Caring for patients with dementia

Patients with dementia have special needs for care. How can caregivers, at home, in assisted living or nursing homes, provide optimal care for patients with dementia in order to ensure a high quality of life for dementia patients and caregivers alike?

What is dementia?

Dementia is a general term for the decline in mental ability and memory that is severe enough to interfere with daily life. It is not one specific disease, but an overall terms that covers a range of symptoms associated with memory loss and decline in other cognitive skills. Alzheimer’s disease and vascular dementia are two of the most common types of dementia.

Frequency of dementia

  • Affects 10 million people in Europe - expected to double by 2030 (source:

The consequences of dementia are serious. All types of dementia are progressive, meaning the structure and chemistry of the brain is gradually damaged over time, affecting the person’s ability to remember, understand, and communicate.

As the condition progresses, the patient will become more dependent on help and loss of memory will increase. The patient will be unable to recognize familiar objects or people and become increasingly weaker.

Fundamentals of dementia care

Caring for residents and patients with dementia requires extra and specialized resources, as this group in particular needs individual and personalized care.

For caregivers, whether at home or in assisted living, the approach to care should be based on accepting that each person with dementia is unique. Each person has different progression of disease, different abilities and disabilities and different needs for support and care.

In addition, always be aware of maintaining dignity, privacy and independence.

An approach to dementia care can be based on an ongoing individual assessment,  taking the following elements into account:

  • Cognitive health
  • Physical health and functioning
  • Behavioral status
  • Sensory capabilities
  • Decision-making capacity
  • Communication abilities
  • Personal background (including cultural, spiritual)

Dementia and communication

Depending on the degree and progression of dementia, communication with dementia patients can prove to be difficult. It is essential that a caregiver provides short and precise communication while remaining on an adult and respectful level. 

Pay attention to body language – your own and that of the patient. This may be a more efficient way of judging if the patient understands what you are saying, if the patient is uncomfortable, hungry, thirsty, needs to go to the bathroom, etc. 

Tip: speak in simple, direct language and accompany with gestures, pictures, or other non-verbal cues as needed.

Dementia and incontinence care

Patients with dementia are almost twice as likely to have urinary incontinence as their peers without dementia. The brain damage caused by the disease can also affect the ability to control the bladder.

In addition to the cognitive causes, some incontinence in dementia patients is actually due to functional incontinence. The patient may no longer be able to find the toilet, especially if they are in a new setting. They may not be able to open or remove their clothes by themselves, just as they may not be able to ask for assistance when they feel the urge to urinate. 

There are ways to help dementia sufferers with the practical problems. Be sure to offer the residents a visit to the toilet every 3-4 hours, helping to show them the way to the toilet, remove any obstacles on the way to the toilet and make the route to the toilet easily recognizable, with colors and posters. Avoid providing too much to drink before bedtime. 

Read more about Incontinence and dementia

Dementia and personal hygiene

Most people learn to take care of personal hygiene, washing and grooming by themselves from an early age. But for someone with dementia, this is not necessarily an easy task. Helping a person with dementia with personal hygiene is not an easy task.  There are approaches to helping a person with dementia overcome personal hygiene tasks:

Personal approach: Some people with dementia may have a fear of showering or washing, either because of their history, or because the experience now seems scary because of their cognitive decline. Maybe the shower stream feels too hard on their skin or they are afraid of their reflection in the mirror. Understanding a person’s unique fears and finding a solution together will make personal hygiene easier to overcome.

Understand their history of personal hygiene: Older generations have not always been used to showering every day. They may have showered once a week, and supplemented with daily washing with a washcloth. While this may no longer be sufficient if the resident is incontinent and often soils their clothing or bed, understanding their previous routines and experiences can help make new routines more comfortable.

Maintain routines for showering and washing: Creating and maintaining fixed routines can help make personal hygiene manageable. Take a shower on a fixed day and time and follow the same routines each time. Consider listening to relaxing music to create a comfortable atmosphere, and ensure that bathing is associated with something pleasant. 

Gentle washing: Many elderly people with dementia experience showering and washing as stressful and strenuous. Traditional washing with soap and water is not always the best solution for residents with dementia, since soaping, lathering, rinsing and drying every part of the body includes many touches that can be very stressful. Gentle washcloths or wash without water products are options that are less stimulating. It also requires less lifting and moving for the caregiver, enabling a more pleasant experience for everyone.

Bed protection: Bed protection offers an extra layer of protection for those who also experience incontinence at night. This also happens to those who wear incontinence products, especially those with dementia, because they often pull on their products in their sleep. As a results, the product moves or breaks, increasing the risk of leakage.

Special risk factors in dementia care

Dementia Wandering

“Wandering” is a term used to describe the behavior of  dementia patients who move around, ‘wander’, in a manner that seems aimless but is actually purposeful. It is actually a behavioral expression of a basic human need or a response to environmental irritants. This could be a response to a need for food, companionship, or perhaps just looking for a bathroom.

Wandering can be beneficial because it provides social stimulation and helps maintain mobility, thereby providing exercise and strength. It can however be dangerous if it results in a patient leaving the premises of the nursing home or his or her own home without being able to return, or if they enter an unsafe area. In these instances the patient is at risk of physical injury, dehydration or worse.

Caregivers should encourage mobility in order to ensure independence mobility, but encourage that it happens in a safe manner by addressing safety concerns. GPS systems, locks and video monitoring are different tools that can be used to track patients who are prone to wandering, but should always be used with special care and permission.


People with dementia are at an increased risk of falling due to their neurological impairments in perceptions and cognition and changes in motor function. Falling can be due to individual risk factors or environmental risk factors. Individual risk factors include incontinence, immobility, depressions, sleep medication etc, while environmental risks include clutter, unsafe footwear or furniture, uneven floors, inadequate lighting, poor weather conditions, etc.

Health caregivers can promote safety and preserve mobility by helping to reduce the risk of fall and fall-related injuries. A holistic and personalized assessment can identify individual risk factors and take environmental conditions into account.

Be sure to investigate their personal history to try to anticipate their future behavior, or enroll the help of professionals who can identify individual solutions to minimize the risk of falling.