological distress

There are many reasons why forest bathing is effective, according to scientists.

Viewing nature, physically handling or touching natural objects, gentle multi-sensory stimulation and immersion in nature have all been proven to have a restorative effect on multiple aspects of mental and physical health.

Additionally, certain evergreen trees release a phytochemical compound that, on its own in studies, has been shown to decrease adrenaline and heart rate.

How much horticulture therapy time does a senior need?

How much exposure is necessary to start seeing these effects? Surprisingly little.

In fact, even just viewing images of nature – or the addition of a single cut flower or houseplant into a room – can have measurable outcomes.

However, the strongest and most profound results will often be achieved in conjunction with a horticultural therapist.

Horticultural therapists are specially trained and uniquely creative

Horticultural therapists are generally some sort of healthcare or social worker who has received additional training and certification specific to this modality.

This often includes occupational therapists, physical therapists, counselors, hospice workers, nurses, spiritual care professionals, activity providers and others.

All of whom have their unique approaches to integrating plant based interactions into their practices in different ways.

What they have in common, besides the plant based nature of their approaches, is that they are helping the participant(s) reach specific, measurable goals.

Horticultural therapy focuses on achieving defined goals

A “specific, measurable goal” could be, for example, to reduce one’s blood pressure by 20 points. Another goal might be to decrease the frequency or dosage of pain medication one is taking.

In dementia care, goals of horticulture therapy often include activity engagement or aggression, yelling, restlessness and other such behavioral symptoms. These types of symptoms can be concretely measured using tools such as the Cohen-Mansfield Agitation Inventory (CMAI).

The CMAI measures 29 specific negative behavioral symptoms in people with dementia.

1. Pacing and aimless wandering
2. Inappropriate dressing or disrobing
3. Spitting
4. Cursing or verbal aggression
5. Constant unwarranted request for attention or help
6. Repetitive sentences or questions
7. Hitting (including self)
8. Kicking
9. Grabbing onto people or things inappropriately
10. Pushing
11. Throwing things
12. Making strange noises
13. Screaming
14. Biting
15. Scratching
16. Trying to get to a different place inappropriately
17. Intentional falling
18. Complaining
19. Negativism
20. Eating or drinking inappropriate substances
21. Hurting self or other
22. Handling things inappropriately
23. Hiding things
24. Hoarding things
25. Tearing things or destroying property
26. Performing repetitive mannerisms
27. Making verbal sexual advances
28. Making physical sexual advances or exposing genitals
29. General restlessness

By performing a behavioral assessment at baseline, and then performing the same assessment at key points during or after the study, these types of behaviors can be measured.

Horticulture therapy is extremely effective for dementia

The results are profound and dramatic. Study after study has shown overwhelming evidence that people with dementia who receive horticultural therapy interventions…

Have significantly less agitation
Have much fewer behavior disturbances
Experience much more emotional stability
Spend significantly more time engaged in activity, and
Spend markedly less time doing nothing

… than their counterparts who receive non-horticultural interventions.

Researchers theorize that enabling people with dementia to have responsibility for and connection with living things is therapeutic for them.

They are receiving gentle multi-sensory stimulation, which is likewise known to be therapeutic. Also, they are engaging in physical activity, social activity and relieving emotional tension.

Horticulture therapy is especially exciting because of what it’s not

Experts are excited about using horticultural therapy to reduce the distressful symptoms of dementia for a number of reasons.

It’s not full of side effects

Medications for dementia symptoms are frequently ineffective and often come with dangerous side effects. These may include, sedation, increased confusion and decreased ability to function independently.

Dementia care experts whole-heartedly agree that non-drug interventions are highly preferred over medications whenever possible.

It’s not expensive

Because horticulture therapy approaches are generally inexpensive, there is no real cost barrier.

It’s not inaccessible

Some of the non-drug interventions out there, such as music or reminiscence therapy, are most effective when based on an individual’s particular memories and experiences.

Horticulture therapy, by contrast, is easy to apply to a wide array of people without a lot of customization.

It’s also easy to incorporate into a variety of different activities and schedules, so it’s well suited to senior living communities and health care facilities.

What’s more, is that it can be done literally anywhere!

Even if a person doesn’t have access to a garden plot or can’t get outdoors at all, horticulture therapy can occur inside.

Horticultural therapy should be utilized to the fullest extent possible to enhance the health and well being of people living with dementia

Researchers acknowledge that it can be hard to separate the exact amount that each individual facet of horticultural therapy contributes to its overall beneficial effect.

Multi-sensory stimulation is known to be therapeutic. The natural world is full of visual, auditory, tactile and olfactory stimuli that promote healing.

Additionally, there are many known (and likely many as yet unknown) phytochemicals that affect how the human body functions on a microscopic level.

What is clear beyond any shadow of a doubt is that horticultural therapy is an easy, inexpensive, accessible and enjoyable way to support and promote good mental, physical, emotional and social health for people living with, or without, dementia.

What to do During Rapid Decline in Dementia

Laura Herman Blog February 11, 2021October 16, 2021dementia, dementia decline

It is important to know how to act during the rapid decline in dementia to avoid the inconvenience.

Alzheimer’s disease and most other causes of dementia are gradually progressive conditions. Sudden or rapid changes in mood, behavior, confusion or ability to function almost always indicate that something else is going on.

Very often this is a medical concern.

Different Medical Conditions and Dementia Decline

Urinary Tract Infection

Urinary tract infections (UTIs) are very common among older women. Men can also get them, especially in the presence of a catheter or prostate issue.

Typical signs of a UTI include burning or discomfort with urination. People with dementia can have difficulty recognizing or communicating discomfort.

They may even deny it when asked.

Look for signs such as dark or foul-smelling urine and changes in urination patterns, especially an increase in frequency or incontinence.

In some cases, the body can fight off a mild infection on its own, especially if fluid intake is increased.

If the symptoms worsen or persist beyond a couple of days the doctor should be contacted. A simple urine test can confirm an infection.

Dehydration

People with dementia tend to be at high risk for dehydration for a number of reasons.

They may forget to drink due to an altered sense of thirst. They may choose not to drink due to fear of urinary incontinence or bladder accidents.

Not to mention, they may have physical or cognitive difficulty obtaining drinks on their own.

In the later stages, it can become very difficult even to swallow.

People are at especially high risk if they take a “water pill” or diuretic medication that causes urination.

Coffee is a mild diuretic.

Some people take diuretic medication for fluid retention, swollen legs, blood pressure, heart conditions or other conditions.

Examples of diuretic medication include Lasix (furosemide), Demadex (torsemide), and Microzide (hydrochlorothiazide).

When people take diuretic medication they can easily become dehydrated, especially after a bout of diarrhea.

Dehydration leads to an electrolyte imbalance which can cause confusion, drowsiness, dry mouth, decreased urination and a rapid heart rate.

The doctor should be notified immediately for proper assessment and treatment.

Constipation

Older adults with dementia are often at high risk for constipation. Many seniors take a number of medications that can slow bowel function.

If they have difficulty moving around their risk for constipation is further increased as well.

Going a couple of days without moving one’s bowels can be very uncomfortable.

It can cause nausea, irritability and changes in appetite.

If the person with dementia has difficulty identifying the cause for his or her discomfort, he or she will usually communicate it behaviorally by getting cranky and irritable.

Going four or five days without a bowel movement is an urgent concern.

The stool grows harder and increasingly difficult to pass, and there exists a high risk for potentially life-threatening complications such as perforating the bowel.

A doctor should be consulted immediately.

Pain

People with dementia experience pain as they always have or as anyone else does.

Dementia itself neither causes nor dulls the pain.

One key difference though is that in many cases the person with dementia can no longer recognize or communicate pain as they once could.

Another change is that they are often no longer able to treat pain on their own before it worsens. It is generally recognized that it is more effective to prevent pain than it is to “chase” it, or treat it once it has escalated.

When a person can no longer take medication, apply heat, change their position, or do what may be needed to address the pain in its early stages managing it starts to become more challenging.

Many family members tend to be under the impression that their loved one “used to have” chronic pain but no longer do. Because they no longer mention it, families assume it no longer bothers them.

A sudden increase in pain may be the result of a bump, fall, ingrown toenail, rash or skin infection, spontaneous compression fracture, or shoes that need replacement.

Whatever the cause, hurting takes a lot of energy. Pain is exhausting on its own, and it can also interfere with sleep.

With dementia, everything including thinking and basic functioning requires a great deal of energy.

Everything becomes increasingly difficult, and it becomes impossible to function at one’s best.

Sleeplessness

It’s no secret that people don’t function well without proper sleep.

If a loved one with dementia is not sleeping well due to pain, illness, depression, nightmares or any other reason, they will not be able to function at their highest level.

When a brain can’t function well the result often includes changes in mood, emotional control, behavior, thinking, reasoning, or motor control.

The brain controls literally everything the person does, so everything is potentially affected.

Changes in medications

Medications tend to affect the elderly much more significantly than the general adult population.

They have different recommended dosing and there are many medications that are considered too dangerous to use in the elderly in most cases.

Furthermore, many elders take multiple medications, many of which affect each other. They may increase or decrease the potency of one another, or increase the risk of dangerous side effects.

To reduce the risk of medication interactions it is important to use only one doctor to the extent possible and to use only one pharmacy.

If a sudden change in behavior or condition occurs, consider whether there have been any recent changes in medication or dosages. Also, consider if the person may have accidentally taken too much or too little of what has been prescribed.

For example, might they have forgotten to take their medication, or might they have accidentally taken more than what was prescribed?

Other medical conditions

Most people with dementia are over 65 and many have additional medical conditions. These may be acting up or newly onset. Uncontrolled blood sugars caused by diabetes, heart conditions, thyroid conditions, other infections or any other underlying medical condition may be to blame.

So, what to do when a loved one with dementia experiences a rapid change or decline?

It is always important to consult with the loved one’s doctor when any sudden change is noted in someone with dementia.

← Previous