, 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 21, 2026dementia, incontinence

At what stage of dementia does incontinence occur? There is no single stage when everyone with dementia becomes incontinent. Continence problems can occur at any stage, although loss of bladder control becomes increasingly common as dementia progresses and is particularly common in the later stages.

Some people never become fully incontinent. Others may begin having occasional accidents much earlier.

Importantly, new or suddenly worsening incontinence should not automatically be assumed to be caused by dementia. Urinary tract infections, constipation, medications and other medical conditions can also cause continence problems and may be treatable.

At What Stage of Dementia Does Incontinence Occur?

The answer varies considerably from one person to another.

According to the NHS, bladder incontinence is common in the later stages of dementia, and some people also experience bowel incontinence.

However, continence problems are not limited to advanced dementia. The Alzheimer’s Society explains that people with dementia can experience difficulties using the toilet for many different reasons as the condition progresses.

A useful way to think about it is:

Earlier stages: most people remain independent with toileting, although some may experience urgency, occasional accidents or continence problems caused by another medical condition.
Middle stages: memory, communication, mobility and difficulty finding or using the toilet can begin causing more frequent accidents.
Later stages: urinary incontinence becomes much more common. Some people also lose bowel control and may require substantial assistance with toileting and personal care.

Dementia does not progress in exactly the same way for everyone, so continence should be assessed according to the individual rather than used alone to determine a particular stage of dementia.

Why Does Dementia Cause Incontinence?

People with dementia may become incontinent for several reasons, and more than one factor may be involved at the same time.

Dementia Australia explains that dementia can make it difficult for a person to recognize that they need the toilet, remember what to do, find the toilet or use it correctly.

Difficulty Recognizing the Need to Go

As dementia progresses, communication between the brain and the bladder or bowel may become less effective.

A person may not recognize the sensation of a full bladder until the need to urinate becomes urgent.

In later dementia, they may have difficulty recognizing the signal altogether.

Difficulty Finding the Toilet

Memory and spatial awareness problems can make a familiar bathroom surprisingly difficult to locate.

A person may know they need the toilet but forget where it is.

Clear signs, good lighting and keeping the route to the bathroom free from clutter can make a significant difference.

Mobility Problems

A person may recognize the need to use the bathroom but simply be unable to reach it quickly enough.

Arthritis, weakness, balance difficulties and reduced mobility can all contribute to functional incontinence.

Continence Health Australia describes functional incontinence as urine leakage caused by difficulty reaching or using the toilet rather than a problem with the bladder itself.

Difficulty Managing Clothing

Buttons, zippers, belts and complicated clothing can become difficult to manage as cognitive and physical abilities decline.

By the time the person has worked out how to remove their clothing, an accident may have already occurred.

Elastic waistbands and simple clothing can make toileting easier.

Communication Difficulties

As communication becomes more difficult, a person may be unable to explain that they need the toilet.

Caregivers may need to watch for non-verbal signs such as:

Fidgeting
Pulling at clothing
Pacing
Restlessness
Repeatedly standing and sitting
Looking around for the bathroom

Incontinence May Have a Treatable Cause

One of the most important things to understand when asking at what stage of dementia does incontinence occur is that dementia is not always the cause.

The Dementia Australia continence guidance recommends speaking with a doctor so other possible causes can be investigated.

These can include:

Urinary tract infections
Constipation
Prostate enlargement
Other bladder or bowel conditions
Reduced mobility
Medication side effects
Changes in fluid intake

Continence Health Australia also recommends investigating new or worsening urinary incontinence rather than assuming that it is simply part of dementia.

Watch for a Sudden Change

A gradual increase in toileting difficulties may occur as dementia progresses.

A sudden change deserves particular attention.

For example, if someone who was normally continent suddenly begins having accidents, becomes more confused or appears unwell, contact their healthcare professional.

A urinary tract infection is one possible cause.

Symptoms can include:

Sudden urinary urgency or frequency
Pain or burning when urinating
Fever
New or worsening incontinence
A noticeable change in the person’s usual condition or behavior

Not everyone will experience the same symptoms, so significant unexplained changes should be medically assessed.

Types of Incontinence in Dementia

Different forms of urinary incontinence require different approaches.

Urge Incontinence

Urge incontinence involves a sudden, strong need to urinate that may be difficult to control.

The person may know they need the toilet but not have enough time to reach it.

Stress Incontinence

Stress incontinence occurs when pressure on the bladder causes leakage.

For example, a person may leak urine when coughing, laughing, sneezing or exercising.

This is not specifically caused by dementia and can occur in people who do not have dementia.

Functional Incontinence

Functional incontinence is particularly relevant for people with dementia.

The bladder itself may function normally, but cognitive or physical problems prevent the person from reaching and using the toilet successfully.

They may:

Forget where the toilet is
Fail to recognize the toilet
Forget how to remove clothing
Be unable to walk there quickly enough
Have difficulty communicating their needs

Bowel Incontinence

Bowel or fecal incontinence may also occur, particularly as dementia becomes advanced.

However, constipation can sometimes produce leakage around impacted stool, so new bowel incontinence should also be discussed with a healthcare professional.

Incontinence Products for Dementia

As continence problems increase, the right products can help protect clothing, bedding and skin while allowing the person to retain as much independence and dignity as possible.

	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

The most suitable product will depend on the person’s mobility, level of incontinence, ability to use the toilet independently and whether protection is required during the day, night or both.

Where possible, seek professional continence advice rather than simply moving immediately to the most absorbent product.

How to Reduce Incontinence and Toilet Accidents

Even when dementia contributes to incontinence, practical changes can sometimes reduce the number of accidents significantly.

Make the Toilet Easy to Find

A person with dementia may have difficulty remembering where the bathroom is or recognizing the toilet once they get there.

The Alzheimer’s Society recommends making the toilet as easy as possible to find and use.

Helpful changes may include:

Putting a clear sign or picture on the toilet door
Keeping the bathroom door visible
Improving lighting
Using night or sensor lights
Removing clutter from the route
Making the toilet itself easy to recognize

Use Easy-to-Remove Clothing

Replace complicated fastenings with clothing that can be removed quickly.

Elastic waistbands can be especially helpful.

This simple change may prevent accidents when the person understands they need the toilet but has difficulty removing their clothing.

Watch for Non-Verbal Clues

Do not rely entirely on asking, “Do you need the toilet?”

A person with dementia may automatically answer no, forget what the question means or fail to recognize the physical sensation.

Instead, learn the person’s usual signs.

Pacing, pulling at clothing, increased agitation or repeatedly getting up may indicate that they need the toilet.

Create a Dementia Toileting Routine

A regular toileting routine can be helpful, particularly when the person is losing the ability to recognize or communicate the need to go.

Rather than repeatedly asking whether the person needs the toilet, caregivers may gently encourage a bathroom visit at predictable times.

For example:

After waking
Before leaving the house
Before or after meals
At regular intervals during the day
Before going to bed

Keeping a simple continence or toilet diary for several days can also reveal patterns.

If accidents repeatedly occur around the same time, a caregiver may be able to offer assistance shortly beforehand.

The routine should be adjusted to the person’s individual needs rather than following a rigid schedule.

Do Not Sacrifice Sleep Unnecessarily

Preventing every overnight accident is not always the most important goal.

Repeatedly waking a person during the night may interfere with valuable sleep and may increase confusion or distress.

For some people, appropriate overnight continence products, waterproof bedding and a clear route to the bathroom may be more practical.

Discuss persistent night-time incontinence with a healthcare professional or continence adviser to determine the most appropriate approach.

Keep the Person Well Hydrated

Reducing fluids dramatically may seem like an obvious way to reduce accidents, but it can create other problems.

People with dementia can already be vulnerable to dehydration because they may forget to drink or no longer recognize thirst.

Dementia Australia recommends maintaining adequate fluid intake.

The person’s healthcare professional can advise on appropriate fluid intake if they have other medical conditions that affect how much they should drink.

Caffeine may increase urinary frequency for some people, but dietary or medication changes should be considered in the context of the person’s overall health.

Can Medication Help Incontinence in Dementia?

Medication may sometimes be appropriate, but it depends on the type and cause of the incontinence.

This is particularly important for people with dementia because some medicines used for overactive bladder can have side effects including confusion, constipation, dizziness and an increased risk of falls.

A 2026 review from Continence Health Australia recommends discussing the potential benefits and harms of continence medication with a doctor or pharmacist.

Some existing medications can also contribute to urinary symptoms.

These can include certain diuretics, sedatives and some other medications.

Do not stop or change prescribed medication without discussing it with the person’s doctor or pharmacist.

When Should You Talk to a Doctor?

Speak with the person’s doctor if continence problems are new, worsening or causing difficulty.

Medical advice is particularly important when there is:

Sudden onset of incontinence
Pain or burning during urination
Fever
Blood in the urine or stool
Severe constipation
A significant change in behavior or confusion
Difficulty emptying the bladder
Repeated falls while trying to reach the toilet
Skin irritation or breakdown

A doctor may investigate medical causes and, when appropriate, refer the person to a continence nurse or other specialist.

At What Stage of Dementia Does Incontinence Occur? Closing Summary

There is no exact answer to at what stage of dementia does incontinence occur because every person’s experience is different.

Continence problems can occur in earlier or middle stages, but bladder incontinence becomes increasingly common in later-stage dementia. Some people may eventually experience bowel incontinence as well.

However, an accident does not necessarily mean dementia has suddenly progressed.

Infections, constipation, medications, mobility problems and other conditions can all contribute to incontinence. New or worsening symptoms should therefore be discussed with a healthcare professional.

For people whose continence problems are related to dementia, simple strategies such as clear toilet signs, easy-to-remove clothing, regular toileting routines, appropriate continence products and careful attention to non-verbal cues can make daily life considerably easier.

Above all, continence care should focus on the individual person’s comfort, dignity and remaining independence.

Bed Sores in Elderly People With Dementia: Prevention & Treatment

Laura Herman Blog March 1, 2021August 23, 2026bedsores, dementia, pressure sores, pressure ulcers

Elderly person in bed at risk of developing pressure sores

Bed sores in elderly people can become a serious health problem, particularly when dementia, reduced mobility, incontinence or poor nutrition make it difficult to protect the skin.

Bed sores are also known as pressure sores, pressure ulcers or pressure injuries. They develop when prolonged pressure, friction or shear damages the skin and the tissue underneath it.

People living with dementia may be especially vulnerable because they may have difficulty moving independently, communicating discomfort or understanding why they need to change position.

The good news is that many pressure injuries can be prevented. Early detection is also important because a small area of skin damage can become much more difficult to treat if pressure continues.

According to MedlinePlus, people who spend much of the day in bed or a chair, cannot reposition themselves, have incontinence or have reduced sensation are at increased risk of pressure injuries.

What Are Bed Sores?

A pressure injury develops when sustained pressure reduces blood flow to an area of skin and underlying tissue.

Without adequate blood flow, the tissue receives less oxygen and nutrients and can eventually become damaged.

Bed sores most often form over bony parts of the body where there is relatively little padding between the skin and bone.

Common locations include:

Heels
Ankles
Hips
Tailbone and sacrum
Elbows
Shoulder blades
Spine
Back or sides of the head
Ears

The Mayo Clinic explains that pressure injuries can develop over hours or days, particularly when someone cannot change position easily.

Why Are Bed Sores in Elderly People More Common?

Age alone does not cause a pressure injury, but older adults are more likely to have several risk factors at the same time.

These can include:

Reduced mobility
Fragile or thinner skin
Reduced circulation
Diabetes or vascular disease
Reduced sensation
Incontinence
Dehydration
Poor appetite or malnutrition
Being underweight or significantly overweight
Spending long periods in a bed, recliner or wheelchair
Previous pressure injuries

This is why preventing bed sores in elderly people usually requires looking at the person’s overall health, mobility, nutrition, continence and skin condition rather than focusing on one factor alone.

Why Dementia Can Increase the Risk of Bed Sores

Dementia can make pressure injury prevention more complicated.

A person may not recognize discomfort or remember that changing position can relieve pressure. Others may have difficulty communicating pain, particularly in later stages of dementia.

Some people may also become frightened or distressed when a caregiver tries to move them because they do not understand what is happening.

Rather than viewing this as the person being “non-compliant,” it can help to consider what may be causing the resistance.

Helpful approaches can include:

Explaining what you are going to do before touching or moving the person
Using a calm, reassuring tone
Moving slowly
Offering simple choices where possible
Watching facial expressions and body language for signs of pain
Trying again later if the situation is not urgent and the person is becoming distressed

See our guide to caring for someone with dementia for more strategies.

What Causes Pressure Injuries?

Three mechanical forces play particularly important roles.

Pressure

Prolonged pressure between a bone and an external surface such as a mattress, chair or wheelchair can reduce blood flow to tissue.

The greater the pressure and the longer it continues, the greater the risk of tissue injury.

Friction

Friction occurs when skin rubs against bedding, clothing or another surface.

Fragile skin can be damaged more easily, especially when it is also damp.

Shear

Shear occurs when deeper tissues move while the skin remains relatively fixed.

A common example occurs when the head of a bed is raised and the person’s body gradually slides downward.

The skin may stay against the sheet while deeper tissue moves, placing stress on small blood vessels.

Moisture and Incontinence

Repeated exposure to urine, stool or perspiration can weaken the skin and increase the likelihood of damage.

This makes careful continence management particularly important for people living with dementia and incontinence.

Poor Nutrition and Hydration

Healthy skin and wound healing require adequate energy, protein, vitamins, minerals and fluid.

Unplanned weight loss, poor appetite and dehydration can therefore increase pressure-injury risk.

Warning Signs of a Pressure Injury

Early identification can prevent a minor problem from becoming a deeper wound.

Look for:

A persistent change in skin color
Redness that does not fade when pressure is removed
Dark red, maroon or purple discoloration
An area that feels warmer or cooler than nearby skin
Skin that feels unusually firm, soft or spongy
Swelling
Tenderness or pain
A blister
Broken skin
Drainage from a wound

Skin color changes may be harder to recognize in darker skin tones, so changes in temperature, firmness and texture are also important.

Any suspected pressure injury in a frail older adult should be assessed by a healthcare professional.

Stages of Pressure Injuries

Healthcare professionals classify pressure injuries according to the depth and type of tissue damage.

The National Pressure Injury Advisory Panel (NPIAP) uses Stage 1 through Stage 4, together with unstageable pressure injury and deep tissue pressure injury.

Stage 1 Pressure Injury

The skin remains intact, but there is an area of persistent non-blanching redness or discoloration.

In darker skin, the color change may not look bright red. Differences in temperature, firmness or sensation may provide additional clues.

Stage 2 Pressure Injury

There is partial loss of the outer layers of skin.

The wound may look shallow and pink or red, or it may appear as an intact or ruptured blister.

Stage 3 Pressure Injury

There is full-thickness loss of skin, and fatty tissue beneath the skin may be visible.

The wound may extend deeper than it first appears and requires professional wound assessment and treatment.

Stage 4 Pressure Injury

There is full-thickness skin and tissue loss with deeper structures such as muscle, tendon, cartilage or bone exposed or directly palpable.

Stage 4 injuries are serious wounds requiring specialist medical care.

Unstageable Pressure Injury

Sometimes the bottom of a deep wound is covered by dead tissue or eschar, making it impossible to determine its true depth until a clinician can assess it properly.

Deep Tissue Pressure Injury

A deep tissue pressure injury may appear as persistent dark red, maroon or purple discoloration, or sometimes a blood-filled blister.

Damage can exist beneath apparently intact skin and may progress rapidly.

Do not try to determine the stage of a serious wound yourself. Accurate staging should be performed by a healthcare professional with appropriate wound-care training.

How Are Bed Sores in Elderly People Treated?

Yes. Many pressure injuries can heal, particularly when they are identified early and the pressure that caused them is removed.

However, deeper pressure injuries may take weeks or months to heal and some may never heal completely.

The first priority is usually to relieve pressure from the affected area.

Professional treatment may also involve:

Assessment and measurement of the wound
Appropriate wound cleaning
Specialized dressings
Removal of dead tissue when medically appropriate
Pain management
Management of infection where present
Pressure-redistributing mattresses or cushions
Nutritional assessment
Management of underlying medical problems

The Mayo Clinic notes that treatment depends on the depth and severity of the wound and may involve a multidisciplinary healthcare team.

How to Prevent Bed Sores in Elderly People With Dementia

Prevention should be individualized to the person’s mobility, health, skin condition and level of risk.

1. Reposition Regularly

People who cannot change position independently need assistance to relieve pressure.

There is no single repositioning schedule that is right for everyone.

The NPIAP recommends choosing repositioning frequency according to factors including the support surface, the person’s tolerance of pressure and individual preferences.

A 2024 NPIAP prevention protocol suggests repositioning people without independent bed mobility approximately every two to three hours where appropriate, but clinical circumstances can require a different schedule.

This is preferable to assuming that every person must automatically be turned exactly every two hours.

A nurse, doctor, wound-care specialist, occupational therapist or physical therapist can help develop an appropriate plan.

2. Use Pressure-Redistributing Surfaces

Specialized mattresses, overlays, wheelchair cushions and heel-offloading devices can reduce pressure on vulnerable areas.

The correct product depends on the person’s mobility, body size, skin condition, existing wounds and how much time they spend in bed or seated.

Avoid choosing equipment purely on the basis of advertising claims. Ask the healthcare team what type of support surface is appropriate.

3. Protect the Heels

Heels are particularly vulnerable because there is little soft tissue between the skin and bone.

For someone at high risk, a healthcare professional may recommend positioning or equipment that allows the heels to be completely offloaded from the mattress.

4. Keep Skin Clean and Dry

Clean the skin promptly after episodes of incontinence and dry it gently.

Barrier creams or other skin-protective products may be recommended when urine or stool repeatedly contacts the skin.

The NICE pressure-ulcer guideline recommends considering a barrier preparation for people at high risk of moisture-associated skin damage.

5. Reduce Friction and Shear

Avoid dragging a person across sheets when repositioning them.

Where possible, use appropriate lifting or transfer equipment and techniques.

Keeping bedding smooth and free from wrinkles and avoiding unnecessarily high elevation of the head of the bed can also reduce shear.

6. Check the Skin Every Day

For someone at high risk, check vulnerable areas regularly.

Pay particular attention to:

Heels
Ankles
Hips
Sacrum and tailbone
Elbows
Shoulder blades
Back of the head
Ears

Also check underneath or around medical devices such as oxygen tubing, braces and catheters where they contact the skin.

7. Support Nutrition and Hydration

A balanced diet and adequate fluid intake are important for maintaining healthy skin.

Someone with an existing pressure injury who is losing weight, eating poorly or showing signs of malnutrition may benefit from assessment by a dietitian.

NICE recommends nutritional assessment for adults who already have a pressure ulcer rather than automatically giving supplements to everyone.

8. Maintain Mobility Where Possible

Any safe movement can help reduce long periods of pressure in one location.

Depending on the person’s abilities, this might involve:

Standing with assistance
Short supervised walks
Transferring between a bed and chair
Changing sitting position
Physical therapy exercises

A physical therapist can advise on safe exercise and mobility for someone with dementia.

Bed Sores and Incontinence

Incontinence deserves particular attention because moisture and contact with urine or stool can damage already fragile skin.

Helpful measures can include:

Promptly changing wet or soiled continence products
Gentle cleansing after episodes of incontinence
Drying rather than rubbing the skin
Using a suitable barrier product when advised
Using absorbent products that wick moisture away from the skin
A person-centered toileting routine where practical

See our guide to incontinence products for people with dementia.

Signs a Pressure Sore May Be Infected

Bed sores in elderly people can become infected, particularly when a wound is deep or difficult to keep clean.

Seek prompt medical advice if there is:

Increasing redness, discoloration, warmth or swelling
Pus or increased drainage
A bad smell from the wound
Increasing pain
Fever
Rapid deterioration of the wound

People with dementia may not be able to describe pain or feeling unwell clearly, so caregivers should also watch for sudden changes in behavior, alertness, appetite or mobility.

Sepsis Is a Medical Emergency

A serious wound infection can sometimes lead to sepsis.

Sepsis is the body’s extreme response to an infection and can become life-threatening very quickly.

The Centers for Disease Control and Prevention advises seeking immediate medical care when sepsis is suspected.

Warning signs can include:

New confusion or disorientation
Shortness of breath
Fever, shivering or feeling unusually cold
Clammy or sweaty skin
Extreme pain or discomfort
A fast heart rate or weak pulse

If someone with a pressure injury becomes suddenly very unwell, seek urgent medical care.

When Should You Contact a Healthcare Professional?

Contact a healthcare professional if you notice a new area of persistent redness, discoloration, broken skin or another suspected pressure injury.

Medical assessment is particularly important when:

The skin has broken down
The wound is deep
There is dark purple or maroon discoloration
There is drainage or a bad smell
The person has diabetes or poor circulation
The injury is worsening
The person is in significant pain
There are signs of infection

More advanced pressure injuries generally require professional wound care rather than home treatment alone.

Bed Sores in Elderly People: The Bottom Line

Bed sores in elderly people are common when mobility, skin health, nutrition or continence are compromised, and dementia can make prevention and treatment more challenging.

The most useful strategy is prevention: reduce prolonged pressure, help the person reposition, keep skin clean and dry, support nutrition and hydration, use appropriate pressure-relieving equipment and inspect vulnerable skin regularly.

If a pressure injury develops, getting professional advice early can make treatment easier and reduce the risk of the wound becoming deeper or infected.

For someone with dementia, care should also remain person-centered. Pain, fear and confusion may affect how the person responds to wound care and repositioning, so gentle communication and an individualized plan are important.

Dementia and Pain

Dementia and Incontinence

Dehydration and Dementia

Dementia and Weight Loss

Quality of Life and Dementia

Dementia and Bathing: Best Practices for Caregivers

Laura Herman Blog February 28, 2021August 20, 2026bathing, dementia

Dementia and bathing can become challenging for both the person living with dementia and the person helping them.

Someone who previously enjoyed a daily shower may suddenly resist bathing, become frightened, insist they have already washed or become upset when another person tries to help.

This does not necessarily mean they are being difficult.

Pain, fear, embarrassment, changes in perception, confusion and difficulty understanding the steps involved in bathing can all contribute.

The goal is not simply to get someone into a bath or shower. It is to meet their hygiene needs while protecting their comfort, dignity and sense of control.

In this guide, we look at why people with dementia may resist bathing, practical ways caregivers can help and alternatives when a traditional bath or shower is not working.

Dementia and Bathing: Why Resistance Happens

There are many reasons people with dementia may resist bathing. Often, several factors occur at the same time.

Understanding what is causing the resistance is one of the most important steps.

A person may not be able to explain what is wrong, so caregivers sometimes need to look for clues.

Physical Discomfort

Bathing may simply feel physically unpleasant.

Possible causes include:

The bathroom is too cold or too hot.
The water temperature is uncomfortable.
The person is experiencing pain.
Standing in the shower is tiring.
They feel unsteady or frightened of falling.
Water hitting sensitive skin feels unpleasant.
They dislike water running over their face or head.
Dry or irritated skin makes washing uncomfortable.

If resistance appears suddenly, consider whether pain, illness, an injury or another physical problem could be contributing.

Fear and Emotional Discomfort

Bathing is a very personal activity.

Someone who has needed help for the first time may feel embarrassed, exposed or frightened.

Possible reasons include:

They feel uncomfortable undressing in front of another person.
They are embarrassed about needing assistance.
They are frightened of stepping into the shower or bath.
Water near their face causes anxiety.
They do not understand why another person is touching them.
The experience reminds them of an upsetting event from the past.

The Alzheimer’s Association notes that people living with dementia may experience bathing as frightening, embarrassing or physically uncomfortable and may communicate this by resisting assistance.

Read the Alzheimer’s Association guidance on bathing.

Changes in Vision and Perception

Dementia can affect how a person interprets what they see.

For example:

A dark bath mat may appear to be a hole.
A drain may look threatening.
Reflections in mirrors may be confusing.
A shiny wet floor may appear unsafe.
Poor contrast between the bath, floor and walls can make it difficult to judge depth.

Good lighting, visual contrast and removing unnecessary reflections may therefore make the bathroom easier to understand.

Changes in Thinking and Memory

Cognitive changes can also explain problems with dementia and bathing.

The person may:

believe they have already showered
forget when they last washed
no longer understand why bathing is necessary
have difficulty sequencing the steps involved
forget how taps, showers or toiletries work
not understand why another person is trying to help them
become overwhelmed by too many instructions at once

Rather than arguing with the person, it is usually more productive to adapt the environment and the way assistance is offered.

How Often Should Someone With Dementia Bathe?

There is no single bathing schedule that suits everyone.

The National Institute on Aging suggests that a bath or shower two or three times per week may be sufficient for many people with Alzheimer’s disease, while allowing flexibility according to the person’s needs.

National Institute on Aging: Bathing, Dressing and Grooming.

On other days, areas such as the face, hands, feet, underarms and genital area can be washed as needed.

Skin condition, continence, mobility, activity level, personal preferences and medical needs should all be considered.

Older people often have fragile or dry skin, so more bathing is not always better.

If you are unsure about an appropriate bathing schedule because of a person’s health or skin condition, discuss it with their doctor or nurse.

When a Person With Dementia Refuses to Bathe

When someone refuses a bath or shower, forcing the issue can increase fear and make the next attempt even harder.

Instead, try to work out what the person is communicating through their resistance.

They may be cold, frightened, tired, embarrassed or simply unable to understand what is happening.

Sometimes the best response is to stop, allow the person to settle and try again later.

The Alzheimer’s Association recommends adapting bathing expectations when necessary and considering alternatives such as sponge bathing.

See their dementia bathing recommendations.

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

Dementia and Bathing: Practical Caregiver Strategies

Small changes can make a surprisingly large difference.

Prepare Everything Beforehand

Have towels, clean clothing, soap, shampoo, washcloths and anything else you need ready before starting.

A person with dementia may become distressed if they are left waiting while someone searches for supplies.

Warm the bathroom first if necessary and check the water temperature.

Protect Privacy and Dignity

Being undressed in front of another person can be uncomfortable at any age.

Keep the person covered with towels wherever possible and expose only the area being washed.

Explain what you are doing before you do it.

Allow the person to wash as much of their own body as they safely can.

Dementia Australia recommends encouraging the person to continue doing as much of their own personal care as possible.

Dementia Australia: Hygiene and personal care.

Keep Instructions Simple

A complete instruction such as “go and have a shower” can involve many individual tasks.

Instead, break the activity into small steps.

For example:

“Here is your towel.”
“Let’s take off your shoes.”
“Step in here.”
“Here is the washcloth.”
“Wash your arm.”

Give one instruction at a time and allow plenty of time for the person to respond.

Offer Simple Choices

Choice can help preserve a sense of control.

Instead of asking a broad question such as “Do you want to have a shower?”, try offering two acceptable options.

For example:

“Would you like a shower now or after breakfast?”
“Would you prefer a bath or a shower?”
“Would you like the blue towel or the white towel?”

Too many choices can be confusing, so keep them simple.

Use Familiar Routines

Think about the person’s lifelong habits.

Did they normally shower in the morning?

Did they always prefer an evening bath?

Were they accustomed to washing their hair separately?

Where possible, preserve familiar routines rather than imposing a completely new one.

Choose the Best Time of Day

Many people with dementia function better at particular times of the day.

If the person is calmer and more alert during the morning, this may be a better time for bathing.

Others may be more relaxed after breakfast or later in the afternoon.

Observe the person’s normal pattern and work with it.

Watch Your Tone and Body Language

If you approach bathing expecting a battle, your tension may be noticeable.

Use a calm voice, relaxed body language and simple reassurance.

Avoid arguing about whether the person needs a bath.

The aim is cooperation, not winning an argument.

Consider Who Is Helping

Some people feel more comfortable receiving intimate personal care from someone of the same sex.

Others cooperate better with a particular family member or familiar professional caregiver.

If one approach consistently causes distress, consider whether another trusted person might have more success.

Consistency can also help. A familiar caregiver may become easier to accept over time.

Use Music or Conversation

Familiar music can sometimes make bathing feel less clinical and provide a pleasant distraction.

Talking about familiar people, places or interests can also shift attention away from the washing process.

Maintain Safety

Bathroom safety becomes increasingly important as dementia progresses.

Consider:

grab rails
a shower chair or bath seat
non-slip surfaces
good lighting
removing loose mats that may cause trips
testing the water temperature
keeping necessary supplies within reach

Never leave someone who requires supervision alone in a bath or shower.

Alternative Bathing Options for Dementia

A traditional shower or bath is not the only way to maintain hygiene.

If standard dementia and bathing routines are causing repeated distress, alternative methods can be very useful.

Sponge Bath

A warm washcloth and basin can provide effective cleaning without requiring the person to get into a shower or bath.

Wash one area at a time and keep the rest of the body warm and covered.

A no-rinse cleanser can also be useful.

Partial Bathing

It is not always necessary to wash the entire body at once.

You can divide personal care across several days.

For example:

hands and arms
face and neck
underarms and torso
legs and feet
hair
perineal care as required

This approach can be particularly helpful for someone who becomes overwhelmed easily.

Bed Bath

For someone who is bedbound or has limited mobility, washing in bed may be safer and more comfortable.

Use warm water, washcloths and towels and keep the person covered as much as possible.

People with complex medical or mobility needs may benefit from assistance from a trained professional caregiver.

Towel Bath

A towel bath uses warm, damp towels or washcloths while the person remains covered and warm.

This may be less frightening than getting into a bath or shower.

No-Rinse Cleansers

No-rinse body cleansers and shampoos can be useful when access to water is difficult or traditional bathing causes distress.

They can also be useful between full baths or showers.

Follow the manufacturer’s instructions and stop using any product that irritates the person’s skin.

Personal Care, Toileting and Incontinence

People experiencing incontinence may require more frequent cleaning of the genital and surrounding areas.

Good hygiene helps reduce discomfort and skin irritation.

If the person can wash themselves safely, provide warm washcloths and allow as much independence as possible.

If assistance is needed, explain what you are doing, preserve privacy and work gently.

Persistent redness, broken skin, pain, unusual discharge or signs of infection should be assessed by a healthcare professional.

How to Overcome Resistance to Dementia and Bathing

When bathing repeatedly becomes difficult, work through the problem systematically.

Look for the cause. Is the person cold, frightened, embarrassed, tired or in pain?
Reframe the goal. The goal is good hygiene and comfort, not necessarily a conventional shower.
Choose the right time. Try bathing when the person is normally calmest and most alert.
Prepare the environment. Warm the room, gather supplies and reduce unnecessary noise or distractions.
Protect dignity. Keep the person covered and encourage independence wherever possible.
Try one change at a time. Different water temperature, another caregiver, a sponge bath or music may completely change the experience.
Be flexible. What works today may not work next week as dementia progresses.

When to Seek Medical Advice

A sudden change in willingness to bathe deserves attention.

Sometimes what appears to be behavioural resistance is actually caused by pain or another health problem.

Speak with a doctor or other healthcare professional if you notice:

sudden or unexplained changes in behaviour
new pain during movement or washing
skin infections, rashes or sores
significant changes in mobility
persistent distress during personal care
a sudden increase in confusion
concerns about the person’s ability to remain safe in the bathroom

A healthcare professional may also be able to recommend occupational therapy, home-care support or bathroom modifications.

Closing Thoughts on Dementia and Bathing

There is no perfect bathing routine for every person living with dementia.

The approach that works best will depend on the person’s personality, history, health, stage of dementia, physical abilities and lifelong habits.

Some people continue enjoying showers for many years. Others may increasingly prefer sponge bathing, partial washing or assistance from a familiar caregiver.

The most important principles are comfort, cleanliness, safety, dignity and flexibility.

When dementia and bathing become difficult, try to understand the reason behind the resistance rather than viewing the refusal itself as the problem.

Often, a small change in timing, language, environment or bathing method can turn a stressful experience into a much calmer one.

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!

Horticulture Therapy for Dementia: Benefits, Activities & Evidence

Laura Herman Blog, Prevention February 14, 2021August 23, 2026alternative therapies, dementia, horticulture therapy

Older woman smelling flowers during a horticultural therapy activity

Horticulture therapy for dementia can provide enjoyable opportunities for people living with dementia to spend time with plants, gardens and nature.

More accurately known as horticultural therapy, it can involve activities such as planting, watering, growing herbs, arranging flowers, harvesting vegetables or simply spending time in a thoughtfully designed garden.

Research suggests that these activities may support mood, engagement, daily functioning and quality of life for some people with dementia.

However, horticultural therapy should not be described as a cure or treatment that reverses dementia. The research is encouraging, but the quality of the available evidence remains limited.

What Is Horticultural Therapy?

The American Horticultural Therapy Association defines horticultural therapy as participation in horticultural activities facilitated by a trained horticultural therapist to achieve specific goals within a treatment, rehabilitation or vocational plan.

There is also a broader practice called therapeutic horticulture. This involves plant-based activities designed to support a person’s wellbeing and may be facilitated by other appropriately trained professionals.

This distinction is useful.

Simply enjoying a garden can be valuable, but formal horticultural therapy involves purposeful activities and specific goals.

What Does Research Say About Horticulture Therapy for Dementia?

Research into horticultural therapy and dementia has grown considerably.

A 2024 systematic review and meta-analysis examined nine randomized controlled trials involving 655 older people diagnosed with dementia.

The researchers reported improvements in several areas among people participating in horticultural therapy compared with conventional care.

These included:

Cognitive test scores
Symptoms of depression
Activities of daily living
Quality of life

The findings are encouraging.

However, the researchers also emphasized that the included studies were of low quality and that better-designed research is needed to confirm the results.

For this reason, it is more accurate to say that horticultural therapy may be beneficial for some people with dementia rather than claiming that its effects have been conclusively proven.

Possible Benefits of Horticultural Therapy for Dementia

Gardening naturally combines several forms of activity.

A person may move their body, use their hands, make choices, interact socially, experience different smells and textures and see the results of something they have cared for.

This combination may help explain why horticultural activities can be meaningful for people living with dementia.

Possible benefits include:

Greater engagement in meaningful activity
Enjoyment and a sense of purpose
Gentle physical activity
Social interaction
Sensory stimulation
Reduced boredom
Support for mood and emotional wellbeing
Opportunities to maintain existing skills
A possible reduction in agitation for some people
Improved quality of life

Not everyone will respond in the same way.

Activities should be based on the person’s abilities, interests, previous experiences and stage of dementia.

Gardening Activities for People With Dementia

Gardening can be adapted to suit many different levels of physical and cognitive ability.

Activities might include:

Watering plants
Planting seeds
Filling pots with soil
Growing herbs
Picking flowers
Arranging flowers in a vase
Harvesting fruit or vegetables
Removing dead flowers
Sorting seeds or gardening materials
Smelling herbs and flowers
Walking through a garden
Sitting outdoors and watching birds or insects

The aim does not need to be producing a perfect garden.

For many people, the value is in the activity itself.

Someone who gardened throughout their life may particularly enjoy returning to familiar tasks. This can provide a sense of identity, competence and connection with their past.

Gardening may also combine well with other group activities for people with dementia.

Therapeutic and Memory Gardens

Specially designed gardens are increasingly used in residential aged care and memory care settings.

These environments can provide a safe way for people to enjoy nature, walk, sit outdoors and engage with plants.

A dementia-friendly garden may include:

Clear, looping walking paths
Accessible seating
Shade
Raised garden beds
Non-toxic plants
Familiar flowers and herbs
Interesting colors, textures and scents
Good visibility and simple navigation

Raised beds can be particularly helpful for people who find bending difficult or who use a wheelchair.

A garden does not need to be large.

Even a small courtyard, balcony, patio or collection of indoor plants can provide opportunities to interact with living things.

Horticultural Therapy Can Be Done Indoors

Access to a large outdoor garden is not essential.

Indoor horticultural activities can include:

Potting small plants
Growing herbs on a windowsill
Arranging cut flowers
Planting seeds in containers
Decorating plant pots
Sorting flowers, leaves or seeds
Caring for indoor plants

These activities can be useful when weather, mobility or health makes outdoor gardening difficult.

Even simply looking at and caring for plants may offer an enjoyable focus for conversation and activity.

Does Horticultural Therapy Reduce Agitation?

Some studies suggest that structured gardening and horticultural programs may reduce agitation or behavioral symptoms in some people with dementia.

This is potentially important because agitation, restlessness and distress can have a major effect on both the person and their caregivers.

Activities involving plants may provide gentle stimulation, physical activity and something meaningful to focus attention on.

However, horticultural therapy will not be appropriate or effective for every episode of agitation.

Sudden or significant changes in behavior should also prompt consideration of possible causes such as pain, infection, medication effects, hunger, thirst, constipation or an uncomfortable environment.

How Much Horticultural Therapy Is Needed?

There is no established medical “dose” of horticultural therapy for dementia.

The 2024 review found that some studies using activities at least twice per week reported positive results, but this does not establish a universal prescription.

Programs vary greatly in length, frequency, activities and the people taking part.

The best approach is usually to offer activities regularly while paying attention to whether the person enjoys them.

If someone becomes tired, frustrated or distressed, the activity can be shortened, simplified or tried again another day.

What Does a Horticultural Therapist Do?

A professional horticultural therapist uses plant-based activities to work toward defined goals.

According to the American Horticultural Therapy Association, registered horticultural therapists receive education in areas including horticultural science, human science and horticultural therapy, together with supervised practical experience.

Goals for a person with dementia might include:

Increasing participation in activities
Encouraging social interaction
Supporting physical movement
Maintaining practical skills
Reducing boredom or distress
Supporting emotional wellbeing

Formal therapy is not necessary for every gardening activity.

Family members, caregivers and activity staff can also offer simple and safe plant-related activities based on a person’s interests and abilities.

Safety Considerations for Gardening With Dementia

Gardening is generally a low-risk activity, but the environment should be adapted to the individual.

Consider:

Using non-toxic plants
Avoiding sharp or potentially dangerous tools where appropriate
Providing supervision when needed
Removing trip hazards
Providing shade and sun protection
Encouraging adequate hydration
Using raised beds or lightweight tools for people with reduced mobility
Avoiding pesticides or chemicals that could be accidentally handled or swallowed

The activity should support independence where possible without creating unnecessary risk.

Is Horticultural Therapy a Treatment for Dementia?

Horticultural therapy is best viewed as a supportive, non-drug intervention.

It does not cure dementia or stop the underlying disease process.

It should also not replace medical assessment, prescribed treatment or care for symptoms that require professional attention.

However, non-drug approaches can play an important role in helping people live well with dementia.

Activities that provide enjoyment, movement, social connection and a sense of purpose can contribute to overall wellbeing.

You can read more about non-drug and alternative approaches for dementia on ReaDementia.

Horticulture Therapy for Dementia: Closing Thoughts

Current research suggests that horticulture therapy for dementia may support cognition, mood, daily functioning and quality of life for some people.

A recent meta-analysis found encouraging results, but the researchers also cautioned that the existing studies were generally low quality and stronger research is still required.

The greatest advantage of gardening may be its simplicity.

It can provide gentle exercise, sensory stimulation, social interaction and meaningful activity at the same time.

For someone who enjoys plants or has gardened in the past, horticultural activities can also reconnect them with familiar skills and experiences.

There is no need to make extravagant claims about horticultural therapy.

Giving a person with dementia the opportunity to plant a seed, smell a flower, water a pot or spend a peaceful afternoon in the garden may simply be an enjoyable and meaningful part of good dementia care.

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.

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Cognitive Stimulation Therapy and Dementia

What is Cognitive Stimulation Therapy?

CST Aims to Improve Cognitive Functioning

Who can Administer Cognitive Stimulation Therapy?

What is a CST Session Like?

CST stimulates particular cognitive skills

What are the Benefits of CST?

What are the Variations of CST?

Individual Cognitive Stimulation Therapy (iCST)

Maintenance CST

Virtual Cognitive Stimulation Therapy (vCST)

What is Next for CST?

Where to Learn About Online CST Training

What can Palliative Care Do for People with Dementia?

Assist with Advanced Care Planning

Minimize Distressing Symptoms of the Disease

Enable People to Reach their Goals

Palliative Care is Underutilized and Misunderstood

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

Incontinence Products for Dementia

Don’t call them diapers

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

Products to protect furniture from wetness

Other supportive equipment

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

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

Try a different style

Look for patterns

Is this a sudden change?

Special clothing for special situations

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

Set them up for independence

Catch them when they’re in the restroom

Avoid “taking” anything without giving something in return

Spare their pride

Incontinence can be Embarrassing, Inconvenient and Challenging

At What Stage of Dementia Does Incontinence Occur?

Why Does Dementia Cause Incontinence?

Difficulty Recognizing the Need to Go

Difficulty Finding the Toilet

Mobility Problems

Difficulty Managing Clothing

Communication Difficulties

Incontinence May Have a Treatable Cause

Watch for a Sudden Change

Types of Incontinence in Dementia

Urge Incontinence

Stress Incontinence

Functional Incontinence

Bowel Incontinence

Incontinence Products for Dementia

How to Reduce Incontinence and Toilet Accidents

Make the Toilet Easy to Find

Use Easy-to-Remove Clothing

Watch for Non-Verbal Clues

Create a Dementia Toileting Routine

Do Not Sacrifice Sleep Unnecessarily

Keep the Person Well Hydrated

Can Medication Help Incontinence in Dementia?

When Should You Talk to a Doctor?

At What Stage of Dementia Does Incontinence Occur? Closing Summary

What Are Bed Sores?

Why Are Bed Sores in Elderly People More Common?

Why Dementia Can Increase the Risk of Bed Sores

What Causes Pressure Injuries?

Pressure

Friction

Shear

Moisture and Incontinence

Poor Nutrition and Hydration

Warning Signs of a Pressure Injury

Stages of Pressure Injuries

Stage 1 Pressure Injury

Stage 2 Pressure Injury

Stage 3 Pressure Injury

Stage 4 Pressure Injury

Unstageable Pressure Injury

Deep Tissue Pressure Injury

How Are Bed Sores in Elderly People Treated?

How to Prevent Bed Sores in Elderly People With Dementia

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