Home' Australian Pharmacist : Australian Pharmacist May 2013 Contents Australian Pharmacist May 2013 I ©Pharmaceutical Society of Australia Ltd. 53
Continuing Professional Development
treated, a carer should have an
-- potentially painful medical
conditions (such as osteoarthritis
and back pain commonly affecting
-- ways to monitor for behaviours
and symptoms that may indicate
pain such as changes in behaviours,
sleeping more than usual or
reluctance to move.
• Eating: problems may occur with
dementia patients for a variety of
reasons including loss of memory,
impaired judgement, loss of appetite,
overeating or insatiable appetite
as well as mouth, chewing and
swallowing problems. In order to
overcome these issues and ensure
adequate nutritional intake for a
person with dementia, the following
strategies may be explored:5,7
-- Encourage regular meal times each
day in a relaxed, calm environment.
-- Prepare familiar foods.
-- Encourage eating all of one food
before moving onto the next as to
reduce confusion between different
tastes and textures.
-- Check medications for appetite
related side effects.
-- Ensure regular dental checkups of
gums, teeth and dentures.
-- Remind the person to swallow with
-- Use simple cutlery and crockery.
-- Moisten foods with sauce and
gravies to increase palatability.
-- Ensure adequate fluid intake.
• Hygiene: It is common for people
with dementia to have difficulty with,
or forget about, personal hygiene.
Ways which may assist a carer to cope
with these issues are to:5,6
-- encourage a consistent bathing
-- break down hygiene related tasks
into simple steps
-- address fears due to water by
preparing a bath ahead of time and
checking depth and temperature
-- address incontinence. This may
include limiting caffeine intake,
observing toileting patterns,
incontinence and bathroom aids
and simplifying clothing
-- ensure enough warmth and light in
-- offer limited options, such as the
choice between a bath and a
• Sleeping problems: Issues with
sleeping may arise due to numerous
reasons in a person with dementia,
such as confusion between night and
day, going to bed early, limited exercise,
upset daily routines or changes in
the person's biological clock. To help
recognise any sleeping issues and
implement strategies to address these,
a carer may try the following:5,6
-- Keep a log or diary to identify
-- Consider medications as a cause.
-- Address issues relating to the
environment in the bedroom such
as temperature or lighting.
-- Reduce caffeine and alcohol.
-- A light snack before bed to address
-- Encourage a regular daily routine.
Caring for the carer
A carer or caregiver is someone who
provides tangible, financial, emotional or
informational and coordinated support
to an impaired person.8 This person may
often provide care to a family member in
their own home in an informal way and
without monetary compensation.8
Both informal and formal carers are
invaluable, both to the person with
dementia that they care for as well as to
the health care system.
Due to the high stress levels associated
with this role, it is crucial that the carer
The following are some of the more
complex management considerations for
a person with dementia and their carer:
• Safety in the home: the home
environment should be one which
helps the patient to be as happy
and independent as possible.5,6
This involves an appropriately
stimulating environment with
orientation cues that are consistent
and familiar.3,4 Simple ways to achieve
this are to:5
-- ensure furniture is simple and
-- avoid hazardous loose rugs and
-- use nightlights to aid orientation
-- store medicines safely
-- fit work safety switches and smoke
-- fit automatic cut offs for appliances
-- avoid long electrical cords.
• Dealing with changes in
communication: dementia patients
may find it hard to find a word,
speak fluently, understand, write,
read, express emotions and may
lose normal social conventions of
conversation.6 Above all, remembering
that communication is made up of
body language, tone and pitch of voice
as well as the words we use may help
encourage carers to communicate in an
appropriate way.5 Other ways to assist
with these changes in communication
-- optimise use of spectacles and
-- allow time in conversation for
-- use short, simple sentences that
help orientate the person to the
-- allow conversation to happen in a
calm, quiet environment
-- avoid arguments.
• Recognising and treating pain:
a person with dementia experiencing
pain may not be able to communicate
their pain clearly or accurately interpret
pain signals. In order to ensure pain
is being recognised and adequately
'Due to the high stress
levels associated with
this role, it is crucial
that the carer looks
after their own health.'
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