Independence refers to the ability to carry out daily activities. Autonomy, on the other hand, is a broader concept that expresses a person's ability to make decisions in various areas of life. Both influence quality of life and self-esteem.
Strengthen the person’s abilities by emphasizing what they are capable of achieving, namely by breaking tasks down into simpler steps. Adapt the environment, as a simplified and predictable organisation helps reduce unnecessary dependence. Encourage active participation as well by offering clear instructions and allowing enough time to complete tasks. In doing so, maintain a balance between protection and independence, ensuring support is offered only when needed, without undermining the person’s identity, autonomy, or self-determination.
Environments
Adapting the environment promotes safety and helps prevent accidents. It is important to keep spaces organised and clear, restrict access to dangerous objects and clearly mark areas of risk.
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Nutrition
Regular mealtimes and simple, appealing meals help support a healthy diet.
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Hygiene and clothing
Respecting dignity and encouraging autonomy makes these care routines easier. Adapting the environment and organising each step promotes greater safety, comfort and well-being.
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A person with dementia becomes more exposed to the risk of domestic accidents. It is essential to identify possible risks, gradually adapting the environment to avoid disorientation.
Ensuring good lighting and safe movement
Keep spaces well lit, especially passageways. Circulation areas should be kept clear and floors dry. Use night lights during the night and mark the switches.
Preventing accidents
Promote organisation, predictability and simplification of the environment. Remove or fix down rugs and install grab bars and handrails. It is important to bear in mind that changes in the arrangement of furniture can cause disorientation.
Securing dangerous products
Stoves, heaters and electrical equipment should be switched off when not in use. Keep toxic products, medication and sharp objects out of reach, for example through the use of drawers with safety locks.
Identifying and guiding
Identify drawers and cupboards with words or images and keep emergency contacts visible on the telephone.
Simplifying the visual environment
Opt for plain surfaces and simple, uniform patterns; changes in floor pattern may be interpreted as holes. Avoid flooring, rugs, or wall coverings with complex patterns or abrupt colour changes, as they may be perceived as holes, steps, or obstacles.
Using signage
Mark areas prone to accidents with visible signs, especially in places that are hard to perceive. The last step of the stairs can be marked with a yellow strip.
Adapting bathing areas
If possible, replace the bathtub with a shower or install a bath chair to help with access. Fitting a toilet seat that contrasts with the colour of the bathroom suite helps with identification. Also place non-slip mats in this area.
A person with dementia may forget to eat or drink, repeat meals or refuse food and medication. Difficulties may also arise with chewing and swallowing or with using cutlery.
Organising meals
Regular schedules and a calm environment aid concentration. Place only the essentials on the table. To improve perception, use a single-colour tablecloth that contrasts with the colour of the crockery.
Encouraging independence
Prepare the meal and arrange the utensils in order to facilitate independent eating. If necessary, cut up the food beforehand and when eating difficulties increase, offer options that can be eaten by hand.
Maintaining hydration
Encourage regular fluid intake, even without any complaint of thirst. This can vary between water, infusions, natural juices or flavoured waters.
Enhancing presentation and taste
Appetising meals that are visually appealing and have well-defined flavours invite consumption. If food needs to be blended, do so separately and present it distinctly to aid recognition.
Supporting safe swallowing
The person should be seated, with their back straight, during and after the meal. Frequent coughing, hoarseness or choking during meals, which may indicate dysphagia (difficulty swallowing), warrant a specialist assessment by a speech and language therapist. Observe whether the person forgets to chew or takes in too much food at a time; in that case it may be necessary to make adjustments to the texture of the food. A food thickener may also be used to adjust the consistency of liquids, including water.
How to help
Hygiene and clothing
As dementia progresses, personal hygiene care and the act of dressing become more challenging. Difficulties may arise in recognising the need to bathe, in understanding and carrying out sequential tasks with coordinated motor gestures, or in selecting appropriate clothing. Resistance to care is frequent, not out of deliberate opposition, but out of fear, sensory discomfort, modesty or an inability to understand what is happening. It is important to ensure predictability, respect for dignity and environmental adaptation.
Maintaining routine and predictability
Prepare the environment and all the necessary items, warm and light the room and, if possible, respect time-of-day preferences. Verbally anticipate what is going to happen; for example, you can announce "now I am going to wet your hair".
Encouraging functional autonomy
Promote active participation in every step, even if only partially. Demonstrate the gesture and begin it so that the person continues it.
Preserving dignity
The loss of control over one's own body is experienced with vulnerability, so to reduce the feeling of exposure only the area to be cleaned can be uncovered. An external professional may promote acceptance of the care.
In cases of urinary or faecal incontinence, it is essential to avoid critical comments or expressions of disapproval. In the early stages, the use of pull-up incontinence pants may be better accepted than traditional incontinence pads.
Promoting safety and comfort
The risk of falls is higher during bathing. Pay attention to the temperature and pressure of the water. Some people tolerate starting the bath with the lower limbs better. Dry carefully, especially the skin folds. In advanced stages, bathing in bed may be a safe alternative. There are techniques for moving the person and changing the bed linen with them lying down that minimise the caregiver's physical effort and the risk of musculoskeletal injuries.
Respecting identity
Clothing is linked to identity, self-esteem and a sense of normality. Maintain care with appearance, respect personal tastes, and habits such as wearing make-up, using accessories or the way of styling hair.
Making dressing easier
The act of dressing involves complex executive skills. Lay out the garments in the order of dressing and favour clothes with simple fastenings, elasticated waists, Velcro or larger buttons. If possible, offer two clothing alternatives to promote autonomy and keep more than one similar item available in case the person insists on wearing a particular garment.
