Caring for Patients with Dementia: A Beginning Guide for Nurses

As defined but he Alzheimer’s Association, “Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life.” Being that this term can include a wide range of symptoms, it is common for nurses to work with patients with dementia often. It is estimated that approximately 25% of hospital beds are being used by people who have dementia!

With such a high number, it should be clear what a nurse’s role is when working with these patients. Caring for patients with dementia can be complex, but there are certain areas that should be the focus.

Reality Orientation

Regardless if you’re working with a patient a few times a week or if they are under your daily care, orienting the patient is important. Orienting the patient throughout the day can help reinforce important information, connect with others and their surroundings. This includes:

• Orienting the patient about the day, time, place, and season. This could look like verbally telling the patient, writing this information down near them, and working the information into conversation. It can also help to have calendars and clocks near the patient as well.
• Referring people by their names. Sometimes people with dementia forget the names of others and may have difficulty asking people what their name is.
• Discussing current events can be helpful when trying to orient the patient and have them connect to the outside world. However, it might be best to discuss events that are positive or neutral if your patient has a tendency to be reactive to negative information.

Observe Client Safety

Maintaining safety while caring for patients with dementia should be a nurse’s biggest priority. There are many reasons why a nurse will have to observe the safety of a client with dementia. Here are some things to watch out for:

• Patients may forget their safety precautions
• Wandering is a common occurrence
• Patients may not clear food from their mouths
• Patients may try to use appliances
• High risk of dehydration
• May engage in combative behaviors with staff or other patients

Handling these behaviors and circumstances will be unique to each patient. However, for all patients with dementia, a nurse will want to prevent these situations from occurring in the first place. Prevention may look like:

• Checking in on your patient throughout the day
• Keeping them occupied with their interests (ex: watching TV, people walking, playing games, etc.)
• Helping patients with their oral care throughout the day and especially after eating
• Facilitating water consumption by reminding patients to drink water, keeping water nearby, and encouraging consumption of liquid based foods (ex: soups, popsicles, jello, etc.)
• Managing outbursts with calmness and clear directions

Medication Management

Sometimes people with dementia forget to take their medication. When caring for patients with dementia, a nurse may have to get a little creative with medication management.

Depending on the setting and specifics of the situation, a home health nurse may provide strategies for family members to implement while a nurse in a hospital may stay at the bedside while the patient takes their medication.

On the other hand, some patients with dementia refuse to take their medication. In this case, it is the nurse’s responsibility to discuss the situation with the medical team to determine an action plan on how to best support the patient.

Emotional Support

It is absolutely critical that nurses who work with individuals with dementia are friendly, warm, and patient. Providing emotional support will look different for each patient, but there are a few key things that all nurses should remember:

• Positive body language and facial expressions (ex: smiling) can help a patient feel safe and build a therapeutic relationship.
• Use short sentences and allow the patient time to process the information is important to keeping frustration levels low.
• Don’t ask too many questions. Often, patients with dementia may not know the answer or become frustrated with trying to articulate one. Since questions should be kept at a minimum, keen observation is important to get a sense of your patient’s interests, dislikes, and preferences so that’s your care reflects their preferences.

Family Education

Educating family members is a key responsibility of a nurse regardless of the patient’s condition. Depending on the setting, the number of times a nurse may contact family members may vary. Important areas to educate family members on include:

• How to engage with the patient verbally
• Ways to help the patient with orientation
• Tips and strategies to manage behavioral challenges
• Strategies for modifying the environment to prevent unfortunate circumstances (ex: wandering)
• Directions on medication management

Have you worked with a patient with dementia before? What are your best tips when caring for patients with dementia? Share in the comments below.

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