Role of Nurse in Dementia

What is the role of Nursing fraternity in dementia management?
Advances in the medical field have been associated with increase in life
expectancy leading to increasing number of old age population. As per the
2011 census, India is home to about 65 million people of age 65 and above,
constituting 5.5% of the total population. Prevalence of dementia in India is
reported to be 2.7%. As the age increase, prevalence of dementia increases. The
rise in dementia and Alzheimer’s disease is alarming and is expected to double
every 20 years, from 47 million people in 2015 to 75 million people in 2030 and
131 million in 2050.
Nurses play a vital role in care of patients with dementia. Nurses are well-
positioned to provide comprehensive dementia information and support so that
people living with dementia are better equipped to self-manage their health and
live well with dementia. In modern medical practice, the role of nurse has
become dynamic, ranging from education and personal care. The profession of
nursing is considered as critical to meets the needs of the elderly population
with dementia and ensures the delivery of high-quality care.
There is no cure for dementia, but with quality nursing care and caregiving,
symptoms can be managed, and progression slowed. Dementia is the 7th
leading cause of death, but progression to mortality can take up to 10 years.
The goal is to maintain as much independence as possible, prevent co-morbid
complications, and decrease the burden on caregivers.
Memory loss and cognitive decline are two of the most challenging issues.
Weight loss of 10% of body weight can happen rapidly due to the fact that
dementia patients forget to eat. They often think they just ate and will ignore
even strong hunger pains.
As dementia progresses, eating can become difficult as they begin to forget to

swallow and can pocket food and choke. Swallowing can become difficult and
foods need to be chopped or pureed. Liquids often need to be thickened.
Feeding a dementia patient an adequate amount of food can take 45 minutes to
an hour. This is a slow and tedious task for caregivers who may become
agitated and frustrated themselves. It’s important to keep an eye on them so
that choking isn’t an issue. Falling asleep is also while being fed is also an
issue. Keep meals healthy but simple. Too much food on a plate can be very
confusing. Using a bowl with one type of food at a time can solve this. Divided
plates with small portions can also help.
Keeping Patients Active
As dementia progresses, patients will lose cognitive and physical abilities and
struggle with all Activities of Daily Living and Instrumental Activities of Daily
Living. Activities of Daily Living include feeding, bathing, dressing/grooming,
ambulation, transferring, and toileting/continence. Instrumental Activities of
Daily Living include managing finances, communication via telephone or mail,
housekeeping and home maintenance chores, shopping and meal preparation,
transportation and managing medications. Support and Assistance will vary
with the severity of need. Remember that patients who have been fiercely
independent will not always give in to accepting help easily despite memory
loss. They can become resistant, aggressive or combative. They may not
remember they need help; nor have a clue as to why. Take things slowly and
explain each step. Wait for them to agree and move forward. Some will require
some premedication with meds such as Ativan or Haldol.
Encourage them to continue to do as much as possible for themselves with

stand-by assistance and supervision. Again, these tasks may take three times
as long as they normally would. Patience is essential. Frequent checks on them
will help to prevent falls or other injuries. Don’t expect them to remember they
need to use a walker or cane or call for assistance. That thought may make
sense at the moment of discussion, but it’s gone from their brain as soon as
you leave the room. Tab alarms, bed alarms, and fall mats should be used.
Toileting every 2-3 hours can also eliminate some of the urgency to get up and
try to use the bathroom unattended. Restraints of any sort are not acceptable
for safety reasons and family and caregivers should be educated on this.
Routines help to keep things running smoothly, but always having a

contingency plan when things go south quickly will also lessen the burden.
Surprises are not fun and for patients whose cognition is damaged, it can
trigger an undesirable response. Moving too quickly or trying to get them to do
something right now can be a mistake. Don’t sneak up on them or come up
from behind without letting them know you’re there.
The nursing interventions for a dementia client are:
 Orient client. Frequently orient client to reality and surroundings. Allow

client to have familiar objects around him or her; use other items, such
as a clock, a calendar, and daily schedules, to assist in maintaining
reality orientation.
 Encourage caregivers about patient reorientation. Teach prospective
caregivers how to orient client to time, person, place, and circumstances,
as required. These caregivers will be responsible for client safety after
discharge from the hospital.
 Enforce with positive feedback. Give positive feedback when thinking
and behavior are appropriate, or when client verbalizes that certain ideas
expressed are not based in reality. Positive feedback increases self-
esteem and enhances desire to repeat appropriate behavior.
 Explain simply. Use simple explanations and face-to-face interaction
when communicating with client. Do not shout message into client’s ear.
Speaking slowly and in a face-to-face position is most effective when
communicating with an elderly individual experiencing a hearing loss.
 Discourage suspiciousness of others. Express reasonable doubt if
client relays suspicious beliefs in response to delusional thinking.
Discuss with the client the potential personal negative effects of
continued suspiciousness of others.
 Avoid cultivation of false ideas. Do not permit rumination of false
ideas. When this begins, talk to client about real people and real events.
 Observe client closely. Close observation of client’s behavior is
indicated if delusional thinking reveals an intention for violence. Client
safety is a nursing priority.
How can we expand home-based care for dementia at the community

level? Please also focus on provision of low-cost quality nursing care by
trained attendants.
supporting this growing population of caregivers requires an

organized,coordinated array of well-designed individual services throughout the
caregiving journey.19 These supportive services may be provided for caregivers

only or for both the caregiver and the person living with dementia.
Examples include:
˃˃ Caregiver education and skills training.
˃˃ Advanced care and advanced financial planning.
˃˃ Home health or personal care services, as well as home modification

programs.
˃˃ Adult day care and respite care.
˃˃ Community-based programs for physical activity and chronic disease self-

care.
˃˃ Peer support groups and opportunities to learn and socialize.
˃˃ Transportation services.
˃˃ Apps for caregivers and people living with dementia and GPS tracking
devices.
˃˃ Online support, information and referral centers.
Services that enhance caregivers’ health or their ability to provide care also may
benefit adults living with dementia and facilitate stronger, healthier relationships
between the two. For caregivers of someone living with dementia, telephone
counseling by social workers and individual/family counseling sessions are
among the enhanced support services that have been shown to improve
caregivers’ capabilities and well-being.
Supportive resources that are designed for both caregivers and people living with
dementia are particularly effective when they take into account the unique social
determinants of health and cultural attributes of the communities they serve.
Applying a broad, systems approach to caregiving

entails envisioning communities and states in which:
˃˃ All caregivers have the training and knowledge to provide needed care.
˃˃ Healthcare providers always involve caregivers on the care team and refer
them to supports and services to help maintain their own health.
˃˃ Employers institute supportive policies and practices to accommodate all

caregivers’ needs.
˃˃ All caregivers and people living with dementia readily participate in

community life and find support wherever they live, work, and play.
To pursue this vision, public health leaders should begin by convening

caregivers, people living with dementia, and stakeholders from the major
community systems that affect caregivers. Involvement from caregivers and
people living with dementia from diverse communities enables plans to respond
to their priorities. Stakeholders — community-based organizations connected
with groups experiencing disadvantages, employers, policy makers and
others — also should be at the table to help craft a framework for sustained
investment in caregiving.
Depending on prior involvement in aging and dementia activities, public health
strategists may need to first become more familiar with the current literature and
relevant issues.

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What is the role of Nursing fraternity in dementia management?

As dementia progresses, eating can become difficult as they begin to forget to

Encourage them to continue to do as much as possible for themselves with

Routines help to keep things running smoothly, but always having a

The nursing interventions for a dementia client are:

 Orient client. Frequently orient client to reality and surroundings. Allow

How can we expand home-based care for dementia at the community

supporting this growing population of caregivers requires an

caregiving journey.19 These supportive services may be provided for caregivers

˃˃ Caregiver education and skills training.

˃˃ Advanced care and advanced financial planning.

˃˃ Home health or personal care services, as well as home modification

˃˃ Adult day care and respite care.

˃˃ Community-based programs for physical activity and chronic disease self-

˃˃ Online support, information and referral centers.

Applying a broad, systems approach to caregiving

˃˃ Employers institute supportive policies and practices to accommodate all

˃˃ All caregivers and people living with dementia readily participate in

To pursue this vision, public health leaders should begin by convening

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