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The Effectiveness of Using Daily Routines in the Care of Patients with Dementia

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Although persons with dementia typically lose recent memory skills, habits are a part of a different memory structure in the brain that tends to remain intact longer. By sticking to the same routine, your loved one doesn’t have to stop and think about what to do next. The routine becomes automatic. Components of a routine may include eating breakfast before getting dressed, sitting in the same recliner in the living room each morning, attending elder care in the afternoon and taking a bath in the evening.

Although organizing your own day may take little conscious effort, giving structure to the day of a person with dementia may pose special challenges. Thinking for two takes sensitivity, ingenuity and patience.

Using routine as a tool. As a caregiver, you know your loved one’s daily rituals better than anyone else. And, you’re in a unique position to customize and refine your loved one’s routine so that it includes meaningful activities for as long as possible. These daily activities, which may seem insignificant, honor the life of your loved one and provide him or her with a sense of purpose.

Keep in mind that just because your loved one is changing doesn’t mean other things must change. Where objects are located in your home, and when and where routine activities happen can stay the same even as your loved one’s disease progresses.

Other aspects of daily life should remain the same and be strengthened. These may include:

  • Personal hygiene routines
  • Mealtime routines such as preparation, serving, eating and cleanup
  • Household chores such as doing laundry, sweeping and dusting

You can use each one of these activities to reinforce routine and capitalize on your loved one’s strengths and interests. These daily tasks also take advantage of procedural or habit memory. By capitalizing on the memory your loved one retains the longest, namely habit memory; you can involve him or her in meaningful, purposeful activities for longer.The progressive nature of Lewy Body Dementia, Alzheimer’s, and other forms of dementia requires that you re-examine your routine frequently — especially if you notice your loved one is agitated, unsettled or depressed. There will come a time when you can’t sustain even basic routines. At this point, flexibility is important. Maybe your loved one used to read the paper each morning but no longer can read. He or she may still be able to hold the paper and turn the pages, and if this is an activity that he or she enjoys and is meaningful to them, then it should be allowed to continue.It is important for caregivers to step down expectations as the disease advances. Routine is a tool. Because no two people respond the same to a routine, it’s up to caregivers to decide what works best for them and the loved ones in their care.

 Here are some tips for maintaining a routine:

  • Identify the routine. Routine tasks are those performed on a daily basis. Dressing for the day or walking the dog are routine tasks. Taking an annual trip to a cabin with extended family is not, and your loved one may now find it unsettling.
  • Retain important rituals. Maybe your wife preferred to eat the evening meal at a television tray in the living room. By continuing this habit in the same environment, you may cue your wife to eat and serve as a bridge to positive memories.
  • Remove distractions and limit choices. This may mean narrowing the clothing choices in the closet, offering two possible outfits to wear (or asking if your loved one would care to wear one particular outfit). It also may mean relocating an item in the house that may otherwise cause your loved one to lose interest in the task at hand.
  • Recognize that change may be necessary. Maybe your husband always helped set the table. As the disease advances, you can continue this routine with some changes. Perhaps your husband can continue to just put the spoons on the table, or maybe he can hold the spoons for a while before you put them on the table yourself. Educate your family and friends about the disease. Too many people visiting at one time may overwhelm your loved one and upset your routine. Before your friends visit, give them communication tips, such as not asking your loved one too many questions. (See “The Importance of Maintaining a Support Network.”)
  • Stay flexible. You can’t schedule every activity and event in advance. When an unexpected or unforeseen change occurs in the routine, just restart your routine the next day.

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