Caring for a loved one with dementia can be both rewarding and challenging. If your loved one has been restless throughout their life, this restlessness may continue as a symptom of their dementia. As an experienced hospice nurse, I understand the difficulties you may face in managing chronic restlessness while ensuring the safety and welfare of your loved one. In this article, I’ll provide practical tips and evidence-based practices to create a calming environment for your loved one, even if they have trouble with fine motor control due to arthritis or other factors.
Understanding Restlessness in Dementia Patients
Restlessness is when someone feels uneasy or restless and cannot stay still. It is normal to feel restless sometimes, but for people with dementia, it can happen more often and make them feel unhappy or frustrated. Dementia is a disease that affects the brain and makes it hard to remember things, think clearly, and communicate with others. People with dementia may feel restless for several reasons, such as:
Changes in the brain: Dementia can damage the parts of the brain that control movement, emotions, and sleep. This can make people with dementia feel restless or agitated, especially in the late afternoon or evening. This is called sundowning.
Difficulty communicating: People with dementia may struggle to find the right words or understand what others are saying. They may also have trouble expressing their needs, feelings, and preferences. This can make them feel frustrated or misunderstood and cause them to act out or become restless.
Feelings of confusion and anxiety: People with dementia may not recognize familiar people, places, or objects. They may also forget where they are, what time it is, or what they are supposed to do. This can make them feel confused, scared, or anxious, leading to restlessness or wandering.
As a caregiver, you may find it challenging to deal with restlessness in your loved one with dementia. You may feel stressed, tired, or helpless. But remember, you are not alone. Many resources and tips can help you cope and provide the best care possible. Some of the tips are:
Keep a routine: Regular meals, activities, and bedtime schedules can help your loved one feel more secure and calm. Try to avoid changes or surprises that may confuse or upset them. Plan activities they enjoy and can do safely, such as listening to music, reading, or gardening.
Minimize stress: Create a peaceful and comfortable environment for your loved one. Reduce noise, clutter, and distractions that may overwhelm them. Use soft lighting, soothing colors, and familiar objects to make them feel at home. Speak slowly, clearly, and gently, and communicate with simple words and gestures. Avoid arguing, criticizing, or correcting them, as this may make them angry or defensive.
Encourage good hygiene: Helping your loved one maintain good hygiene can improve their physical and mental health. Assist them with bathing, dressing, and grooming, and respect their privacy and dignity. Choose clothes that are easy to put on and take off, such as those with elastic waistbands or Velcro fasteners. Use a shower chair or grab bars to prevent falls in the bathroom.
Seek professional help: If your loved one’s restlessness is severe or affects their quality of life, you may want to consult a doctor or a dementia specialist. They may be able to prescribe medication or other treatments that can help reduce restlessness or agitation. They may also refer you to other services or support groups to help you and your loved one.
Restlessness in dementia patients is a common and challenging problem, but it can be managed with patience, compassion, and understanding. These tips can help your loved one feel more comfortable and relaxed and improve your relationship. Remember, you are doing a great job and deserve to care for yourself.
Understanding Sundowning
Sundowning is when people with dementia feel more confused, anxious, or restless in the late afternoon or evening. Dementia is a disease that affects the brain and makes it hard to remember things, think clearly, and communicate with others. Sundowning can make people with dementia act differently, such as:
Pacing around the room or wandering outside
Getting angry or upset easily
Seeing or hearing things that are not there
Having trouble sleeping or staying awake at night
Sundowning is not a disease but a set of symptoms or behaviors that may happen with dementia. Doctors do not know exactly why sundowning happens, but some reasons are:
Changes in the brain: Dementia can damage the parts of the brain that control movement, emotions, and sleep. This can make people with dementia more sensitive to changes in light and darkness, which can affect their internal body clock.
Difficulty communicating: People with dementia may struggle to find the right words or understand what others are saying. They may also have trouble telling others what they need, want, or feel. This can make them feel frustrated or misunderstood and cause them to act out or become restless.
Feelings of confusion and anxiety: People with dementia may not recognize familiar people, places, or things. They may also forget where they are, what time it is, or what they are supposed to do. This can make them feel confused, scared, or anxious, leading to restlessness or wandering.
Sundowning can be hard for both the person with dementia and their caregiver. You may feel stressed, tired, or helpless. But remember, you are not alone. Many resources and tips can help you cope and provide the best care possible. Some of the tips are:
Keep a routine: Having a regular schedule for meals, activities, and bedtime can help a person with dementia feel more secure and calm. Try to avoid changes or surprises that may confuse or upset them. Plan activities they enjoy and can do safely, such as listening to music, reading, or gardening.
Minimize stress: Try to create a peaceful and comfortable environment for the person with dementia. Reduce noise, clutter, and distractions that may overwhelm them. Use soft lighting, soothing colors, and familiar objects to make them feel at home. Speak slowly, clearly, and gently, and communicate with simple words and gestures. Avoid arguing, criticizing, or correcting them, as this may make them angry or defensive.
Encourage good hygiene: Helping people with dementia maintain good hygiene can improve their physical and mental health. Assist them with bathing, dressing, and grooming, and respect their privacy and dignity. Choose clothes that are easy to put on and take off, such as those with elastic waistbands or Velcro fasteners. Use a shower chair or grab bars to prevent falls in the bathroom.
Seek professional help: If the person’s sundowning is severe or affects their quality of life, you may want to consult a doctor or a dementia specialist. They may be able to prescribe medication or other treatments that can help reduce sundowning or agitation. They may also refer you to other services or support groups to help you and your loved one.
Sundowning is a common and challenging problem but can be managed with patience, compassion, and understanding. By following these tips, you can help the person with dementia feel more comfortable and relaxed and improve your relationship with them. Remember, you are doing a great job and deserve to care for yourself.
Creating a Calming Environment
If your loved one has dementia, you may notice that they sometimes feel restless or agitated. They may pace around, fidget with things, or get upset easily. This can be hard for both of you, and you may wonder what you can do to help them feel calmer and more relaxed.
Restlessness in dementia patients can happen for several reasons, such as changes in the brain, difficulty communicating, or feelings of confusion and anxiety. You cannot always prevent or stop restlessness, but you can create a calming environment that makes your loved one feel more comfortable and peaceful. A calming environment is familiar, safe, and soothing for your loved one. Here are some tips on how to create a calming environment:
Familiarity and Routine: Dementia patients often find comfort in familiarity and routine. They like to know what to expect and what to do. Establish a daily schedule for meals, activities, and bedtime, and stick to it as much as possible. Avoid changing things or surprising your loved one, which may confuse or upset them. For example, if they always have breakfast at 8 a.m., try to keep it that way. If they like to watch a certain TV show, make sure it is on simultaneously every day.
Safety Measures: Ensure that your home is safe for your loved one. Remove any objects that may cause them to trip or fall, such as rugs, cords, or toys. Secure any furniture that may tip over, such as bookshelves or lamps. Consider installing safety gates or locks to prevent your loved one from wandering into dangerous areas, such as staircases, kitchens, or bathrooms. You can also use alarms or sensors to alert you if your loved one tries to leave the house or enter a restricted area.
Limiting Caffeine and Sugar: Avoid giving your loved one too much caffeine or sugary foods, as these can make them more restless or agitated. Caffeine is found in coffee, tea, soda, chocolate, and some medications. Sugar is found in candy, cookies, cakes, and other sweets. Instead, offer your loved one water, juice, milk, herbal tea, and healthy snacks such as fruits, nuts, or cheese.
Purposeful Activities: Engage your loved one in activities that match their abilities and interests. Activities can help your loved one feel more engaged, productive, and happy. They can also distract them from their restlessness or agitation. Choose simple tasks that your loved one can do safely and successfully, such as folding laundry, sorting items, or arranging flowers. You can also do activities your loved one enjoys, such as listening to music, reading, or gardening. Avoid too difficult, boring, or stressful activities for your loved one, as these can make them feel frustrated or anxious.
Calm and Soothing Surroundings: Use soft, calming colors in living spaces, such as blue, green, or purple. These colors can have a relaxing effect on your loved one. Minimize noise or distractions that may overwhelm your loved one, such as loud music, TV, or phone calls. You can also use soft music or nature sounds like birds, waves, or rain to create a tranquil ambiance. To create a pleasant smell, you can also use aromatherapy, such as lavender, chamomile, or vanilla. Aromatherapy can help your loved one feel calmer and more relaxed.
Memory Triggers: Display familiar photographs, mementos, or objects with sentimental value for your loved one. These items can serve as memory triggers and help your loved one remember their past, identity, and loved ones. Memory triggers can also provide comfort and happiness for your loved one. For example, you can show your loved one a photo album of their family, a trophy they won, or a souvenir from a trip they took. You can also talk to your loved one about these items and share stories and memories with them.
Gentle Physical Contact: Offer gentle touch, such as holding hands, giving a hug, or stroking their hair. Physical contact can soothe your loved one and make them feel more secure. It can also help you bond with your loved one and show them you care. Be mindful of your loved one’s preferences and comfort level, and do not force physical contact if they do not want it or if it makes them uncomfortable.
Outdoor Time: Outdoors can be therapeutic and reduce restlessness, even in a garden or patio. Nature can have a calming influence on your loved one and make them feel more connected to the world. You can also enjoy the fresh air, sunlight, and scenery with your loved one. You can do simple activities outdoors, such as walking, sitting, or birdwatching. Ensure your loved one is dressed appropriately for the weather and has sunscreen, hat, sunglasses, or water if needed.
Creating a calming environment for your loved one with dementia can help them feel more comfortable and relaxed and reduce their restlessness or agitation. It can also improve your relationship with them and make caregiving more enjoyable. Remember, you are doing a wonderful job and deserve to care for yourself.
Adapted Activities for Limited Fine Motor Control
If your loved one has dementia, you may notice that they sometimes have trouble using their hands or fingers. They may find it hard to do things like buttoning a shirt, writing a note, or picking up a spoon. This can be because of arthritis, when the joints in the hands become swollen and painful, or other limitations that affect their fine motor skills. Fine motor skills are making small and precise hand or finger movements.
Having trouble with fine motor skills can make your loved one feel frustrated or sad. They may be unable to do some of the things they used to enjoy, or they may need more help from you or others. But this does not mean they cannot have fun or feel good. There are many activities that they can still do, even if their fine motor skills are limited. These activities can provide joy, stimulation, and a sense of accomplishment for your loved one without causing frustration or stress. Here are some examples of adapted activities for limited fine motor control:
Folding Laundry: Simple tasks like folding laundry can be meaningful for your loved one. They can help sort and fold clothes, even if their fine motor skills are limited. This can provide a sense of purpose and contribution and a chance to practice their hand-eye coordination and memory. You can also use this activity to talk to your loved one about the clothes, such as who they belong to, what color they are, or when they were worn.
Sorting Objects: Organizing and sorting items, such as a deck of cards or a box of buttons, can be engaging and mentally stimulating for your loved one. They can use their hands to pick up and arrange the items by various categories, such as color, shape, size, or type. This can help them exercise their cognitive skills, such as attention, memory, and problem-solving. You can also use this activity to talk to your loved one about the items, such as what they are, what they are used for, or where they came from.
Memory Boxes: Create memories filled with familiar objects and photos your loved one can explore and reminisce about. Memory boxes hold meaningful or special items for your loved one, such as a wedding ring, a favorite book, or a family photo. Your loved one can use their hands to touch and feel the items and their eyes to look at the photos. This can help them recall their past, identity, and loved ones. You can also use this activity to talk to your loved one about the items and photos and share stories and memories with them.
Gardening: If your loved one enjoys spending time outdoors, consider creating a small garden area to engage in light gardening tasks like watering plants or pulling weeds. Gardening can be therapeutic and relaxing for your loved one and connect with nature. You can choose plants that are easy to care for, such as herbs, flowers, or succulents. You can also provide easy tools, such as a watering can with a handle, gloves, or a small shovel. You can also use this activity to talk to your loved one about the plants, such as their names, colors, or smells.
Sensory Bins: Create sensory bins with different textures, such as dried beans, rice, or sand. Sensory bins are containers that hold materials that stimulate the senses, such as touch, sight, or smell. Your loved one can use their hands to explore and feel the textures and their eyes to look at the colors or shapes. This can help them engage their sensory system, which can have a calming and soothing effect. You can also use this activity to talk to your loved one about the materials, such as what they are, how they feel, or what they sound like.
Puzzle Boards: Larger puzzle pieces with knobs or magnetic puzzles are great options for individuals with limited dexterity. These puzzles can still offer mental stimulation and a sense of accomplishment for your loved one without being too difficult or frustrating. You can choose puzzles appropriate for your loved one’s cognitive level, such as those with fewer pieces, simpler images, or familiar themes. You can also use this activity to talk to your loved one about the puzzle, such as what it is, what it shows, or how to solve it.
Sensory Art: Encourage your loved one to express themselves through sensory art, using materials like finger paint, soft clay, or fabric pieces. Sensory art is a form of art that involves using the senses, such as touch, sight, or smell, to create something. The focus is on the process rather than the result, so your loved one does not have to worry about making perfect or realistic artwork. They can enjoy the feeling and the fun of making something with their hands. You can also use this activity to talk to your loved one about their art, such as what they made, what colors they used, or how they felt.
Music Therapy: Listening to familiar songs or playing simple instruments like shakers or tambourines can provide joy and a sense of participation for your loved one. Music therapy is a form of therapy that uses music to improve physical, mental, and emotional well-being. Music can help your loved one relax, remember, and communicate. You can choose meaningful or enjoyable songs for your loved one, such as those from their childhood, culture, or favorite genre. You can also use this activity to talk to your loved one about the music, such as what it is, who sings it, or what it means.
These are some examples of adapted activities for limited fine motor control for habitually restless dementia patients. These activities can provide joy, stimulation, and a sense of accomplishment for your loved one without causing frustration or stress. They can also improve your relationship with your loved one and make caregiving more enjoyable. Remember, you are doing an excellent job and deserve to care for yourself.
Remember the Power of Connection
If your loved one has dementia, you may notice that they sometimes act differently or have trouble talking to you. They may forget your name, repeat themselves, or say things that do not make sense. They may also get angry, sad, or scared easily. This can be hard for both of you, and you may feel hurt, lonely, or frustrated.
But remember, your loved one is still the same person you know and love. They are not trying to be difficult or mean. They are just having trouble with their brain, making it hard to remember things, think clearly, and communicate with others. Dementia is a disease that affects the brain, and it is not their fault.
One of the most important things you can do for your loved one is to stay connected with them. Connection is when you feel close to someone and share your feelings, thoughts, and experiences. Connection can make you and your loved one feel happier, calm, and more secure. Here are some tips on how to stay connected with your loved one:
Be patient: Try to be patient with your loved one, even if they say or do confusing or upsetting things. Please do not argue, correct, or scold them; this may make them feel worse. Instead, try to understand what they are feeling or trying to say and respond with kindness and respect. For example, if they repeatedly ask the same question, do not get annoyed or say, “I already told you.” Instead, answer them calmly and gently or distract them with something else.
Be empathetic: Try to be empathetic with your loved one, which means putting yourself in their shoes and feeling what they feel. Try to imagine how they feel and what they need or want. Do not judge, criticize, or blame them; this may make them feel bad. Instead, show them that you care and are there for them. For example, if they are scared or anxious, do not say “There is nothing to be afraid of” or “Calm down”. Instead, say, “I know you are feeling scared, and that is okay. I am here with you and will keep you safe.”
Be understanding: Try to be understanding with your loved ones, which means accepting them as they are and not expecting them to be different. Do not compare them to how they used to be or other people, as this may make them feel inadequate or guilty. Instead, appreciate them for who they are now and celebrate their strengths and abilities. For example, if they cannot remember your name, do not say, “How can you forget me?” or “Don’t you love me?”. Instead, say, “It’s okay if you don’t remember my name. I am your (son, daughter, friend, etc.), and I love you very much.”
Be supportive: Try to be supportive of your loved one, which means helping them with their needs and wants and encouraging them to do their best. Do not do everything for them or take away their choices, which may make them feel helpless or dependent. Instead, help them do what they can and offer choices when possible. For example, if they need help dressing, do not say, “Let me do it for you” or “You have to wear this.” Instead, say, “Do you need some help with that?” or “What would you like to wear today?”
Be present: Try to be present with your loved one, giving them your full attention and focus and being in the moment with them. Do not be distracted by your phone, TV, or other things; this may make them feel ignored or unimportant. Instead, look at them, listen, and talk to them. For example, if they tell you a story, do not say “Uh-huh” or “That’s nice.” Instead, say “That sounds interesting” or “Tell me more”.
Be affectionate: Try to be affectionate with your loved one, showing them your love and care through physical contact, such as holding hands, hugging, or kissing. Physical contact can have a soothing and comforting effect on your loved one and make them feel more secure and loved. Be mindful of your loved one’s preferences and comfort level, and do not force physical contact if they do not want it or if it makes them uncomfortable.
Staying connected with your loved one can help them feel more comfortable and relaxed, reducing their restlessness or agitation. It can also improve your relationship with them and make caregiving more enjoyable. Remember, you are doing an excellent job and deserve to care for yourself.
Conclusion
As a conclusion to the article on dementia care for loved ones who are habitually restless, it’s essential to recognize the challenges and rewards of caring for a loved one with dementia. Understanding the reasons behind restlessness in dementia patients, such as changes in the brain, difficulty communicating, and feelings of confusion and anxiety, is crucial in providing effective care. Creating a calming environment, establishing a routine, minimizing stress, encouraging good hygiene, seeking professional help, and adapting activities for limited fine motor control are practical strategies to manage restlessness and improve the well-being of both the patient and the caregiver. Additionally, staying connected with patience and empathy is essential for maintaining a strong and positive relationship with the loved one. Remember, you are doing an excellent job and deserve to care for yourself, too. Your dedication and compassion are invaluable in providing comfort and support to your loved one through their end-of-life journey.
