Dementia often brings about changes in the brain that affect not only memory but also a person’s ability to think clearly, make sound decisions, and control their behavior. One of the lesser-known impacts of dementia, especially in the early stages, is the increased likelihood of erratic behavior. This can manifest as unpredictable choices or impulsive actions that would be unusual for the person prior to the onset of dementia.
Understanding Erratic Behavior in Dementia
Erratic behavior in dementia stems from changes in the brain’s ability to regulate emotions and process information. Dementia, particularly Alzheimer’s disease and frontotemporal dementia, affects the prefrontal cortex — the part of the brain responsible for judgment, planning, and impulse control. As dementia progresses, individuals may make decisions that are out of character, sometimes ignoring risks or consequences that they previously would have carefully considered.
Impact on Decision-Making
Impaired Judgment and Risk Evaluation Individuals with dementia may find it difficult to assess risks or foresee the outcomes of their actions. This could lead them to make unsafe choices, such as leaving doors unlocked or mishandling medications.
Difficulty Following Logical Steps Everyday decisions, like managing finances or remembering appointments, often require a step-by-step process that dementia disrupts. A person may begin the process but forget how to finish it. As a result, someone with dementia may make financial mistakes, such as overpaying bills or falling victim to scams.
Emotional Reactivity and Impulsivity Dementia can lead to a heightened emotional response, making individuals more susceptible to making decisions based on fleeting emotions rather than rational thought. For instance, they might become easily frustrated or anxious and make impulsive choices without considering alternatives.
Helping Loved Ones Make Decisions
Supporting a loved one with dementia through decision-making involves creating a safe environment and encouraging simplified choices. Establishing routines, using reminders, and enlisting the help of professionals can also reduce the impact of dementia on important decisions. As dementia progresses, guardianship or power of attorney may be necessary to ensure that important decisions are made in their best interest.
Dementia’s impact on decision-making is a serious concern, especially as it leads to erratic behavior. By understanding these changes, caregivers and family members can take proactive steps to safeguard the well-being and safety of their loved ones. If you do not already have a care team in place, consider bringing in professional staff to help support your loved one and family. NursePartners’ team of certified nursing assistants are trained in dementia care and are ready to help: 610-323-9800.
Bathing a senior with dementia can be a delicate and challenging task. Dementia often affects memory, comprehension, and emotional responses, so it’s important to approach bath time with sensitivity, patience, and respect. Creating a positive experience can improve not only hygiene but also the person’s sense of dignity and well-being. Here are key considerations to keep in mind:
1. Prepare the Environment Ensure the bathroom is warm, well-lit, and safe. Have all the necessary supplies ready—towels, soap, and clean clothes—to avoid leaving the senior unattended. Non-slip mats, grab bars, and a shower chair can make the process more secure and comfortable for both the caregiver and the senior. Go the extra mile by bringing warm towels, adjusting the room lightening and scents, and ensuring that everything is set up for enjoyable experience.
2. Communicate Calmly and Reassure Explain each step gently, even if the person may not fully understand. A soothing tone and familiar words can reduce anxiety. For example, say “Let’s wash your hands” instead of “It’s time to bathe,” as specific instructions may feel less overwhelming.
3. Maintain Privacy and Dignity Many seniors with dementia may feel vulnerable during bath time. Keep them covered with towels or a bathrobe as much as possible to maintain privacy. Letting them participate—like washing their own face or arms—can promote independence and preserve dignity.
4. Be Flexible and Attentive Adapt to the senior’s preferences and moods. If they seem resistant or fearful, it may help to switch to a sponge bath or try again later. Being attentive to their reactions ensures a gentler, more respectful experience.
5. Use Touch to Reassure A comforting touch can offer reassurance. Holding their hand or gently guiding them can reduce feelings of confusion or agitation. Stay mindful of non-verbal cues, as body language often communicates more than words.
6. Focus on Comfort, Not Perfection The goal is to keep the person clean and comfortable. If a full bath is too stressful, consider alternatives like a sponge bath or focusing on key areas—hands, face, underarms, and the groin.
Caring for a senior with dementia requires adaptability and empathy. By creating a calm and supportive environment, you can help ensure that bath time is a positive experience that maintains their dignity and comfort.
Teepa Snow and the Positive Approach to Care (“PAC”) team, emphasize several key strategies for deescalating tension between caregivers (“carepartners”) and individuals living with dementia. Her approach is rooted in the Positive Approach to Care, which focuses on understanding the person with dementia, adjusting care strategies, and promoting positive communication. Here are some of their recommendations:
1. Stay Calm and Use a Positive, Supportive Tone
Approach with empathy: The PAC stress the importance of remaining calm and non-confrontational. The care partner should use a gentle, positive tone of voice, avoiding frustration or anger, as people with dementia often react strongly to emotional cues.
Body language: Non-verbal cues such as facial expressions, body posture, and gestures are critical. Teepa advises maintaining a relaxed posture, a soft gaze, and open palms to convey safety and support.
2. Step Back and Observe
Recognize triggers: The PAC suggest that care partners should try to identify what might be causing the tension. Is the person with dementia feeling anxious, frustrated, or confused? Understanding the root cause can help the carepartner intervene more effectively.
Pause before reacting: Instead of reacting immediately, encourage caregivers to take a step back and assess the situation. This moment of reflection can allow both the carepartner and the person with dementia to cool down.
3. Use Positive Physical Approach (“PPA”)
Approach from the front: The PAC emphasize approaching the person living with dementia from the front, so they can see the care partner coming. Sudden movements or approaching from behind can be startling and escalate tension.
Create a connection: Establish eye contact, offer a smile, and touch gently if appropriate (for example, on the forearm or hand) to create a sense of trust and safety.
4. Modify Communication
Simplify language: The PAC advise carepartners to use short, simple sentences with clear instructions. This helps the person with dementia process the information more easily.
Validate emotions: Acknowledging the feelings of the person with dementia, even if their logic seems off, is crucial. For example, saying something like, “I see you’re upset. Let’s see how we can make this better” can help defuse a situation.
Avoid arguing or correcting: Instead of trying to convince the person of reality or correct them, go along with their perspective in a non-confrontational way. This prevents unnecessary conflict.
5. Redirection and Distraction
Shift the focus: Gently redirect the person’s attention to something else if they are fixated on something that is causing distress. This could be an activity, a change of environment, or engaging them in a simple task.
Offer a choice: Giving the person two simple options (e.g., “Would you like to sit here or over there?”) can help them feel a sense of control and diffuse tension.
6. Adapt Environment and Expectations
Minimize overstimulation: The environment can play a significant role in how a person with dementia responds. Reducing noise, simplifying the space, or turning off a TV can reduce confusion and agitation.
Adjust expectations: Encourage carepartners to meet the person where they are, adjusting tasks to the person’s current abilities and avoiding frustration with unrealistic expectations.
7. Use a “Hand-under-Hand” Technique
The PAC developed a method called the Hand-under-Hand technique, which allows the carepartner to guide the person with dementia through tasks, offering support and connection without being overpowering. This technique helps with both communication and physical interaction, providing a sense of safety and reassurance.
The PAC methods focus on fostering a compassionate, respectful relationship, where the carepartner seeks to understand the perspective and needs of the person living with dementia, thus preventing and deescalating tension effectively.
Lewy Body Dementia (LBD) is a progressive neurological disorder caused by the buildup of abnormal protein deposits (Lewy bodies) in the brain. This results in both cognitive and motor impairments, which worsen over time. Here, we’ll explore some of the extreme symptoms that can emerge as the disease progresses.
1. Severe Hallucinations and Delusions
A hallmark of LBD is vivid visual hallucinations, often involving people, animals, or objects. Over time, these hallucinations become more frequent and intense. Patients may also experience delusions, like Capgras syndrome, where they believe their loved ones are impostors. These false beliefs can cause paranoia, fear, and mistrust, making caregiving especially difficult.
2. Cognitive Fluctuations
Cognitive function in LBD patients can fluctuate dramatically, even within a single day. Patients may switch between near-normal cognition and extreme confusion. During severe episodes, individuals may not recognize familiar people or become completely unresponsive, leading to significant distress for both the patient and their caregivers.
3. Severe Parkinsonism and Mobility Issues
LBD often causes Parkinson’s-like motor symptoms, including tremors, stiffness, and slowness of movement. In advanced stages, these symptoms worsen, leading to severe mobility impairment. Many patients eventually become bedridden, needing full assistance with daily tasks. The risk of falls also increases, making mobility challenges even more dangerous.
4. Sleep Disorders and REM Sleep Behavior Disorder
Patients with LBD frequently suffer from severe sleep disturbances. The most extreme form is REM Sleep Behavior Disorder (RBD), where individuals physically act out their dreams, sometimes violently. This poses a risk of injury to both the patient and their bed partner. Insomnia and excessive daytime sleepiness are also common, worsening cognitive and emotional symptoms.
5. Autonomic Nervous System Dysfunction
LBD often disrupts the autonomic nervous system, leading to extreme symptoms like:
Blood pressure fluctuations: Frequent dizziness and fainting due to orthostatic hypotension.
Bladder and bowel dysfunction: Incontinence or severe constipation.
Body temperature regulation issues: Difficulty feeling comfortable, leading to extremes of feeling too hot or cold.
These complications can worsen overall health, leading to additional challenges like dehydration and infections.
6. Medication Sensitivity
LBD patients are highly sensitive to certain medications, especially antipsychotics. These drugs can exacerbate symptoms, causing severe side effects like worsened motor control and even life-threatening conditions. Non-drug approaches are often preferred, though options for managing psychiatric symptoms are limited.
Conclusion
Lewy Body Dementia is a complex and severe condition marked by extreme symptoms such as hallucinations, cognitive fluctuations, motor impairments, and sleep disturbances. These symptoms make caregiving challenging and require comprehensive, specialized care. Awareness of the extreme nature of LBD’s symptoms can help families and caregivers better understand and manage this debilitating disorder.
NursePartners has helped thousands of families in the Philadelphia region, caring for loved ones living with Alzheimer’s disease, Lewy Body disease, and other forms of dementia. Call us to learn more about how we can best support you, 610-323-9800.
Dementia, a decline in cognitive function beyond normal aging, can be worsened by a lack of mental stimulation. Older adults who stop engaging their brains through activities such as socializing, problem-solving, or learning may experience a more rapid onset of dementia. Here are the key signs to watch for, especially in those who are running more on habit than on social and intellectual curiosity:
1. Memory Loss
Difficulty remembering recent events, names, or tasks is often one of the earliest signs. Repeatedly asking the same questions or forgetting appointments is common in dementia.
2. Confusion and Disorientation
People may lose track of time, forget where they are, or become confused in familiar settings. This is especially prevalent in individuals who aren’t actively engaging in cognitive activities.
3. Difficulty with Daily Tasks
Familiar tasks such as cooking, managing finances, or following directions become challenging. This may happen more quickly in adults who don’t challenge their brains regularly.
4. Decline in Communication Skills
A person might struggle to find the right words or follow conversations. Social withdrawal often accompanies this, particularly when the individual is no longer mentally or socially active.
5. Mood and Personality Changes
Depression, irritability, or apathy can occur, especially in those who are less engaged in stimulating activities. These mood shifts often signal cognitive decline.
Cognitive Inactivity and Dementia
Lack of mental stimulation can accelerate cognitive decline in older adults. Regular brain engagement—through reading, puzzles, or social interaction—helps build neural connections. Without these activities, the brain’s cognitive reserve diminishes, increasing the risk of dementia.
Preventive Measures
While there’s no cure for dementia, engaging the brain can help delay its onset. Simple steps like doing puzzles, learning new skills, staying socially active, and maintaining a healthy lifestyle can slow cognitive decline and promote better mental health.
In summary, older adults who stop challenging their brains are at higher risk of developing dementia, or having their dementia progress quicker. Recognizing early signs and promoting brain-engaging activities are key to maintaining cognitive function as we age. NursePartners has a team of dementia certified carepartners who seek to build engaging and durable relationships with your loved one. Want to learn more? Call us today at 610-323-9800!
As we know, often it is not what we say, but how we say it, that impacts our probability of success. It is no different than with caregiving.
Someone living with dementia is grappling with a loss of control. They are older adults who have lived their entire lives, led successful careers, raised families, and are used to being in control. It is not easy to accept the fact that they need help from others to carry on with basic tasks.
Therefore, consider the following phrases and how we might change them:
I want you to … –> May I help with that?
You need to … –> Can I do that with you?
That’s not what I told you … –> Would it be alright if?
No, not like that… –> How about we try it this way?
You can’t… –> How do you feel about this?
Let me do that for you… –> How about we do this together?
Why don’t you… –> Do you prefer this or that?
Don’t you remember? –> This is your (house/sister/son,etc.).
Please do this… –> Would you like to do that now or in a few minutes?
In addition to changing our phrases, we can also use new ones when we encounter difficult situations. If your loved one in angered or frustrated, acknowledge how they feel and explicitly express empathy. They do not like their situation any more than you. This will help them feel understood.
Some of these ideas came from the Mayo Clinic’s magazine “Living with Dementia”, specifically Chapter 3, p. 42.
NursePartners adopts the terminology “carepartner” to describe a “caregiver” who is a partner in a client’s care. The key word is partner, since the certified nursing assistant involves the client in their own care. This helps preserve the client’s sense of dignity and responsibility for their own well-being.
In particular, carepartners connect with clients before providing care. This requires getting to know more than that client’s clinical care needs and digging deeper into the client’s interests and life history.
It also involves using the hand-under-hand technique to guide and support the client to partake in their own care. Sometimes this can be used to help transfer a client, help bring a spoon to the mouth, or hold a sponge while bathing. For some tasks, the carepartner can help trigger muscle memory which allows the client to continue the action independently.
The Mayo Clinic also differentiates the term caregiver from carepartner.
“Learning to approach support and caring as a partnership means seeing the person living with dementia as a while person, and not making assumptions based on a diagnosis or label. It means including the person with dementia in decision-making. A care partnering approach is one of doing ‘with‘ rather than always doing ‘“‘for'” (Chp. 2, p. 18).
The advice from this article comes from NursePartners Positive Approach to Care training as defined by Teepa Snow. We have also incorporated information from the Mayo Clinic’s magazine, Living with Dementia: A Guide to Caregiving and Support. Specifically it came from Chapter 2, “Your role as a caregiver”. The original content was published by Meredith Operations Corporation in 2023.
A diagnosis of dementia affects everyone differently. According to the Mayo Clinic’s magazine, Living with Dementia: A Guide to Caregiving and Support,these reactions can summarized as follows:
Embarassment
Sadness
Fear
Disbelief
Anger
Shock
Loss
Numbness
Relief
Before the diagnosis, individuals and their families may have been frustrated by their inability to explain changes in mood, behavior, and memory. This is why sometimes a diagnosis can provide understanding into the true root cause and help individuals and their families adapt to the new reality.
The diagnosis empowers us to proactively support ourselves or our loved ones to find new ways to support the person living with dementia. The Mayo Clinic suggests that a diagnosis can:
Give us the answers to those changes in mood, behavior, and memory that we noticed before. Clarity can allow us to focus on what we can change, and acknowledge what we cannot.
Cognitive changes will be seen for what they are, a part of the disease process, instead of a defect of the individual.
We can support the older adult to leverage their current abilities to still live a life fully of meaning, focusing on what they can do, instead of dwelling on what they cannot.
We can prepare ourselves with information, support, and resources for those living with dementia. We can join support teams and learn from other who have gone through the journey.
Proactively connect and engage with the person living with dementia. Activity and socialization will help slow the disease progression and improve the quality of life.
Permit the person living with dementia to organize their health and financial legal documents and plan ahead for the future.
The advice from this article come from the Mayo Clinic’s magazine, Living with Dementia: A Guide to Caregiving and Support. Specifically it came from Chapter 1, “Adjusting to a diagnosis”. The original content was published by Meredith Operations Corporation in 2023.
Late-stage dementia can be a tough and challenging time for caregivers and loved ones. However, understanding what to expect during this stage can help make the experience more manageable. The progression of dementia is marked by changes such as memory loss, language impairment, and carrying out familiar daily tasks. Though it’s difficult to predict the exact course of this progressive disorder, the last stage of dementia has specific identifiable characteristics.
As caregivers, it’s important to understand what happens in your loved one’s brain and how that affects their behavior and capabilities. At NursePartners, our Certified Nursing Assistants (CNAs), also known as CarePartners, support and care for dementia patients whether they are aging at home or in a healthcare facility. We’ll connect with your loved one as they endure the last stage of dementia symptoms, which can be a challenging and emotionally charged experience.
It’s important to understand the final stages of this disease so you can better adjust your care techniques to be more effective. In this post, we’ll let you know what to look out for during the final stages of dementia.
What is Late-stage Dementia?
Late-stage dementia is the final stage of progressive brain disorder. This is when symptoms become severe enough to significantly interfere with daily life and everyday activities. The exact symptoms will vary from person to person, but they can be extremely challenging for the individual and their caregivers.
At NursePartners, we are trained in using The GEMS™: Brain Change Model, designed by world-renowned occupational therapist Teepa Snow. We use this approach to connect with and care for patients at every stage of dementia.
Under The GEMS™: Brain Change Model, Dr. Snow categorizes dementia stages as gemstones. It’s an approach that encourages a strong care partnership by seeing your loved one as precious, unique, and capable. Our CarePartners use this model to help them to live fully in their moment. The advanced stages of dementia are classified as follows:
Amber
Ambers prefer to live in the present and are sensation-driven, manipulating, gathering, and touching objects. They emphasize wants and needs and occasionally wander while unaware of risks. Since they have trouble comprehending and expressing needs due to their limited communication ability, choosing familiar and sensory-stimulating activities is best.
Ruby
Rubies start to lose their motor coordination. They also experience difficulty with visual awareness and major sensory changes, causing them to require assistance with everyday activities and actions such as brushing, buttoning, and walking. Hand-under-hand assistance helps rubies feel safe and secure.
Pearl
In the last stage of dementia are our Pearls. They are oblivious to their surroundings like a pearl layered and concealed within a shell. They are also motionless and quiet. Pearls cherish intimate moments by clinging to pleasant noises and recognizable voices.
What are the Symptoms of Dementia Towards the End of Life?
The symptoms of late-stage dementia can vary depending on the underlying cause. Still, people in the last stage of dementia are more likely to experience a decline in physical and cognitive function.
The last stage of dementia symptoms include:
Difficulty remembering names and faces
Struggling to speak coherently
Having a limited understanding of what is being said to them
Inability to walk
Difficulty swallowing and feeding themselves
Inability to use the toilet independently.
They may also suffer from weight loss, incontinence, and sleep problems. In addition, people with late-stage dementia are at an increased risk for falls and other accidents. As the condition progresses, they typically become bedridden and require around-the-clock care.
Further changes are common as a patient’s condition deteriorates within a few days or hours of dying. The person may:
worsen more quickly than before
lose consciousness
be unable to swallow
become agitated or restless
develop an irregular breathing pattern
have a chesty or rattly sound to their breathing
have cold hands and feet.
How Long Does the Late-stage of Dementia Usually Last?
On average, the final stage of dementia last one to two years. Ultimately, the length of time a person spends in the last stage of dementia will depend on many factors, including the underlying cause of the disease and the individual’s overall health.
How to Support Someone During the Last Stage of Dementia?
Knowing that your family member or friend is near the end of life can be devastating, but making some plans may make things easier. When someone reaches the final stages of life, one of the main concerns is ensuring they are comfortable and as pain-free as possible.
There are a few things that you can do to manage difficult behaviors associated with late-stage dementia:
Create a calm and safe environment: Make sure the space around them is uncluttered and free from potential hazards. Consider using soft lighting and calming music to create a soothing atmosphere.
Encourage communication: Try engaging them in conversation and activities they enjoy. This can help them feel more connected and less frustrated.
Provide support: It is important to provide physical and emotional support to the person with dementia and other caregivers. This can help reduce stress levels and prevent burnout.
Professional Help for Late-Stage Dementia Available in Philadelphia, Montgomery, Chester, and Delaware Counties
For 20 years, NursePartners has supported families by providing compassionate and experienced nurse care to their loved ones living with dementia. We will work with you to devise a comprehensive care plan for your relative.
Contact us today by calling 610.323.9800 for a free consultation. You may also complete our online contact form.
Our traditional home care clients are entitled to a basic list of rights, which we call the “Bill of Rights”. We keep these in mind throughout the entire process, from meeting the client, forming the care team, and through supporting them throughout the length of service.
Know his/her rights.
Choose the home car agency that will provider their care.
Receive competent care without regard to race, creed, color, age, gender, sexual orientation, or national origin.
A personal and written care plan and participation in decisions affecting their care.
Receive services with reasonable accommodations of individual needs and preferences.
Be treated with respect, consideration, and kindness.
Be served by dependable and responsible caregivers.
Enjoy confidentiality regarding all medical, financial, and personal information.
Be free of physical, verbal, emotional, and sexual abuse from anyone, including caregivers.
Request caregiver replacements when necessary.
Contact the agency twenty-four hours a day, seven days per week.
Receive services as contracted and given an explanation of all changes.
Voice complaints, have them reviewed, and resolved without an interruption in service.
Receive referrals to other health care providers if the service is denied based upon the ability to pay.
Refuse any treatment or service.
Entitled to privacy, modesty, and security.
Have their property respected.
If the client is living with dementia, they are entitled to the rights above, in additional to a few more which are worth enumerating.
To be informed of their diagnosis.
To have appropriate, ongoing medical care.
To be productive in work and play.
To have expressed feelings taken seriously.
To be free from psychotropic medications if at all possible.
To live in a safe, structured, and predictable environment.
To enjoy meaningful activities to fill each day.
To be out-of-doors on a regular basis.
To have physical contact including hugging, caressing, and handholding.
To be with persons who know one’s life story, including cultural and religious traditions.
To be cared for by individuals well-trained in dementia care
