Caring for Adults: Changing Relationships During Cognitive Decline

PROGRESSION AND NEEDS

Stages of Dementia

Between 12% and 18% of older adults over age 60 experience subtle changes in memory or functioning. If the changes do not interfere with normal life activities, the person may live for decades with only mild cognitive impairment (MCI). Dementia differs from MCI in that it is more noticeable to others and involves impairment with memory, judgment, problem-solving abilities and daily activities.

Those diagnosed with dementia progress in three stages: early, moderate, and late. The symptoms and rate of progression vary from person to person and according to the type of dementia they have—Alzheimer’s disease, frontotemporal dementia, vascular dementia and Parkinson’s disease, for example.

Each stage is unique and comes with a variety of changes in feelings, behaviors, skills and safety that require new approaches and strategies for daily care and communication.

What to Expect and How to Plan Accordingly

Early Dementia

In the early stages, called mild dementia, your loved one may function independently or begin to require some assistance in daily activities. Mild dementia often leads people to have difficulty remembering the right words for a conversation and names, staying organized, making decisions, managing money, or keeping track of medications. These cognitive changes are subtle at first, noticeable mostly to family and close friends.

This stage requires the least amount of physical care, yet it is often the most demanding of the care partner’s emotions and time. Both the care partner and the person who is experiencing the changes can feel overwhelmed by the dawning realization that life as they know it is changing, but it is typically the care partner who reacts first with a mix of fear, anger, sadness and grief.

In addition, care partners begin to feel more anxiety, worrying about what will happen next or how they will cope. When the loved one does not accept the memory loss and demands to live independently, care partners are in a difficult position with few alternatives that satisfy both parties as short-term memory problems, personality changes and more become apparent.

Moderate Dementia

As a person enters the moderate stage, dementia symptoms become more pronounced. You may notice changes in behavior such as loss of inhibitions, paranoia, fatigue, extreme forgetfulness, confusion and wandering. At this stage, your loved one will need more assistance and environmental modifications.

It is also common for people in this stage to become withdrawn. Changes in the brain make it more difficult to process and make sense of what is happening around them, so social isolation feels more comfortable. However, isolation can have devastating consequences for someone living with dementia. Socialization and stimulation are critical to improving quality of life, but both must be adapted to account for confusion and slower processing speeds.

It is at this stage that many unpaid care providers, like family members, experience what is known as caregiver burnout, or exhaustion from their new responsibilities. These individuals can benefit from external support, especially help in the home, adult day programs, and support groups. Depending on available resources for the affected family member’s personal care and socialization needs, it may be time to start considering assisted living.

Late or Severe Dementia

Although each stage of dementia presents a family with a variety of difficult challenges and emotional losses, the late stage of dementia is the most physically demanding and is marked by severe cognitive decline. Your loved one likely can no longer communicate clearly and usually cannot recognize family members, which complicates interactions. Mobility, continence and skills like chewing and swallowing become impaired.

At this point, your loved one will require round-the-clock care and supervision—exceeding the capacity of most families—and an environment adapted to 24/7 support for daily activities such as eating, getting dressed, bathing and toileting. As the dementia advances, caregiving will shift from cognitive to physical interactions, with an emphasis on comfort and soothing stimulation.

Having a higher level of support from professionals with experience providing memory care and help with activities of daily living will make it easier for family members to focus on what is most important: engaging with their loved ones in ways that create positive moments for both.

NAVIGATING EMOTIONS

Communication Strategies for Caregivers

For most care partners, assuming the many responsibilities of caregiving happens gradually. Over time, the relationship becomes increasingly dominated by one partner’s miscommunication, behavior changes and lapses in judgment, all complicated by a seeming absence of empathy from the person living with dementia.

There are rewards in this new role, but there are also hazards, mistakes, blame, anger and fear for the future. For most care partners, nothing in life has prepared them for this. Profound feelings of aloneness set in. One spouse described it: “I am spending full time taking care of my wife, but I am not much good at it. I feel like I have lost my lifelong companion, and at the same time, all our friends have pretty much disappeared.” 
Fortunately, there are strategies or Cardinal Principles that can reduce some stress for both the caregiver and the receiver.

Fortunately, there are strategies or Cardinal Principles that can reduce some stress for both the caregiver and the receiver. 

To apply the Cardinal Principles effectively, keep in mind that dementia damages brain cells. Your loved one does not think the way you do or even how they used to. Their behavior may seem irrational, stubborn, selfish or even mean, but these changes come from the affected person trying to make sense of an environment that often does not make sense to them.

Try to understand the perspective. Adapt your behavior and the environment, because your loved one can no longer adapt. 

See the world through their eyes:
What is causing confusion and misidentification? 

Listen for themes:
Do the same points come up frequently? Often angry outbursts mask humiliation at not being in control of one’s own life. 

Be sensitive to causes of shame or humiliation:
Your loved one may be embarrassed to acknowledge they need help. Try to appeal to their pride by using something you know they are proud of to encourage a specific behavior. 

Watch for triggers to inappropriate behaviors:

After the behavior, think about what happened just before. Identifying the trigger can help head it off in the future. 

Give them choices:
Avoid asking open-ended questions. Ask for permission to provide help, and provide options so your loved one feels a sense of autonomy. 

Make them the expert:
For example, say, “Do you think you want to wear this blouse?” rather than “Put on this blouse.” 

Adapt the environment for the person, not the other way around:
Anticipate (and avoid) stressors such as crowded, noisy places. 

If whatever you’re doing doesn’t work, stop immediately:
Don’t argue and don’t try harder to make your loved one comply. This tactic only increases agitation. 

Experiment with new strategies:
Try different approaches. Check in and ask yourself, “Why did this work? Or why didn’t it?” 

Know that nothing works all the time:
Tell yourself that if something did not work this time, it might work next time. 

DIFFUSING CONFRONTATION

Communication Tips

• Begin any interaction with a smile and cheerful demeanor

• Greet the person by name and make eye contact

• Use short, simple sentences

• Use body language to enhance the message

• Repeat using the same words and a gentle tone

• If agitation happens, stop and come back later

• Ask for permission to help

• Accept blame and apologize when appropriate

• Respond to feelings rather than words

• Forgive yourself for negative feelings

Remember the Don’ts:

• Don’t lecture

• Don’t reason

• Don’t blame

• Don’t remind them that they forget

• Don’t take it personally

Communication Examples

“What do you mean, I’m going to the doctor? No one told me about this. No one tells me anything!” 

Don’t: “I have called you every day about this appointment for a week, and you circled it on your calendar.” 

Do (Make them the expert): “Do you think it is a good idea to go now? There is an appointment waiting for you, and they are hard to get. You always liked this doctor." 

“You’re stealing my money and trying to take my house from me.” 

Don’t: “I am doing no such thing. I have Power of Attorney, and it is my responsibility to pay all your bills. You are being ungrateful.” 

Do (Distract rather than argue): “I think it is time for me to go. My sister will come over and check this out.” 

“I am the head of this household. I make the decisions. No one tells me what to do.” 

Don’t: “You know that your doctor said you have memory loss, so I have to make all the decisions from now on.” 

Do (Make them the expert and apologize): “You are right. I was really out of line on that one. I apologize. It won’t happen again.” 

“You never call me. I get very lonely. Why do you leave me all alone? 

Don’t: “I call you every day, sometimes twice a day. My sister does too. You get plenty of calls. Just concentrate and pay attention.” 

Do (Distract): “Do you like the cookies I baked? They are your favorite recipe. Do you think they are up to your standard?” 

“I know you are visiting, but I don’t remember who you are.” 

Don’t: “Mom, please. This is your grandson. Surely you remember him.” 

Do (Avoid shaming): “Mom, isn’t it wonderful that your grandson Richard is here to visit you!” 

“Why did you bring me black coffee? I have always used cream. How can we be married this long and you don’t know this?” 

Don’t: “You have never used cream in the 47 years I have known you.” 

Do (Make them the expert, apologize, and distract): “How could I have made such a mistake! I apologize for that. What do you think about this new photo of the grandkids?” 

SYMPTOMS OF DECLINE

Coping with Dementia Behaviors

Different types of dementia and different stages of the disease can create a host of different symptoms that may be difficult to respond to. The following tips can make it a little easier to anticipate and respond to changing behaviors caused by dementia.

Paranoia

Dementia causes confusion and memory loss, which may manifest as a loved one becoming uncharacteristically suspicious or accusatory, a type of paranoia. Accusations of theft, infidelity, bribery or other crimes can feel hurtful, unfair and untrue. It can help if you remind yourself that your loved one’s brain is just trying to make sense of an increasingly confusing world. 

• Listen to the fear.
• Respond by taking it seriously.
• Don’t try to talk them out of the fear.
• Offer to help make the situation better.

Delusions

Delusions are fixed ideas and no amount of reason, cajoling or distraction will change the delusion. For example, a delusion could be an unwavering belief that there are bugs in the shower or that someone lives with your loved one in their room. Because they’re fixed, the only way to cope with delusions is to work around them and accommodate them in some way.

Here are some tips: 

• Listen sensitively to the delusion.
• Take it seriously.
• Think of a solution that will accommodate it.
• Ask the person if that solution is okay with them.

Hallucinations

A hallucination is when a person sees, hears, feels, smells or tastes something that is not there. Hallucinations can occur in the early stages of some Parkinson’s-related dementias and the later stages of Alzheimer’s-type dementia. Hallucinations can also be a side effect of fevers or medications. They may be frightening or benign. But whatever they are, it is important to have a physician evaluate the person and determine if medication is needed or if a non-drug approach will be sufficient.

Here are some tips for coping with a hallucination: 

• Listen to the feelings as well as the content of the fear.
• Respond to the feelings. If benign, you might say, “Isn’t that nice to see your daughter?” If frightening, you might say, “This is awful for you. Let’s see what we can do to fix the situation.”
• Attempt distraction, such as moving to another room or doing an activity.
• Be honest: “No, I don’t see it, but I know you do.”

Delirium

Delirium is an abrupt change in the brain that causes mental confusion and emotional disruption. It makes it difficult to think, remember, sleep or pay attention. Delirium often occurs during alcohol withdrawal, after surgery, due to medication, or when experiencing dehydration or dementia. If you suspect delirium, you must contact your loved one’s physician. 

Sundowning

"Sundowning" (also known as sundown syndrome) is not a formally recognized condition, and there is no standard definition for sundowning or its symptoms. However, sundowning in general often refers to trouble sleeping or increased confusion, restlessness, anxiety or disorientation that lasts from dusk throughout the night for people living with dementia.

Sundowning is thought to be due to some combination of physical and mental exhaustion from the day, disruption to one’s biological clock, a weakening ability to distinguish dreams from reality, or reduced visual perception that results in upsetting shadows or difficulty seeing in dim light. Consequently, symptoms tend to grow more severe as dementia progresses.

There is no single approach that works best for handling sundowning. Simply be aware of triggers and make modifications to avoid those triggers. 

Common triggers: A heavy evening meal, loud music, TV shows, poor lighting, darkness viewed through the windows at night, and alcohol/caffeine consumption are all common sundown syndrome triggers.

Strategies for avoiding sundowning: Sticking to a routine and spending time outside in the sunlight can sometimes help avoid disrupting biological clocks. Often, taking a walk together can help, because physical movement can be calming. In the evening, keep interiors and exteriors well-lit, and pursue quiet activities. 

A SECURE ENVIRONMENT

Ensuring Safety with At-Home Care

Dementia uniquely affects each person. You will need to continually assess your environment based on your loved one’s current symptoms, such as level of memory loss, comprehension, confusion, wandering, disorientation and physical limitations such as balance, coordination and mobility.

Changes in symptoms of dementia may require additional environmental alterations. Individuals with dementia may forget how to use an appliance, get lost on their own street, become more sensitive to high or low temperatures, and grow more disoriented. In addition, their cognitive and physical abilities will change over time as the disease progresses. For example, as dementia progresses, people can lose the ability to recognize themselves in a mirror and will become agitated, certain that an intruder is in their home. 

Tips for Environmental Modifications

• Consider how to maximize independence. Involve your loved one in decisions whenever possible, and make sure changes are compatible with them.
• If the familiar works, don’t change it.
• Start with simple solutions first.
• Tailor modifications to fit a person’s age, interests and culture. For instance, use an apron—rather than a bib—to protect an avid baker’s clothing during mealtime, or place a futon on the floor for someone who falls out of bed.
• Weigh the risk level against maintaining independence, and seek a balance. For example, a man with poor balance fell frequently when walking, but he had been an athlete and remembered how to handle falls to reduce injury. Because of this, his desire to walk and feel independent outweighed the safety need to keep him sitting down all day.
• Maintain a consistent, predictable routine for all daily activities.

Priority Checklist for Home Safety

Locks: Install deadbolts above the doors to garages, basements, outdoor areas or rooms with hazardous materials. Remove locks on interior doors to prevent being locked in. Hide a house key outside in case the door closes and locks. 

Lighting: Install brighter lighting and nightlights for navigating at night. Because changes in light levels can be confusing or disorienting, you may want to install additional lights in dimmer areas of your home and outdoor lights to reduce the confusion about nighttime darkness. 

Kitchen: Install new stove knob covers or remove knobs when the stove is not in use. Store vitamins and medications out of sight and out of reach. If you have a garbage disposal, disconnect it from the power supply. 

Firearms: If you own a gun, remove it from your home or store it in a locked cabinet. 

Bedroom: Make sure there are plenty of seating areas so your loved one can dress and undress with ease. Rearrange closets and put everything within easy reach. 

Strategies for Safe Bathing and Showering

Bathing can be a challenge for caregivers. Because of changes in visual perception and general confusion, people with dementia can think showering or bathing is frightening, uncomfortable, or dangerous.

Also, people with dementia often feel humiliated by the suggestion that they need help with bathing. When confronted with perceived dangers or humiliation, most people will try to protect themselves in some way, lashing out verbally or physically, which can result in safety hazards for both caregiver and care receiver. 

Tips for Getting Your Loved Ones to Bathe or Shower

There’s no one right answer for how to approach showering and bathing. What works for one person may not work for another. However, there are some basic tactics you can take to make showering more pleasant. 

• Before suggesting a shower, prepare the bathroom. Get everything ready and make sure the bathroom is warm.
• Turn the water on and make sure it’s warm.
• Try small talk or talking about something pleasant beforehand.
• Think of a purpose for the shower, such as someone coming to visit.
• Use euphemisms rather than the word “shower.” You may find more success with “freshen up,” “brush your hair,” or other phrases.
• Make the person the expert and give them choices. “Do you think that will work?” “Which soap should we use?”
• Make it a joint activity. “Should we both get freshened up before dinner?”
• If the person is embarrassed, have a large bath towel ready so they can cover up. If the person becomes angry at something you do, apologize. “I am so sorry; I won’t make that mistake again.”
• Don’t rush the process! Leave plenty of time.
• Adjust your expectations. It can be very challenging to get your loved one to take a conventional bath or shower. Remember that it’s OK to give a sponge bath between showers and baths.

How to Handle Wandering

A person with dementia can become easily confused by their environment, which may lead to wandering. Sometimes, they wander for a specific reason—maybe they want to visit a friend from their old neighborhood—and become disoriented once they get outside. Other times, they wander aimlessly or go explore an area that they mistakenly think they recognize. Any person with dementia is at risk for wandering, which is dangerous for the individual and stressful for family members. To protect your loved one, you should understand what can trigger wandering behavior and take steps to prevent it from happening.

Identify Triggers

Identify triggers that lead up to your loved one wandering off. Look for patterns. Was it just accidental? If so, more vigilance is required now. For example, in strange or crowded places, do not leave the loved one alone. 

If it occurs at a certain time of day, plan activities or distractions that begin just before the wandering behavior. 

Nighttime wandering is more complex. Again, look for patterns: Are they going to the bathroom and that triggers a search? Or have circadian rhythms changed, and they’ve confused day and night? Whatever the trigger, for a successful intervention, begin just before the wandering begins. If you wait too long, it will be difficult to intervene. 

Implement a Safety System

The first step in a safety system is to assess your loved one’s ability to make decisions. Can your loved one call 911 in an emergency, or make decisions about safety? If not, the loved one cannot be left alone unsupervised. You will also need a plan to manage supervision.

Risk can also be reduced by installing deadbolts on all doors, setting up security alarms, or using alarm mats on the side of the bed.

Sometimes environmental modifications are effective, such as painting doors the same colors as the walls or using wallpaper that looks like a bookshelf rather than a door. Another strategy is to put away all cues that could trigger an urge to leave, such as keys, coats, or shoes. 

Start Searching Immediately

If your loved one does wander off, begin searching immediately.

• Generally, you should start looking nearby within a 1.5-mile radius.
• Wanderers typically walk in the direction of their dominant hand.
• Check any previous wandering areas, as well as near brush or tree lines.
• If you can’t find your loved one within 15 minutes, call 911. State that your loved one has dementia and has wandered off. Request filing a missing person’s report. 

Join a Wandering Support Program

For added peace of mind, caregivers may want to explore programs such as the Wandering Support program offered by the Alzheimer’s Association and MedicAlert Foundation. Membership in the program includes 24/7 emergency response and an ID bracelet or accessory that helps law enforcement, first responders or good Samaritans contact caregivers and coordinate the safe return of their loved one. 

Reducing Fall Risks

Fall risk is very high with dementia. As dementia progresses, impairment in gait, balance and perception also progresses. Some medications prescribed to combat the signs of dementia may also affect balance. These impairments, along with basic confusion, lead to a tendency for falling. A thorough assessment of your home and your loved one’s safety can be your biggest tool to prevent falls, because it alerts you to areas needing urgent correction. 

Home Fall Risk Checklist

Flooring: Is it slippery, cluttered or an uneven surface? Are there area rugs?

Furniture: Are there unstable tables or chairs?

Electrical cords: Are they on the floor or draped across desks and tables?

Bedspreads: Do they reach and partially cover the floor?

Grab bars: Are there any grab bars? Are they stable?

Desired items: Are they easily accessible? Are they within reach?

Be sure to consider:

• Improper wearing of shoes (such as on the wrong foot) and clothes
• Gait and balance problems
• Dizziness and orthostatic hypotension (a form of low blood pressure)
• Urinary problems (frequency, urgency, incontinence)
• Improper use of walker or cane
• Compromising medical conditions (Parkinson’s, degenerative joints, compromised breath control)
• Sleep disturbances
• Hostility, anger, and mood changes

Safety While Eating

Every dementia stage is characterized by changes in eating habits and skills. Those in the early stages often lose interest in formerly enjoyed foods and tend to prefer the same meals day after day. They can eat unassisted and correctly use all utensils, but they cannot eat and talk at the same time. 

Those with mid-stage dementia show pronounced changes in eating skills. Use of utensils is often limited to a spoon or the combination of hands and a spoon. Spills go unnoticed. Napkins, placemats, or loud music can become a distraction from the task of eating. They might gorge themselves or eat too quickly or eat too slowly. As dementia progresses, your loved one may eat non-edible items because they don’t recognize what is or isn’t food. Food is sometimes hoarded or held in their cheek.

When the late stage sets in, a person is essentially unable to eat without total assistance. Both perceptual problems and motor problems prevent them from getting food to their mouth, and it might limit chewing and swallowing. For both the moderate and late stages, the caregiver must provide basic prompts, including gestures, demonstrations and hand-over-hand assistance.

Safety is always a major consideration for any person in the middle to late stages. Here are some safety tips for helping a person with dementia eat:

• Never leave a person with moderate to late-stage dementia unattended while they are eating.
• Cut food in bite-size pieces.
• Provide verbal prompts to keep them focused on eating.
• Provide gestures, demonstrations and hand-over-hand prompts to help them begin eating or to assist with the steps of eating.
• If possible, have them sit upright and tilted forward slightly to prevent choking.
• Check food temperature before serving.
• Lock up or hide dangerous chemicals, including liquid detergents and other household cleansers.
• If they hoard food, find a non-humiliating way to remove food from wherever they’re storing it. 

OVERCOMING APATHY

Psychosocial Aspects of Support

Of all the changes faced by a person with dementia, probably the most painful is loss of identity, often called “the loss of self.” It is bad enough to struggle with basic daily activities, but memory impairment and the resulting confusion can also lead someone to feel like they no longer “fit” in the social world. 

When coping skills are gone, it becomes harder to get started with an activity, and apathy and isolation set in. Caregiver attempts to motivate are typically met with “No, I don’t want to,” because the person with dementia doesn’t know how to start or complete an activity. This leads to depression and accelerates further decline—but this can be moderated if caregivers find strategies to overcome apathy and enrich the environment.

Overcoming apathy requires strategies based on the life story and underlying identity of the person with dementia. A caregiver needs to entice the individual with dementia, then reassure that person that they will be successful.

Tips for Reassurance

Provide a truthful reason to do something.
“I need your help making salad. Can you tear the lettuce for me?”

Relate the request to past interests. 
“Let’s go to Betty’s recital! She’s playing all your favorite Mozart pieces.”

Make the person feel needed.
“Mary and Angie are looking forward to seeing you in the church group. I don’t think you want to let them down. They would be so disappointed if you didn’t come!”

Give reassurance.
“You have always liked doing this craft. I will be there beside you to make sure we get each step right.”

Find the “key” that unlocks motivation.
Take note of words or enticements that work; these are unique to the individual, so you’ll have to experiment to find them.

Natural opportunities for social engagement, such as visits from old friends or attending family celebrations, can be successful as well. Following a few tips can make the experience a positive one both for the person with dementia and their friends or family members:

• Prepare friends and family in advance for what to expect.
• Let groups know that if the loved one becomes agitated, you will take them away from the group.
• Keep gatherings small.
• Speak slowly and simply to the loved one.
• Listen to the loved one and give them time to talk.
• If the loved one becomes confused, angry, or offended by a conversation, change the subject or take the loved one away from the group.

MENTAL RESILIENCE

Maintaining Cognitive Function

All people need to maintain cognitive function to keep their brain agile. When we are young, the tasks we perform as part of our career, school and other social activities are often sufficient. But when we retire and especially when we have dementia, we need consistent practice to ensure Whole Brain Fitness.

The Three Pillars of Whole Brain Fitness

Mind

• Maintain mental fitness: Brain games modified for different functional levels can be a fun and socially interactive way to maintain mental fitness. Those in the early stages of dementia can still play the card games they’ve always enjoyed, but reminders of rules and additional prompts may be helpful now. The Alzheimer’s Association has lists of books with brain games designed for people with dementia. Word games, word finding, finishing proverbs or finding smaller words in a large word or phrase are usually good activities, even in moderate stages of dementia.
  
  Later stages will need primarily sensory materials used as word games. For instance, holding an orange, smelling an orange, and asking, “What is this fruit?” When your loved one gets overwhelmed or starts to lose interest in an activity, seek out new ones to keep their interest and continue to build cognitive function.
   
• Meaningful activities: Regularly participating in meaningful activities can give your loved one a sense of purpose. These activities can include helping to care for a pet or baby, setting tables and helping clean, or helping with small chores like clipping coupons, sorting mail, or folding laundry.  

Body

• Physical activity: This is the most important of all the pillars. Research suggests that 30 minutes of aerobic and strength training 5-7 days per week is ideal for building bone density, improving muscle strength, reducing anxiety and, most importantly, oxygenating blood to the brain. However, consult with your loved one’s doctor about the amount of physical activity they can do.
  
  In addition to aerobic exercise, introducing resistance weights and balance exercises can be helpful. Depending on your loved one’s level of physical ability, appropriate activities can vary. Walking, gardening, dancing, swimming and tai chi are appropriate for mobile people with good balance. Seated exercises can be more appropriate for people with balance issues or who use wheelchairs.
   
• Nutrition: There is considerable research on the importance of diet as an element in brain health. The MIND diet, developed at Rush University through a grant from the National Institute of Aging, has emerged with promising results that appear to delay symptoms and improve functioning in a substantial percentage of people with dementia.
  
  The MIND diet is similar to DASH and Mediterranean diets, which were developed to prevent heart disease. The diet specifically selects foods that appear to improve brain health, such as leafy greens, nuts and berries, and whole grains with reductions in red meat and saturated fats. The MIND diet may also have protective effects against Parkinson’s disease.
   
• Reduce stress: Chronic stress causes our bodies to release hormones that eventually affect memory. Notice triggers that lead your loved one to feel agitated or anxious and work to remove them. You can also minimize stressful situations—like confusion over which door leads to the bathroom or finding an item in the fridge—by adding signs or labels in your home to help your loved one recognize what they’re looking at.

Spirit

• Strong social network: When cognitive changes start, withdrawal and isolation are common, which can lead to accelerated decline in physical and mental capacity. In addition, friends or family members may find it difficult to interact with your loved one and will avoid contact, which only worsens the effects of isolation. Whether your loved one is in the early or late stage of dementia, a social network provides support and an outlet needed to maintain function, build confidence, and have happy, fulfilling days.
  
  The caregiver will need to find or create an optimal social environment that is adapted for changes in cognitive functioning. Adult day cares can be great senior care options, as well as support groups sponsored by the Alzheimer’s Association, which can serve as social groups for caregiver and care receiver alike.
   
• Sense of purpose: We all need a reason to get up in the morning. Feeling that your life has meaning and that you’re in control fosters positive attitudes and emotions. Helping your loved one engage in an activity that restores a sense of control and purpose will require being mindful of previous interests and figuring out a way to adapt those interests and social needs to their functional level.
   
• Meditation and mindfulness: Meditation and other mind-body exercises like yoga can be adapted to functional levels. Depending on your loved one’s mental state, these mindfulness activities can include such activities as focusing on peaceful music, saying prayers, or listening to poetry.

Adapting Your Approach as Dementia Advances

Dementia is not a static state. Your loved one’s abilities and preferences may change on a daily or weekly basis, and they will certainly change as dementia progresses. Consequently, you’ll need to modify the way you care for your loved one over time. Providing more help with bathing or adjusting your strategy for bathing, making dining modifications, or seeking out new activities better suited to their function level will all be necessary at some or numerous points.

Refer often to the Cardinal Principles as a guide for refining your caregiving approach. In addition, be sure to check in with your loved one’s physician periodically; they may recommend certain modifications. At some point, you may also find it helpful to adjust your care strategy to include at-home care or a memory care community.