Running head: DEMENTIA: A COMPREHENSIVE APPROACH FOR CAREGIVERS 1

Dementia: A Comprehensive Approach for Caregivers

Tiffany L. Rothe
James Madison University
DEMENTIA: A COMPREHENSIVE APPROACH FOR CAREGIVERS 2

Abstract
Several different studies were conducted relating to patients with dementia. One study,

concerning falls, concluded that patients with dementia were three times more likely to sustain

an injury from a fall. Another study conducted showed that implementing exercise into a daily

routine for a patient with dementia may help them be able to retrieve episodic memories more

efficiently. Lastly, two separate studies were performed that proved educating staff and student

nurses about how to care for patients with dementia resulted in both better patient outcomes and

positive learning experiences. This paper is written to help nurses understand a variety of focus

areas for nurses who work with patients that have dementia.
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Safety and Care for Patients with Dementia

First and foremost, a nurse must understand the multi-facets of dementia before being

able to render compassionate and comprehensive care of a patient with dementia. According to

Eliopoulos (2018), Dementia is an irreversible, progressive impairment in cognitive function

affecting memory, orientation, judgment, reasoning, attention, language and problem-solving.

When reviewing this definition, putting yourself in the place of a patient with dementia might

help you visualize the impact that the effects of this disease can have on a caregiver. These

patients often appear confused, perform acts that might be considered out of character for the

individual, and often appear to not be the person they were once known to be. The patient

diagnosed with dementia can also display behaviors that involve personality changes, delusions,

agitation, or anger, and sometimes they may even experience hallucinations (Lewis, Dirksen,

Heitkemper, and Bucher, 2014). A dementia diagnosis isnt just difficult for the patient; it is also

a trial for the family. With this diagnosis, there are several factors a caregiver or nurse must

understand that deal with safety and fall prevention, benefits of physical activity, and how to

communicate respectfully and appropriately with a patient who has dementia.

Safety and Fall Prevention

Safety is the most critical issue at hand. A nurse takes a vow to always keep the patient

safe. Keeping a patient with dementia safe can sometimes be more of a struggle than ensuring

safety of a patient who doesnt have the diagnosis of dementia. As stated before, these patients

are often confused and present with behaviors that are uncharacteristic for that individual. I

personally have witnessed a variety of these behaviors while working with hospice. Many other

nurses have experienced taking care of patients who have exhibited anywhere from mild

confusion (forgetting what day it is) to severe confusion (being found outside, in the woods,
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because they were following a little boy). Regardless of the degree of confusion, safety is a

priority with all patients.

According to Rowe (2015), Dementia is considered an independent risk factor for

falling because of its associated impairments in judgment, gait, visual-spatial perception, and the

ability to recognize and avoid hazards. If these patients are confused and already have the

weaknesses often associated with aging, then that puts them at an elevated risk for falls. It can

also be proven that it is more difficult for an aging adult to recover from these injuries compared

to someone in their youth.

It is estimated that 42% to 72% of residents of nursing homes have dementia;

this diagnosis carries with it a high risk of falling. In addition to falling more

frequently than residents without cognitive impairment, those with dementia are 3

times more likely to be seriously injured in a fall (Rowe, 2015).

As you can see, these patients are not only at an increased risk for falling, but this risk is further

impacted by the fact that they also carry the risk of experiencing a severe injury from the fall.

While there is no tangible way to fix this increased risk, there are many ways to

implement interventions that attempt to lessen the number of falls for the patient with dementia.

These interventions range from eliminating any type of clutter (ex: cords/ wires, rugs/ runners,

and clear pathways) to adding equipment for the patient to grab onto when ambulating (ex: grab

bars and railings) (Rowe, 2015). Along with the interventions mentioned previously, families

may also choose to use a variety of monitoring devices such as video systems, Lifeline systems,

and personal alarms to their homes to help aid in fall prevention. When families implemented

these additional interventions, a further decrease in falls resulted.

Benefits of Physical Activity

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Increased physical activity can also have a positive effect on patients who have been

diagnosed with dementia. A study was conducted by Cedervall, Torres, and Aberg (2015) to see

how patients diagnosed with mild Alzheimers disease and patients with dementia perceived

physical activity and how they incorporated it in their everyday life. The patients described the

quality of their physical life before the diagnosis and the ways the diagnosis has impacted their

ability to perform physical activity. The results from the study were astounding. According to

Cedervall, Torres, and Aberg, Physical activity could help the participants to shift the focus

from the dementia diagnosis (i.e. ill health) to a more healthy and able self (2015). By striving

to maintain continuity in physical activities, individuals can manage to sustain well-being and

selfhood despite the threats that dementia can impose (Cedervall, Torres, and Aberg, 2015).

Simply by incorporating physical activity into a daily routine, the patient with dementia can shift

the focus of the disease to a better quality of life.

The implementation of physical activity doesnt just improve quality of life, it can also

help slow down the progression of the disease. Lee, Park, and Park (2016) discovered that

implementing physical activity into a daily schedule had a positive effect with the improvement

of physical capacity. It is clear that programs that implement physical activity are incredibly

useful for the patient diagnosed with dementia. Among the physical activities for patient with

dementia, combined exercise, consisting of multiple exercises, showed the largest effect size

(Lee, Park, and Park, 2016). Not only does physical activity have a positive impact on capacity,

but, long term physical exercise decreases the level of reactive oxygen species and protein

carbonyls in the hippocampus that protect neurons against oxidative stress (Lee, Park, and Park,

2016). This means that performing physical activity might help the patient with dementia be able

to retrieve episodic memories better. Incorporating physical activity into the care of patients with
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dementia is necessary if caregivers desire to see both an increase in physical capacity and a

decrease in the diseases progression.

Appropriate and Respectful Communication

Patients with dementia are rarely seen as easy to work with; these patients can sometimes

appear to be confused, agitated, and even angry. From the nurses perspective it can be difficult

to provide care to someone doesnt want to cooperate, and because of this, it is a high priority for

employers to properly and thoroughly educate staff about the depth and complexity of a

dementia diagnosis. According to Lewis, Dirksen, Heitkemper, and Bucher (2014), there are

certain guidelines for dealing with patients with dementia: remembering to treat them like they

are an adult even if they are behaving like a child, giving them appreciation when they are

successful, remembering to be flexible while trying different methods to solve problems,

understanding that the dementia patient follows simplified tasks best, and attempting to use

distraction techniques by changing the subject if they are confused. By putting these guidelines

into practice, patients with dementia not only feel more respected, but the caregiver is better able

to form a positive relationship with that patient. The result is that the patient has a better quality

of life.

There are also specific techniques that nurses should be aware of that can have a negative

impact on the patient that has dementia. Behaviors that should be avoided are arguing or

criticizing, rationalizing, ignoring them if they are present, forcing them to interact with others or

participate in activities if they dont want to, and using words that might belittle the patient (ex:

sweetheart or honey) (Lewis, Dirksen, Heitkemper, and Bucher, 2014). If nurses are trained to be

more cognizant of the diverse ways in which they can interact with a patient with dementia, then

they are likely to form a more positive relationship with the individual. Any type of negative
DEMENTIA: A COMPREHENSIVE APPROACH FOR CAREGIVERS 7

behavior towards these patients can have a negative outcome and cause frustration between the

employee and the patient. Studies have been conducted that prove that, staff training may

contribute to the improvement of the status of residents with dementia (Yasuda & Sakakibara,

2017). It is important that employers implement routine training to help staff understand how to

care for a patient with dementia.

Understanding the importance of educating employees about these positive and negative

guidelines doesnt just benefit the employees, but it can have a trickle-down effect when those

employees educate new nurses or student nurses about the appropriate ways to interact with

patients who have dementia. Most first-year nursing students are placed in a clinical

environment, such as a nursing home, for their first patient interactions. As frightening as it is to

be alone with a patient for the first time, student nurses need additional support from employees

when interacting with difficult patients. Students spoke about their unfamiliarity with dementia

and how scared they were to care for residents especially if the resident was physically

aggressive (Honan, 2016). It is necessary that all caregivers are well educated about the proper

care of these patients, not only enabling them to better offer their support to student nurses, but

also promoting an environment that leads to better patient outcomes.

Conclusion

It is imperative that nurses remain cognizant of the way they interact with patients that

have dementia. There are multiple factors that nurses must always keep in the front of their

mind: patient safety and fall prevention, the benefits of physical activity, and the importance of

appropriate and respectful communication. By implementing safety precautions, the nurse is

adhering to their promise of always keeping the patient safe. When nurses promote physical

exercise into a daily routine for a patient with dementia, it increases the patients quality of life.
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When caregivers are educated about how to properly interact with these patients, nurses can

show respect for the patient while promoting better patient outcomes and a positive and

confident working environment. By combining these factors into the daily care of patients with

dementia, nurses are implementing patient centered care that will produce far more positive

results and vastly improved quality of life for the patient.

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Cedervall, Y., Torres, S., & berg, A. C. (2015). Maintaining well-being and selfhood through

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Eliopoulos, C. (2018). Gerontological nursing (9th ed.). Philadelphia, PA: Wolters Kluwer.
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