4. Supporting someone with memory loss
Forgetting recent conversations or events
People with memory problems will find it hard to store, and then remember, recent conversations and events. The part of the brain (the hippocampus) that allows new information to be processed may be damaged. This makes it harder for the person to form new memories and learn new information. The person may forget a conversation they’ve had, something they’ve recently done, or an appointment or plan. It is important to remember that the person isn’t being difficult or ignoring you. Their brain hasn’t kept the information, and so it may feel like the first time they’ve heard it. The following tips may help.
- Avoid telling the person they have heard the information before.
- Ask yourself whether it really matters if the person remembers a recent conversation or event. Forcing the matter can makes things worse.
- Set up a regular routine. This can make it easier for the person to remember what is going to happen during the day.
- Encourage them to use a diary or journal to record things that have happened. Pictures and words are useful tools. They can be used to remind the person what they have done, as a conversation starter.
- Include cues and prompts, and try to give context, instead of asking vague questions. For example, ‘It must be a while since breakfast. Are you hungry?’ rather than ‘Have you had breakfast?’
- Consider using reminders such as sticky notes or a wall calendar for one-off tasks, and more permanent reminders for tasks the person does more often (such as keeping a note by the door to remember keys and wallet).
- Consider assistive technology devices, such as an automatic calendar clock, to help the person remember important things.
- Focus on one thing at a time: giving the person too much information may be overwhelming.
- Keep information simple, and repeat it often (if necessary).
- Reduce distractions such as background noise.
- Keep questions simple and specific, for example‘Do you want tea or coffee?’ rather than, ‘What would you like to drink?’ This helps the person to make a choice by narrowing down options.
Struggling to find the right word
People with dementia may have difficulties finding the right word in a conversation. They may also struggle with remembering names of items or people. They may:
- struggle to find the right word in a conversation (for example saying shoe instead of chair) or seem stuck because the word is ‘on the tip of their tongue’
- struggle to remember the meaning of words
- forget people’s names even if they know them well
- forget the names of objects (such as knife, book, tree).
These difficulties can make it harder to communicate with a person with dementia. However, there are a number of ways to support conversation.
- Give the person enough time to find the word, but try not to leave it so long that the person becomes embarrassed.
- Consider the context of what the person is saying – this may give clues to the word they are trying to find.
- Turn down background noise and try to make sure the environment is not too distracting.
- Consider the time of day when the person is at their best. This may be in the morning when they have more energy.
- Don’t rush the person. If they feel stressed or under pressure it may make things worse. Be patient and don’t complete the sentence for them.
For more information on communicating with a person with dementia see factsheet 500, Communicating.
Tips: supporting a person with dementia when they forget the names of objects and people
- Try to find tactful ways to give the person reminders or prompts (for example ‘Here’s our neighbour, Bill’).
- Try not to put the person on the spot or say things that highlight they have forgotten the person’s name (such as ‘You must remember who this is?’).
- It’s much harder for the person to remember names if they’re tired or stressed. Try to wait until they’re feeling a bit better.
- Ask the person whether it would be helpful for other people to introduce themselves when they speak to them. This may depend on how the person feels about their difficulties and whether they are happy for others to know.
- Use prompts, cues and context to help with naming items. The person may recognise something and what it is used for, even if they can’t remember its name.
- Consider using a ‘memory book’ or ‘memory box’ with photos and brief information on people (such as their name or relationship) for the person with dementia to refer to.
- Try not to visit places that are too busy, such as markets – the person may cope better in situations with fewer people.
People with dementia often lose and misplace items, as a result of their memory loss. They may:
- lose common items, such as glasses or keys
- leave items in unusual or ‘wrong’ places, for example keys in the bathroom or tea bags in the fridge
- put an item somewhere for safe keeping, and then forget where it is.
Knowing the person will help you think of where they might put things as you will be aware of possible connections that they make.
The person may also think that someone is taking items, if they aren’t where they thought they were. This can be difficult both for the person and those around them. However, the person with dementia is trying to make sense of their reality and what is happening. They may not remember that they have put an item somewhere, so may assume that someone has taken it. Equally however, there may be truth in what the person is saying – don’t dismiss it because they have dementia. It’s important to see things from their point of view.
Tips: supporting a person with dementia when they lose items
- Try to keep items in the same place, where the person is used to them being, for example keys on a hook or in a drawer.
- Consider getting copies of items that are important or often misplaced, such as keys, glasses, important documents.
- Make the most of the environment. Keep rooms and drawers tidy so that things are easier to find. Good, evenly-distributed lighting can also help.
- Use visual clues that explain where items go, such as pictures or photos on cupboard doors of what goes inside them.
- Put regularly used items where they can be seen and are easily accessible.
- Consider a locator device to help find items that often get lost, such as keys. For more information see factsheet 437, Assistive technology – devices to help with everyday living.
- Ask yourself whether it really matters. A lost wallet is more important than putting cutlery in the wrong place. If it doesn’t matter it is often best to leave it as it is.
Difficulties with day-to-day tasks
As dementia progresses, the person may have more and more difficulties with tasks they have done many times before, such as getting dressed, making a cup of tea or a familiar meal, taking medication, or hobbies (for example knitting a familiar pattern). This may be partly due to having difficulties remembering the sequence of actions that are needed.
When a person begins to have difficulties with familiar tasks, it can be very worrying for those around them. Family or carers may be worried about the person’s ongoing safety and their ability to manage, which may lead to them stopping the person from carrying out activities. However, it is important to support the person with dementia to do as much as possible, and for as long as possible. Consider the following tips.
- Think about using assistive technology. There are lots of devices available to help people with dementia manage everyday activities – for example, dosette or medication reminder boxes. Another example are motion sensors. These play a recorded message to remind people to take their keys when they pass by the sensor. For more information see factsheet 437, Assistive technology – devices to help with everyday living.
- Support the person to do as much for themselves as possible, by breaking tasks down into smaller, simpler steps.
- Try to find ways to make tasks easier by putting out things the person will need to complete an activity, for example tea bags, a mug and sugar.
- Keep work spaces clutter free and leave regularly used items in the line of sight.
- Use reminder signs to prompt the person, such as simple instructions for using the microwave.
- Make adjustments to the environment that make things easier for the person, such as labelling cupboards with pictures of what is inside and making sure areas are well lit.
- Consider asking for help from an occupational therapist. They will be able to advise on coping strategies and suitable devices for helping with day-to-day tasks.
Getting lost in familiar surroundings
A person with dementia may go to the shops, and then forget where they were going or why. This can lead to them not recognising their environment and getting lost. These tips may be helpful.
- Make sure the person has some form of identification on them when they go out, as well as contact numbers of people they know well. An emergency identification device, such as those provided by MedicAlert, may be helpful (see ‘Other useful organisations’).
- If the person is happy to, they could tell people like neighbours and local shop owners about their difficulties. They may be able to help if the person gets lost. The person may find that having a mobile phone is useful. There are easy-to-use mobile phones available if the person is not used to or is struggling with one.
- If you’re worried about the person getting lost, consider ways to support them so they can go out (such as going to the shops together).
- Talk to the person about assistive technology products, such as a GPS device. These use satellite or mobile phone technology to locate the person. This can help them continue to go out, and reassure them that if they get lost, someone will know where they are. Consider carefully whether you’re comfortable using these, and any risks and benefits – especially if the person is unable to make decisions. For more information on this see factsheet 484, Making decisions and managing difficult situations.
As dementia progresses the person may get lost within their own home, or not recall that where they are now is their current home. They may revert to a memory of a former home (such as a childhood home). The following may be helpful.
- Make sure there are familiar items that clearly belong in the person’s home, such as ornaments or familiar objects.
- Have a reminder of the home address, for example ‘This is 23 The Avenue, Windsor’ somewhere it can be seen, for example by the front door or on a whiteboard in the kitchen.
- Talk to the person about the home they used to live in, and what it means for them. It can help them to place it in the past.
People with dementia may often forget upcoming events – for example, medical appointments, visits and anniversaries.
- Consider using calendars and clocks to remind the person of upcoming events. Place them where the person with dementia will see them, such as on the bedside table or by the phone. This is likely to work best with people who are used to using them.
- If the person uses a mobile phone, or has an online calendar, consider entering reminders for events and appointments.
- Use a noticeboard to display appointment cards –again this should be somewhere where the person will easily see it.
- For certain appointments (such as GP, dentist or hairdressers) it may be possible to arrange a reminder text before the appointment. This may be useful if the person uses a mobile phone.
- Think about how the person remembered events in the past. Using a similar technique is likely to be more successful than trying to learn a new one. For example, did they use a diary or calendar? If so, using one of these may help.
It is important to support the person with dementia to do as much as possible, and for as long as possible.
As the person’s dementia progresses, they may be less able to recognise people. This is because the brain can no longer remember faces or put visual information together. The person may have difficulty:
- recognising faces, including those that are familiar. Hearing a person speak or smelling distinctive perfume or aftershave may help them recognise someone
- recognising their own reflection in a mirror – they may think it is someone else
- recognising a relative or close friend who has come to visit – they may think there is an intruder in their home.
Some people with dementia may think that a younger relative is their spouse or parent. This may be because a person with dementia believes they are living in a different time period (such as when they were newly married). Because they are able to recall memories from their past, and not recent ones, the person with dementia may not identify their spouse. In their mind, their partner is a much younger person, so they may mistake a younger relative as their spouse – especially if they look similar. They may not recognise their children because they believe themselves to be much younger than they are and don’t believe they are old enough to have children, especially adult children.
Not recognising people can be very distressing for both the person with dementia and those around them. It is important to try not to take it personally. Even if the person doesn’t seem to recognise those closest to them, they will still have an emotional attachment to the person, such as knowing that someone makes them feel safe or happy. The following may help:
- Try to find tactful ways to give the person cues or reminders without mentioning the person’s memory loss (for example ‘Hasn’t our granddaughter grown?’).
- Using aids like a ‘memory book’, which includes pictures of family and friends, can act as a useful prompt.
- Offer the person reassurance and address what they are trying to communicate. If they don’t recognise people, they may feel like they are surrounded by strangers and get distressed.
- Focus on how the person responds to you even if they don’t recognise you (such as smiling when they see you).
- Try not to show the person that you are offended or upset by them not remembering your name or recognising you – it is unlikely to be a personal rejection. Instead, offer them reassurance and focus on how you make them feel.
- Talk about how you feel about the situation with someone you trust and try to address your feelings.
Alzheimer’s Society’s Talking Point is an online discussion forum that may be a useful resource. You can get practical suggestions, advice and talk with others experiencing the same things. Go to alzheimers.org.uk/talkingpoint