Managing Day to Day
With medical interventions for the treatment of dementia being limited, learning skills to manage day-to-day life becomes the priority.
Progressively Lowered Stress Threshold (PLST) is a conceptual model for care developed by Dr. Geri Hall which offers a framework to understand and reduce behaviors associated with Alzheimer’s disease and related disorders. PLST is exactly as the name implies. As the dementia progresses, the person’s ability to tolerate stress decreases. Stress is anything that requires thought.
Since it takes more and more energy to process information from what the person is hearing, seeing, feeling, it's important to keep the following in mind to best manage day-to-day.
Fatigue is the person with dementia's worst enemy. They are going to become fatigued more easily and are less likely to identify it than in the past.
Strategies that may help:
- Provide plenty of rest and rest periods. Schedule the day to allow for some down time so the person may rest and recharge.
- Shorten activities. Instead of playing the full round of golf, play nine holes instead.
- Get to know their best time of day. When are they are their peak, their sharpest? It will be different for each person, but try to schedule the day around this. When they are at their best, schedule doctor appointments, social visit or more taxing activities.
Someone with dementia loses the ability to plan and sequence activities. In addition, as the disease progresses the world becomes less and less familiar.
Strategies to consider:
- Be consistent. In a world that has become unpredictable, comfort can be found in consistency. Routine is predictable, so try to have a schedule that the person take comfort in and rely on.
Since having to think and process information increases stress, too much information or too high of expectations can be overwhelming.
Try these strategies:
- Announce only when and what is necessary. Consider what the person really needs to know and when they need to know it. If you know the information could be anxiety producing, less is more.
- Have realistic expectations. Always assume a person with dementia is trying as hard as they can in difficult circumstances. Holding them to a standard or expectation from the past is not only an attempt to control something that cannot be controlled, it is unrealistic and anxiety producing.
As dementia sets in, the area of the brain responsible for interpreting information becomes damaged. So while their eyes are still seeing and their ears are still hearing, the brain is not processing the information the same way it has in the past.
Strategies that may help:
- Never argue or orient to your reality. Know that whatever the person is presenting you with is their reality. By trying to convince them otherwise, you will create a barrier between the two of you. Instead, work with the reality that is being shared.
- Remove distractions. Excess information increases the likelihood of overwhelm. Turn off the TV in the background or pull the drapes at night, take down family pictures. Explore the environment with your sense and eliminate what is not necessary.
The ability to express thoughts, wants and needs while communicating understanding changes in a person with dementia. As their ability to communicate changes, you must adapt to the way you communicate as well.
Here are some strategies to help.
- Respond to the emotion. What most people want is to be understood on an emotional level. Listen beyond the words that are being used to identify the emotion. Acknowledge and validate that. "You sound _______. I would feel the same way, too!"
- Pay attention to non-verbals. Verbal communication is a complicated process for the brain. As the dementia progresses, listen more to what the person's non-verbals are saying to you. Be mindful of what yours is saying, too.
Looking for more to improve communication? Check out our Care TIPS.
Early in dementia, a persons ability to initiate and engage activities can change. Because of this, many people with dementia can feel a loss of purpose.
Try these strategies:
- Encourage participation. Invite the person to participate and be there to help them through the steps if needed.
- Focus on pleasure. Rather than focusing on the task at hand, keep the focus on the enjoyment of the activity.
- Adapt as the disease progresses. Consider how the person can continue to be involved in loved hobbies by adapting them. For example, an avid gardener may enjoy snapping peas even if they aren't able to be in the garden.