Alzheimer's Society

It is easy to assume that people with dementia inevitably lose all their skills and become incapable of carrying out everyday activities. With time, dementia will affect a person's skills but there are plenty of ways to make sure they stay active for as long as possible. This factsheet suggests a range of ways to help someone with dementia to feel good about themselves and continue to take part in everyday activities.

Help the person maintain their independence

People with dementia need to continue carrying out as many of their previous activities as independently as possible, in order to retain their skills. Doing things for themselves will enhance their physical, social and emotional well-being, through the preservation of their dignity, confidence and self-esteem. 

If you spend time with someone with dementia, you need to support and encourage them to do whatever they can for themselves, and to offer only as much help as they need. This is not always easy - not least because it may be frustrating watching something being done slowly when you could do it more quickly and easily yourself. But even if the person is struggling with a task, try to avoid the temptation to take over. If you do, they may lose confidence and are likely to cope less well.

Tips: helping out

• If you do need to offer help, try to do things with, rather than for, the person. This will help them feel more involved.
• Always try to focus on what the person can do rather than what they can't. 
• Remember that they may have a short attention span and may find it hard to remember or concentrate on things. 
• Try to be patient, and allow plenty of time. 
• Give plenty of praise and encouragement. 
• If you feel yourself becoming irritated or frustrated, think how the person might also be feeling. Take time out to give yourself, and the person, some time alone. If you feel that you both need some time apart, make sure that the person is safe, then go into another room for a few minutes. Remember, it is important to look after yourself - for more advice, see Factsheet 523, Carers: looking after yourself.

Offer help sensitively

As the dementia progresses, the person may find certain tasks increasingly difficult, while others may remain manageable for much longer. By helping sensitively, you can offer support while enabling them to do what they can for themselves. You will need to adjust the level of help you offer, so that they can continue to make the best use of their remaining skills.

Tips

• Try breaking the task down into sections. For example, the person may find it easier to continue dressing themselves if you put their clothes out for them in the order that they need to put them on. Or you could pass the next garment to them, holding it out ready for them to grasp at the right place, or encourage them to put their vest on over their head before you straighten it down for them.  
• Even if the person can't complete a full task, achieving one or two steps of it - particularly the final step - can give them a sense of achievement.
• Make sure that any reminders or instructions are simple. Use short sentences, with gestures and body language to add meaning.
• Be tactful. Try to imagine that you are the person receiving help, and speak in a way that you would find helpful if you were in their position. 
• Try doing things together, such as folding clothes or drying dishes. 
• Try integrating opportunities to do things into the daily routine.
• Make sure that the person doesn't feel that they are being supervised or criticised in any way. This means checking your tone of voice as well as the words that you use.
• When the dementia is at a more advanced stage, try pointing, demonstrating, or guiding an action rather than giving a verbal explanation. For example, the person may be able to brush their own hair if you hand them the brush and start by gently guiding their hand. Use your voice to make reassuring and encouraging sounds rather than using actual words.

Make sure the person feels safe

Feeling safe is essential for our sense of well-being, but for a person with dementia the world may feel like an unsafe place for much of the time. Most of us can only imagine how frightening it must be to experience the world in this way.

Tips

• Respond to how the person is feeling at that very moment.
• Be reassuring, and avoid confronting them with distressing reminders or tasks.
• Remember, the more you can help the person not to feel anxious and stressed, the more likely they are to be able to use their skills to the best advantage.

Make sure they have things to do

We all need to feel useful. This is as true for people with dementia as it is for anyone else. Encouraging the person to carry out activities around the home or garden is a way of enabling them to feel needed while maintaining their everyday skills. In the home, they may like to carry out simple tasks, such as dusting, polishing, folding clothes, laying and clearing tables, drying dishes and sorting cutlery. Work in the garden might include digging, watering, raking or sweeping leaves.

Leisure activities are equally important. Try to help the person maintain skills related to their past interests and habits. For example, if they used to enjoy carpentry, they may get satisfaction from sanding a piece of wood. If they enjoyed cooking, they may be able to advise you on a recipe or help prepare a particular dish by peeling the vegetables. Encourage the person to go outdoors and possibly on accompanied outings to the shops, garden centre and other public places. Sitting and chatting, watching others and listening to music all count as 'activities'. Opportunities to engage with children and animals can bring lots of pleasure too.

Tips

• Remember that it's more important that the person feels useful than that they complete the task perfectly. 
• If you do have to redo a task that they have done, be very tactful, or try to do it without their noticing. 
• Always thank the person for their help.

Use memory aids

You can use memory aids and other reminders to help the person use their skills for longer. These may be of most help in the early stages of dementia when the person is better able to understand the message and to act upon it.

Ideas include:

• labelling cupboards and drawers, perhaps using pictures rather than words - for example, a photo of a cup and jar of coffee
• a large calendar showing the day, month and year
• a noticeboard for messages 
• notes stuck by the front door.

There are also a number of technological aids specially designed to help people with memory problems. For more information, see Factsheet 437, Assistive technology.

Help the person relax

A person will be at their best if they are relaxed. There are plenty of things you can do to help the person feel calm and secure.

Tips

• Ensure that the person is as close as possible to people and things that they recognise, and that they enjoy being with. 
• Make sure the atmosphere is relaxed and uncritical. 
• Try to ensure familiar surroundings and a regular routine, as this will be reassuring. 
• Try to avoid too many conflicting sounds or large numbers of people, as this can add to a person's confusion. If possible, turn off the radio or the television. If the person needs to concentrate on something in particular, take them to a quiet place. 
• If the person becomes upset or embarrassed by their declining abilities or clumsiness, give them plenty of reassurance, and when things do go wrong, be tactful and encouraging. Having a good laugh about it together often helps.

Consider seeking professional advice

If the person with dementia finds it particularly hard to cope with certain activities, either because of the dementia or because of other disabilities, there may be some recognised solutions out there. An occupational therapist will be able to advise on aids, adaptations and different approaches to practical tasks, to help the person retain their independence for as long as possible. You can contact an occupational therapist through:

• social services (look in the phone book under your local council)
• your GP
• your local Memory Service (ask your local hospital for details)
• the College of Occupational Therapists (see 'Useful organisation', below), if you would like details of a private practitioner.

If the occupational therapist recommends any changes, try to make them as soon as possible, to give the person the best chance of absorbing new information. The earlier you contact an occupational therapist, the more effective their solutions will be.

Your local Alzheimer's Society branch will always be willing to talk to you and offer advice and information to support your needs.

For more information, Dementia Catalogue, our specialist dementia information resource, is available on the website at alzheimers.org.uk/dementiacatalogue

Useful organisation

College of Occupational Therapists

106-114 Borough High Street
Southwark
London SE1 1LB
T 020 7357 6480
E info@cot.co.uk
W www.cot.co.uk

Provides details of independent occupational therapists in your local area.

Factsheet 521

Last updated: July 2008
Last reviewed: July 2008
Reviewed by: The College of Occupational Therapists, mental health and older people specialist sections