Daily Living: From Effortless to Effortful

Sep 22, 2017

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Daily Living: From Effortless to Effortful

Daily Living: From Effortless to Effortful

Posted in : All, Dementia Care on by : Pooja Jain

The tasks we perform on a daily basis so seamlessly, without any thought or conscious effort, are often found difficult by a person with dementia (PwD). In particular, they find it hard to remember and carry out activities that have a sequential order. For instance, think about the steps involved in wearing clothes – knowing the order in which clothes are worn, the orientation of each item, and finally the intricacy of buttons and knots that may be involved. This is a lot to take on for a person whose cognitive skills are declining. Additionally, there could be a physical aspect too, as their motor abilities may be deteriorating. Therefore, as the disease progresses, the ability to perform daily activities independently will likely change and assistance will be required by a caregiver and/or assistive products.

It is important for caregivers to note the dependency levels of PwD so they can plan appropriately for care management – know where to motivate them so PwD can maintain their independence and when and how to step in. The CogniCare app can help caregivers to capture this information, which will not only help the health professionals understand the status and progression of the disease better but also allows caregivers to really know the needs of PwD.

The following four-step approach can help identify and strategize to improve the quality of life of PwD for as long as possible.

1.   Identify

Observe the PwD and identify the various tasks that have become more challenging for them.

Activities of Daily Living:

  • Washing & Bathing
  • Eating & Drinking
  • Toilet & Continence
  • Financial management
  • Medication management
  • Housekeeping
  • Extracurriculars
  • Dressing
  • Shopping

2.   Plan

Once all the tasks that the PwD needs assistance with have been identified, it is important to determine which problem needs to be addressed first. Trying to carry out all the tasks in one day could put a lot of pressure on the PwD as well as the caregiver. Use the following suggestions to prioritise and plan tasks:

  • Time of day

Be aware that there could be behavioural responses to cognitive changes – know what time of the day the PwD is at their best (cognitively and physically) so the difficult tasks can set aside during that time.

Pay special attention to where and what PwD are already doing in the day. Plan according to that. If they have motor problems but tend to walk around the house or wander out at a certain time, choose that period to go for a walk with them.

  • Strengths

Know which skills and abilities of PwD are still strong and make adjustments to challenging tasks. For example, remove the cap of toothpaste – they may have lost their strength but their coordination to brush may still exist.

  • Preference

Focus on tasks PwD prefer. Notice how they react to each task, what makes them happy and excited versus frightened and anxious. If they can not perform a certain task but they really enjoy it and it makes them feel like an important part of the family, for example cooking for everyone, chose to do those tasks first.

By choosing tasks that make PwD feel productive can not only improve the quality of life of PwD but caregivers as well.

3.    Interventions

There are several ways to make challenging tasks simpler or at least more possible to do. Here are few approaches that can be adapted to a routine or a certain task:

  •  Graded Assistance

This means caregivers providing the minimal assistance needed for the PwD to carry out the entire task in a safe and secure manner. Graded assistance can be in the form of verbal or visual prompts, enactment of the tasks, or partial physical support. For example, PwD may struggle with getting in the car – the dark leg space might frighten them or have reduced strength/coordination to perform this task. In either case, the caregiver can open the door, ask PwD to face them and let them take a seat. Subsequently, the caregiver can ask PwD to put their legs into the car.  In this manner, the caregiver is breaking the task down step-by-step and assisting where necessary.

This helps in encouraging and maintaining the functional independence of the PwD for long as possible.

  • Interests

Know the activities PwD is interested in. For example, if they enjoy listening to music, play their favourite song while carrying out tasks that they find difficult, or refuse and are resistive to.

  • Assistive living products/ Assistive technology

These products are any piece of item, equipment or software that maintain or improve the daily functionality of PwD. For example adaptive wearables. These wearables are manufactured with velcro and magnetic closures, replacing the need to button clothes and tie laces, allowing PwD to wear their own clothes. This helps maintain their independence for a longer time.

  •  Routine

 Performing tasks or activities in the same sequence and at the same time every day establishes a routine and continuity which, PwD tend to learn over time and unconsciously prepare the body and mind for the upcoming task. This makes them less agitated and confused due to the sense of familiarity to their day.

Having a routine also helps caregivers keep track of what needs to be done, saving time figuring out what needs to be accomplished and when every day. This also allows the caregiver to be focused on the goals.

  • Encouragement   

By encouraging and motivating PwD to perform their own tasks and continue to participate in activities around the house makes them feel like they are still an active part of the family and feel valued. This sense of belonging and well-being keeps them happy.

4.   Evaluate

The type of symptoms that present and its progression is different for each PwD. Consequently, each caregiver will need to try out different approaches to see what is a suitable method. Use the above techniques and tailor it to the needs of PwD.

Just know that the responses by the PwD to a chosen method may change over time – be ready to revisit the list of approaches from time to time!

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