Introducing a routine at any stage of life can only be considered a positive. It helps us to achieve our daily goals, keeps us on track and can give us a sense of purpose too. We may find that a routine is more important than ever in the years that follow retirement having spent so many years getting up at the same time and following the same pattern day after day. As we age, some people may find sticking to their lifelong, daily routine easy, but others, particularly those with cognitive decline, such as that which is experienced in dementia, will find it increasingly difficult. However, studies and experience have shown us that the person with dementia actually responds, and functions, better when they are following a daily routine as opposed to when they are not.
Whilst, your currently daily routine may consist of many activities that take place inside and away from the home, complicated tasks like this will only serve to further confuse and ultimately distress your loved one. So when you are creating a routine, make sure you keep it simple. Over the course of my career, I have cared for many people both in and out of their own homes and the routine that I follow is generally exactly the same from person to person because the needs that I am meeting and assisting with are always the same. When I speaking with families regarding the best way to go about creating a daily routine for someone with dementia, we begin by discussing what the person in question can and cannot accomplish, what their likes and dislikes are and any issues with anxiety throughout the day. Once we have answered these questions (which I have discussed below) we then discuss the 5 key rules that need to be kept in mind when deciding to implement the best routine.
Creating A Daily Routine for Someone with Dementia
When you decide that the time is right to start introducing a routine, don’t dive in head first. Start by observing your loved one and then answer the following questions:
- What can they do? (think about promoting independence)
- What task are they unable to do? (what task may you ask them to do that could cause confusion/agitation?)
- Is there any particular time of the day when confusion and anxiety are highest?
- Are there any activities from the pre-illness days that they can safely accomplish now?
Once you have a general idea of the answers to these questions, the 5 key rules below can help you establish the basis of your routine. Don’t forget that this is not an exact science and it may always be fluid and adjusted on a day to day basis or it may never change at all. When it comes to dementia care, there is no normal.
1. Set Realistic Expectations
When you are caring for a person with dementia, it is important to remember that you must be fluid. What may work today, may not work tomorrow and that is okay too. The aim of all care that we provide, be is as a family member or employee is to be consistent but also to have the ability to adjust our expectations according to the situation. You may find that the more you get to know someone and their abilities, the more you will notice a pattern emerge. It may be that every couple of days you take a break and leave your loved one in bed for an extra few hours as they are tired or it might be that you skip a daily shower. The reality of this type of care is that things change and we must not be so set in our expectations that we can go with the flow and adjust our reactions and activities on a daily basis.
As the disease progresses, we may find that motivation in our loved one disappears and we may become frustrated as a result. Frustration is normal and to be expected but pushing your loved one to complete tasks that they are not capable of doing is going to cause nothing but stress and friction between you both.
2. Reduce Agitation and Anxiety
My personal view on reducing agitation and anxiety goes beyond that of the person you are caring for. It is also about reducing your agitation and anxiety. Day to day life can be hard on us all, never mind when you add in caring for a family member with dementia. Reducing the agitation that your loved one feels will, in turn, reduce your agitation.
Reducing agitation and anxiety covers more than just the tasks that need to be completed. Ensuring continuity of care with as few caregivers as possible, and only allowing those with a good relationship with your loved one can greatly help. Not only are they familiar with your family member, usually they are in a position to reduce any anxiety just as it begins due to the regular visits and getting to know the intricacies of the disease.
Removing clutter from the environment or any items that have proven to be problematic in the past can help reduce the recurrence of episodes of agitation and anxiety.
3. Choose Familiar Activities
Picking activities that you know your loved one is capable of doing and completing is the most beneficial way to ensure that a daily routine goes well. When deciding what activities are best, it is beneficial to have an understanding of their mental and physical abilities to ensure tensions don’t rise due to unrealistic expectations. For example, in the morning, don’t have a bath if your loved one has difficulty with mobility, a shower is much more convenient and stress-free.
Trying to introduce activities that have never been done before – such as swimming – can cause a whole host of issues such as stress, anxiety and confusion but including a daily walk (which has been a part of your loved one’s life for years) can bring calmness and relaxation.
4. Promote Independence
I am all about promoting independence. Even if it is something as small as washing their own arms in the shower, if the person I am caring for can achieve any aspect of their own care without much prompting or encouragement and no distress, I ensure it becomes a fixture in our day to day activities. As the person with dementia has progressive memory loss, more than likely, they have lost the inability to learn new tasks, so we must remember that promoting independence is not about learning new skills but giving them the opportunity to retain the skills they have. I generally find that the best (and safest) way to do this is during the time when we attend to personal hygiene. I may prompt someone by handing them the face cloth and soap and tell them where to wash, but I allow them to wash themselves. I find that this approach is best because it promotes independence and protects the dignity of the person I am with, which in turn reduces anxiety and stress (in us both).
5. Dedicated Time
As I have already mentioned (several times!), creating a daily routine for someone with dementia is all about reducing frustration, agitation and confusion. We can find the best activities for our loved ones, promote independence and adjust our expectations all we want but unless we are giving ourselves and our loved one the time (and plenty of it) to accomplish the routine we have spent time creating, we may as well not do it. You don’t want to overwhelm your loved one by trying to fit a lot into a short space of time and potentially cause stress and agitation because you need to get the tasks done quickly to move on to something else. When planning your own daily routine, ensure that you leave enough time to complete the daily tasks so that you are not clock watching.
Creating a routine can be as hard or as difficult as you like it to be. Depending on the client and the illnesses that I am dealing with, I sometimes sit down and plan out the routine, other times I just go with the flow and see how we get on. Regardless of the approach that I take, I always have the questions and points above in my mind to ensure that I have some sort of guide in place.
As always, I hope that this has been helpful. If you have any questions that you would like answered, please don’t hesitate to comment below. I am always interested in improving my skills and seeing how others tackle situations, so if you approach daily routines in a different way, I would love to hear how you do it and how I can include that approach in my day-to-day care.