Alzheimer's Society

If you are caring for someone with dementia, it's important to
help them remain as fit and healthy as possible - both physically
and mentally. The better they feel, the more they can enjoy life,
making life more pleasurable for both of you.

Exercise

Everyone needs some form of regular exercise, whether they have dementia or not. Look for some form of exercise that the person with dementia might enjoy, or ask your GP, occupational therapist or physiotherapist to advise.

Exercising will:

• Enable the person to remain mobile - and therefore, independent - for as long as possible
• Improve circulation and help prevent stiffness and muscle wasting
• Help the person feel more relaxed and calm, and sleep better
• Reduce anxiety, stress and depression.

Well-being

The mental health and well-being of the person you are caring for is as important as their physical health. They will need:

• Affection and reassurance that you still value them, and that they matter to you
• Freedom from as much external stress as possible
• Appropriate activities and stimulation to help them to remain alert and motivated for as long as possible.

The health and well-being of the person you are caring for will be affected by many different factors. Use these pointers to check whether you can make any adjustments to their lifestyle or environment to boost their health.

Eating well

Eating too little or missing out on essential nutrients will reduce the person's resistance to illness and may make them feel more confused. If the person refuses to eat a balanced diet, the GP may suggest alternatives, or may prescribe vitamins or supplements.

• If the person forgets to eat, they may need someone with them at mealtimes. Having Meals on Wheels delivered won't help if the person forgets to eat them.
• Eating fatty, sugary foods can cause considerable weight gain, leading to further health problems. Eating sweet foods can cause peaks and troughs in energy levels, exacerbating mood swings.
• If the person is eating so much that they feel uncomfortable, tactfully limit the amount of food available, or offer low-calorie alternatives.
• Make sure they drink enough fluids. Dehydration is a health risk and can increase confusion.

For more information, see the Society's carers' advice sheet Eating and its 'Food for Thought' booklets.

Keeping warm

Becoming cold for any length of time is a serious health risk - particularly for older people or for those who are inactive and have poor circulation. A severe drop in body temperature can cause hypothermia, which can result in loss of consciousness and even death. The person you are caring for may feel the cold far more than you do, but they may not realise it or may be unable to tell you.

• Try to make sure that the rooms where the person sits and sleeps during the day are kept warm. Draught proofing and roof insulation will help.
• Use layers of clothing, ideally with natural fibres, such as wool.
• Encourage the person to wear a hat, gloves and warm socks if they go out in cold weather - and indoors too, if necessary.

Tackling constipation

This is a common problem among older and less active people. It can cause pain and discomfort, and can also increase the person's confusion. If problems persist, consult the GP, but rather than using laxatives, you can help prevent constipation through:

• Plenty of foods that are high in fibre, such as cereals, wholemeal bread, fruit and vegetables
• Fibre supplements (available from health food stores and on prescription)
• Plenty of liquid
• Regular exercise.

A good night's sleep

We all need a good night's rest, but people with dementia can find it hard to sleep. They can also become confused about night and day and may get up in the middle of the night, thinking it's morning. It may help if you can:

• Discourage the person from taking too many daytime naps. Encourage them to take part in stimulating activities, as they are more likely to doze off if they are bored
• Limit fluids in the evening, and avoid stimulating drinks such as tea and coffee
• Encourage the person to take some form of exercise during the day
• Find soothing and relaxing ways to encourage the person to sleep, such as giving them a warm milky drink at bedtime.

What to do about smoking

It's common knowledge that smoking is bad for us, and people with dementia have been known to forget about smoking if cigarettes and ashtrays are removed from sight. But trying to make the person you are caring for stop smoking may make them tense and irritable. There is also an ethical question about the person's right to continue to enjoy something that they have enjoyed in the past - whether or not it is bad for them.

For a person with memory loss, smoking not only damages their health - it can also mean an increased fire risk. If the person you're caring for does smoke, try to make it as safe as possible - for example, by replacing matches with disposable lighters.

Dealing with alcohol

A drink in company may be a pleasant way for the person you are caring for to relax. However, people with dementia can appear more confused after a drink, so the amount may need to be limited. Also, alcohol doesn't mix well with certain medicines. If in doubt, ask the GP for advice.

If you are concerned that the person is drinking too much because they've forgotten how much they've had, or that they are drinking inappropriately, you may decide to keep alcohol out of reach and out of sight. As with smoking, you as the carer need to balance the issue of the person's right to enjoy a pleasurable activity against the risk.

Dealing with hearing problems

Poor hearing can add to the person's confusion and feelings of isolation. If you think the person you are caring for has a hearing problem, ask their GP to refer them for a hearing test. The test, and hearing aids, are free on the NHS.

If the person uses a hearing aid, make sure it's switched on and working properly. As the dementia progresses the person may find that the hearing aid is too difficult to manage and simply adds to their confusion.

If the person has hearing difficulties that a hearing aid can't resolve, try to attract their attention before speaking to them. Touch them on the arm to indicate where you are, make sure you're facing them, and then speak slowly and clearly. If they don't understand you, try altering the form of words you're using rather than repeating the same phrase more loudly. Make sure there's no distracting noise, such as television, radio or loud voices.

Ensuring good eyesight

Problems with sight can increase confusion in people with dementia, and can make it harder for them to recognise people or objects. Optometrists have special techniques for assessing sight, even for people in late dementia. They should also check for cataracts and glaucoma, both of which can lead to blindness if left untreated, as well as for certain other medical conditions. Tactfully remind the person to wear their glasses if necessary, and check that their lenses are clean.

Healthy teeth and gums

It's important that the person you are caring for has regular dental check-ups to make sure there are no problems with their teeth, gums or dentures. Any pain or discomfort will distress the person and may lead to difficulties with eating and drinking, which may increase their confusion.

If you notice any problems, such as swollen gums, ulcers, broken teeth or missing fillings, let the dentist know at once. Explaining that the person has dementia will help the dentist treat the person more effectively. Encourage or help the person to follow the dentist's instructions, such as brushing and flossing their teeth, and cleaning their dentures regularly.

Foot care

Healthy feet are essential if the person with dementia is to remain mobile and active.

• Make sure they wear well-fitting shoes. Although slippers are comfortable, they should not be worn for more than a few hours at a time as they don't offer enough support to the feet.
• Make sure their feet are kept clean and dry, with toenails cut short.
• If there are problems such as corns or ingrowing toenails, consult a state-registered chiropodist.
• If any part of the foot becomes swollen or painful or the skin changes colour, contact the GP as soon as possible.

Remaining mobile

The more mobile the person remains, the better it will be for their health - and the easier for you to manage. Look for ways to help the person remain mobile.

• If the person becomes unsteady on their feet, seek advice from an occupational therapist on aids and equipment such as grab rails to help people move around. For more information, see the Society's information sheets Adaptations, improvements and repairs to the home and Equipment to help with disability.
• If the person spends a lot of time sitting down, make sure they have a firm, comfortable chair that is easy for them to sit down in and get up from.
• If the person needs your support when they move around, seek advice from an occupational therapist or physiotherapist so you can safely give them the support they need without injuring yourself.

Depression and anxiety

A certain amount of depression or anxiety is very common in people with dementia - particularly in the early stages, when they may be aware of their declining abilities. You can help in the following ways:

• If they are able to talk about what is troubling them, listen and show that you are trying to understand their feelings. Do not brush their feelings aside or attempt to jolly them along. Their feelings are very real.
• Offer affection, reassurance and support.
• If you feel that the person is extremely depressed or anxious, ask the GP for advice - the sooner the better.

For more information, see the Society's information sheet Depression.

Spotting a problem

As the carer, you need to keep an eye on the state of the person's health. As the dementia progresses, they will become less able to identify health problems or to tell you about them, so look out for signs that they might be in pain or discomfort. If you help them wash or dress, discreetly look out for cuts and bruises in case they have fallen and forgotten to tell you. Also look out for rashes or sore places. Any red patches that don't go away after a few hours could be pressure sores, so tell the GP or district nurse immediately. For more information, see the Society's carers' advice sheet Pressure sores.

Getting check-ups

It is worth getting check-ups with the GP, as well as sight, hearing and dental checks, as soon as possible after diagnosis. At this stage, the person may still be able to give information about themselves, and be better able to adjust to any changes, such as a different hearing aid.

Later check-ups will be easier if the professional has been able to establish a relationship with the person at an early stage of their dementia. Ask the person's GP for a general health check if you are worried. If there's an area of particular concern, such as diabetes, make sure the person has regular check-ups.

Medication

In general, the fewer drugs the person has to take the better, both for their dementia and their general health. This includes prescription and over-the-counter drugs.

• As soon as possible after diagnosis, check with the GP to make sure that the person is not taking any drugs that they don't need any more, and that they are taking the lowest possible effective dose.
• Make sure any drugs prescribed to manage behaviour are reviewed very regularly.
• Tell the GP if you suspect that the person's medication may be increasing their confusion or causing other unwanted sideeffects.
• Help the person take their medication at the right time with box compartments or individual tablets marked with days or times. For more severe memory problems, you may have to supervise their medication in case they overlook a dose or take an extra dose by mistake. Place medicines out of reach and out of sight as an extra precaution.

Carers' advice sheet 522

Last updated: February 2006
Last reviewed: February 2006