You may have had a recent diagnosis of dementia and want to try and maintain as much independence as possible, or you may be supporting a person with dementia and want to help them be as independent as they can. Either way, encouraging independence can have positive benefits for our sense of self, role within our family/home, wellbeing, and ability to function.
As always, it is important to remember that every person is unique and so these suggestions may not work for everyone and what works this week may not work next week. However, we hope you will find the confidence to try different and new ideas.
To try and help you promote independence in yourself or others we have broken the things to consider into 3 main areas: Person, Task and Environment.
If a task becomes more difficult then we (the person with dementia) may need change how we approach that task. Probably the most obvious one when talking about dementia would be memory. If memory becomes an issue, then we cannot change our memory so we must think of ways we can change how we approach memory. Some ways we can do this would include:
- Use Routines – Having a robust routine is one of the best memory prompts
- Write It Down
- Use Clocks With Date Displays
- Make Use of Technology
Another example may be concentration or attention. You may find that you have difficulty splitting your concentration between tasks e.g. making toast and a cup of tea at the same time. Again, we cannot change the difficulty with concentration so we have to adapt to it:
- Concentrating on one task at a time and plan for tasks to take longer than they used to
- Take regular breaks
- Have a set time each day to do specific tasks
- Eat well and exercise as these can promote concentration and good sleep quality
If a person is no longer able to use utensils to eat, then consider finger foods instead. Eating with fingers may not be normal in some cultures but by adapting their techniques/equipment it means they can still be independent with the task.
Remember that if you are tired, ill, or stressed it can affect how well you can do a task. Try and time tasks for when you are feeling your best to help reduce frustration. For some, this may mean having help with getting washed and dressed so that you have the energy to participate in other more meaningful activities. So, if you cannot adapt the task, then try and think of ways you can work around it to maintain that independence or participation.
Sometimes, when something becomes too difficult, we need to adapt the task to enable us to still enjoy it. Adaptation can take many forms, but some examples may be:
- Mirroring – this is when you position yourself opposite the person with dementia so they can copy what you are doing. This can work for eating or brushing teeth.
- Tandem activity – complete tasks alongside the person with dementia. This way you can help support them when they get stuck. This can work for baking or even building a shed.
- Task grading – Sometimes you need to reduce the difficulty or involvement in a task as the dementia progresses. An example may be when a person becomes unsafe using the stove, rather than stopping them from cooking, they could help with the food preparation. They are involved with the task and still have a role, but the task has been graded to a safer level.
- Equipment – addition of equipment such as chair raisers, shower stools, or non-slip mats can promote independence whilst also reducing risk of injury. Coloured plates can help food stand out better, whilst thick handled cutlery may help with eating.
- Technology – Use technology to help you remember the tasks you need to do, and be less reliant on others:
- clocks showing the day and date as well as the time
- reminder devices to prompt when to take medication or appointment alerts
- telephones with big buttons – these can be pre-programmed with frequently used numbers
- music players and radios with easy-to-use controls
- Smartphones and tablets – Many people with dementia find using a mobile phone or tablet helps. These devices often have a range of apps that can help people, such as an alarm clock, notes function and a reminder function.
- Forward or Backward Chaining – Forward chaining and backward chaining are teaching techniques to help a person learn multi-step tasks, mastering one step at a time and “chaining” them together until all steps are mastered. For example, making a cup of Tea. In forward changing you may start with helping the person fill the kettle whilst you then complete then next steps. Once they are independent with the kettle you may work on them being independent with setting up the mugs with tea bags. In Backward chaining you would complete all but the last step where you would support the person to put the milk in the cup and then over time, work backwards. This may work well when introducing a new routine.
- Prompting – It can be easy to jump in and do a task for a person with dementia. But sometimes they just need you to talk them through it. Try giving verbal prompts to help the person still do the task themselves.
- Memory – Memory difficulties can affect our ability to complete tasks. Try breaking the task down into smaller parts to reduce the risk of getting lost in the process. An example may be not remembering which part of a recipe you are on. Break a recipe up into parts, with each part on a different piece of paper and set out all the ingredients. During each step, put the ingredient you have used away, and then at the end of the step turn over the sheet of paper to the next one. This may help reduce the risk of getting lost in the recipe or forgetting what ingredients have already been used. This method can be used for anything from making models to building
flat pack furniture.
One area that can often be over looked is the environment. This can play an important part in enabling task participation.
- Senses – In order to engage in a task and environment, the first thing we need to do is make sure our senses are optimised. Make sure hearing aids are working and in place and that glasses are cleaned. Do not forget to get hearing and eyes checked as regularly as is practicable.
- Sight – Some people find filtering out excess visual information difficult. This means that if there are a lot of objects on a table or in a cupboard they can find it hard to block out the items they do not want, to find the item they do. Try and keep excess clutter to a minimum. For others, putting something in sight, rather than in a cupboard, can help them to find it easier. An example would be putting all the items to make a cup of coffee on the kitchen bench or a tray so that they can be easily seen and not hidden in cupboard or among other items.
- Sound – As with sight, some people find it difficult to filter out external noise. This can make concentrating on a task or conversation very difficult. Try and turn off any potential noisy distractions. For others, music may help with a task as it can provide a calming environment. See our tip sheet on showering and bathing to see how music may help with this task.
- Choice – This is similar to sight, but the problem is the person cannot or has difficulty, choosing things. An example may be getting dressed where there is a cupboard full of clothes, resulting in clothing that is not suited for the time of year. Try and reduce choice to a level that works. For the clothes, you may initially just remove all of the unseasonable clothing, and then, as the dementia progresses, you may put out a small choice of clothing for the person to choose from.
- Light – Light is important as it helps us to see what we are doing. Make sure the room is well lit so that the person can see what they are doing. A well lit room may also help reduce hallucination triggers, and may reduce the person’s evening confusion. Lights can also be used as a guide. Having a toilet light on at night can help some people with dementia to navigate to the toilet independently. Night lights are also an excellent option to help navigation as well as reduce the risk of falls. Have a look at our tip sheet No.6. Tips
for Home Safety for more ideas around making the home environment safer.
- Memory – Memory difficulties can affect a person’s independence in different ways. For some, remembering where items are located can be difficult. Try using labels on cupboard doors and drawers to make finding things more easily. Another example is having clothes on open shelves as a visual prompt to where these are located.
If you are finding doing something is becoming more difficult then try and remember person, task, environment. Can you adapt your approach to the task? Does the task need to be changed or modified to make it achievable? Or is the environment a barrier to that task being done? By thinking about these 3 key elements you may be able to come up with new and novel ways to keep promoting independence in yourself or the person you are supporting.
Finally, Be Kind to Yourself
You are human. None of us are perfect-especially during these times at home. Take care of yourself, as well as your family member who has dementia.
The Dementia Waikato Support Coordinators are Occupational Therapists with expertise in promoting independence. We are available to assist you with any concerns you may have re home safety and how you may be able to encourage the person with a dementia diagnosis to be as independent as possible. Feel free to contact us at Dementia Waikato if you need to talk about any issues you are having with the person you are caring for. Dementia Waikato staff are all working from home and can speak with you on the phone 07 929 4042 or via email firstname.lastname@example.org