Daily care

1. Behaviour is communication. Someone who becomes agitated is telling you something they can no longer say. Pain, hunger, thirst, needing the toilet, too hot, too loud, too many people, frightened. Check those first, every time, before you treat it as "the dementia".
2. You cannot win an argument with a damaged brain, and you do not need to. Being right does not help anyone here. Go for calm instead.
3. Change the situation, not the person. You can alter the room, the light, the noise, the time of day and how you ask. You cannot alter their capacity.
4. A new behaviour deserves a medical check. A sudden change over days — not months — is often a urinary infection, pain, constipation, or a reaction to a medicine. Call the doctor.

Before you speak: turn off the television. Come into view from the front, not from behind. Get to their eye level. Say who you are, even if you think it is obvious.

How to say it:

• Short sentences. One idea at a time.
• One instruction, then wait. Break "get ready for bed" into six separate steps.
• Ask questions that can be answered with yes or no, or offer two choices you are holding up.
• Slow down and lower your voice rather than raising it. Speaking louder sounds like anger.
• Use names, not "he" and "she". Pronouns get lost.
• Give them time to find a word. Count to ten in your head before you supply it.
• Point, demonstrate, hand them the object. Show, do not just tell.

Your face and body carry more than your words. Long after language goes, people read tone and expression accurately. If you are exhausted and tense, they will pick it up and match it. That is not a moral failing on your part — it is a reason to take a break before a difficult task, not after it.

The same question, over and over. They are not testing you. Each time is genuinely the first time for them. Answer briefly, in the same words. If it is a question about time — "when are we going?" — write the answer on a card or a whiteboard they can check themselves. Often the repetition is anxiety wearing the clothes of a question; a hand on the arm and "you're safe, I'm here" can settle it when a factual answer will not.

When they say something that is not true. Asking for a parent who died forty years ago. Insisting they have to get to work. Believing money has been stolen.

Correcting them delivers fresh grief or fresh humiliation, and it does not stick. Instead:

• Answer the feeling. "You're missing your mum." Usually the feeling is what is real.
• Do not lie elaborately, but do not force the truth either. "She's not here right now" is both true and kind.
• Redirect afterwards. "Tell me about her." Move, change the room, offer a drink. Then the conversation has somewhere to go.
• For accusations of stealing: do not defend yourself. Help them look. Learn the hiding places. Keep duplicates of keys, glasses and the wallet.

In the moment:

• Stop the task. Whatever it was can wait.
• Make sure you both have a way out of the room. Do not get cornered.
• Stay out of arm's reach if they are lashing out, and keep your voice low and slow.
• Do not grab, restrain or crowd them. Do not argue.
• Say less. Reduce the noise and the light. Send extra people out of the room.
• Offer one simple, appealing thing: a drink, music they know, going outside.
• If you are losing your temper — and you will sometimes — and they are safe, step out for two minutes. Walking away is a legitimate technique, not a failure.

Afterwards, write down what happened just before. A pattern usually appears within a couple of weeks: always at bath time, always when the grandchildren visit, always before lunch. The pattern tells you what to change.

If a doctor or care home suggests medication, read what the studies show about antipsychotics for agitation: the benefit is modest and the risks are real.

Many people become more confused, restless and anxious in the late afternoon and evening. It is common enough to have its own name. Nobody is certain why it happens; tiredness, fading light, disrupted body clocks and the general noise of the end of the day all seem to play a part.

What tends to help:

• Turn the lights on before dusk, not after. Close the curtains so the windows stop turning into dark mirrors.
• Move the demanding tasks — bathing, appointments, visitors — to the morning.
• Keep the late afternoon quiet and low-stimulation. One person, one activity.
• Daylight and activity earlier in the day, especially a walk outside in the morning.
• Make the main meal at lunchtime and keep the evening one light.
• Check caffeine, alcohol and long daytime naps.
• Keep the evening exactly the same, every night.
• Plan your own evening around it. This is often the worst hour of the day for the caregiver too.

If it is severe or getting worse, tell the doctor — sometimes pain, a sleep disorder or a medicine schedule is driving it.

Wandering is common, and it is dangerous: a person who is not found quickly can come to serious harm. Full detail is on the safety page, including what to prepare in advance and what to do in the first minutes someone is missing.

In day-to-day terms, wandering usually has a reason. They are looking for a bathroom they cannot find, trying to go to a job they had in 1979, bored, in pain, or trying to get away from noise. Reducing the reason works better than locking a door.

• Put a clear sign with a picture on the bathroom door.
• Build in a long walk every day — restlessness needs somewhere to go.
• Watch for the times of day it happens and fill them with something.
• Take care with front doors: locks out of the usual line of sight, a bell or chime, dark mats that can read as a barrier.
• Never lock someone in a house alone. That is a fire risk, not a safety measure.

Bathing is the single most-reported flashpoint in dementia care. It involves being undressed, cold, wet and handled by someone else — frightening if you no longer fully understand what is happening.

Before: warm the room first. Lay everything out. Decide what you will do if they refuse (usually: stop and try again in an hour).

During:

• Say what you are about to do before each step. Never surprise someone with water.
• Keep them covered with a towel as much as possible — dignity reduces resistance.
• Shower spray on the feet first, working up. Faces last, and gently.
• Hand them a flannel to hold or a task to do. Having a job reduces panic.
• Grab bars, a shower chair, a hand-held shower head and a non-slip mat make all of it easier.
• Test the water yourself. Ask the plumber or landlord to turn the maximum hot-water temperature down.

Lower your standards deliberately. A daily bath is a modern habit, not a medical requirement. Two or three a week, with a wash at the sink in between, is fine for most people. This is one of the easiest places to stop fighting.

Dressing: lay clothes out in the order they go on. Offer two options, not a wardrobe. Buy elastic waists, slip-on shoes, front fastenings, large buttons. If they want to wear the same jumper every day, buy three of that jumper.

Weight loss is common in dementia and it matters — it predicts falls, infections and hospital stays.

• Serve one food at a time. A full plate can be overwhelming.
• Use a plain plate in a colour that contrasts with the food. Visual processing is often impaired, and mashed potato on a white plate can genuinely disappear.
• Clear the table of everything else, and turn the television off.
• Finger food solves a lot: sandwiches, fruit, cut-up cooked vegetables, cheese. Cutlery is a skill that goes early.
• Eat with them. People eat more in company, and they will copy your movements.
• Six small meals often work better than three big ones.
• A sweet tooth frequently appears. Within reason, let it — calories are the priority.
• Offer drinks all through the day. Thirst fades, and dehydration causes confusion, constipation and infections. Jellies, ice lollies, soup and fruit all count.
• Check the mouth. Toothache, ulcers and badly fitting dentures are common, hidden reasons for refusing food.

• Take them every two hours or so rather than waiting to be asked. Accidents are often a matter of not finding the room in time.
• A picture sign on the door; the door left open; a night light along the route.
• A contrasting toilet seat — a white seat on a white floor can be invisible.
• Clothes that come down fast: elastic waists, no belts, no complicated fastenings.
• Watch for the signals — tugging at clothes, pacing, sudden restlessness.
• Less fluid in the last couple of hours before bed, but not less during the day.
• After an accident, say nothing about it. Keep it brisk and ordinary. The shame is the part that causes damage.

New incontinence deserves a call to the doctor. Urinary infections, constipation, diabetes and medicines are all common causes and several are easily treated.

• Daylight in the morning, ideally outdoors, is the strongest lever you have on a broken body clock.
• Keep naps short and before mid-afternoon.
• Same bedtime, same order of events, every night.
• Caffeine stays in the system for hours. Check what is in the afternoon cup of tea.
• Alcohol in the evening wrecks the second half of the night.
• Check the bedroom: too hot, too cold, too dark to find the bathroom, too much shadow.
• Pain is a very common and very missed cause of night waking.

If nothing works, speak to the doctor. Sleep medicines are used cautiously in dementia because several increase confusion and falls — that is a conversation for a prescriber, and this page does not recommend any medicine or dose.

An empty day produces agitation, wandering and sleeping at the wrong times. Activity is not a luxury here; it is part of the care.

What works:

• The process, not the product. Folding the same basket of towels twice is a success if the folding was satisfying.
• Old skills over new ones. A gardener can still garden. A mechanic can sort a box of bolts. Long-practised abilities survive much longer than new learning.
• Music from when they were roughly fifteen to twenty-five. That is the era that stays, and it reaches people well into the late stage.
• Useful jobs. Sweeping, drying up, sorting socks, winding wool. Feeling useful is a need that outlasts capability.
• Outside, daily, if at all possible. Light, movement and change of scene help mood and sleep together.
• Touch and animals. Hand cream and a hand massage. A dog. A baby. These reach people when conversation cannot.
• Photographs from long ago rather than recent ones — and do not quiz them. "Tell me about this" is better than "who is that?"

Adult day programmes deserve a serious look. They give the person a structured day with other people, and give you several hours back. Around a quarter of people using adult day services in the US have dementia. Your Area Agency on Aging can tell you what exists locally; the help page explains how to reach yours.