Dementia is a condition that makes it hard for people to remember things, think clearly, and do everyday tasks. Dementia is caused by changes in the brain that affect how the brain cells work. There are different types of dementia, such as Alzheimer’s disease, vascular dementia, and Lewy body dementia. Some of the symptoms of dementia are confusion, memory loss, mood changes, and trouble speaking or understanding.
Trunk control is the ability to move and balance the upper part of your body, such as your chest, back, and shoulders. Trunk control is essential for posture and mobility, which means sitting, standing, and moving around. Having reasonable trunk control helps you breathe better, avoid pain, and prevent injuries.
Some people with dementia may lose trunk control over time. This can happen for many reasons, such as muscle weakness, stiffness, pain, or poor blood flow. Losing trunk control can make it hard for people to sit up, roll over, or change positions. This can lead to problems such as pressure ulcers, contractures, falls, and infections. Pressure ulcers are sores on the skin when too much pressure is on one area. Contractures are when the muscles or joints become tight and cannot stretch. Falls are when people lose their balance and fall. Infections are when germs enter the body and cause illness.
If you are a caregiver for someone with dementia who has lost trunk control, you may wonder how you can help them. Repositioning is one way you can help. Repositioning means moving or turning the person to a different position. It can help improve the person’s comfort, skin health, and blood flow. It can also prevent or treat pressure ulcers, contractures, falls, and infections.
In this article, we will share some tips for repositioning dementia patients who have lost trunk control. These tips are based on the latest research and best practices. We hope these tips will help you provide better care for your loved one.
Tip 1: Assess the Patient’s Needs and Abilities
Before you reposition someone with dementia who has lost trunk control, you need to assess their needs and abilities. You must check how well they can think, move, and feel. This will help you decide how often and how to reposition them.
To evaluate the patient’s level of cognitive impairment, you need to see how well they can remember, understand, and communicate. Mental impairment means having trouble with thinking skills. Some people with dementia may have mild cognitive impairment, which means they can still do some things by themselves. Others may have severe mental impairment, which means they need a lot of help and supervision.
To evaluate the patient’s physical function, you must see how well they can use their muscles and joints. Physical function means having the ability to move and balance. Some people with dementia may have good physical function, which means they can still walk, sit, and stand. Others may have poor physical function, so they cannot move much.
To evaluate the patient’s pain, you must see how much and where it hurts. Pain means feeling discomfort or distress in the body. Some people with dementia may have no pain, which means they are comfortable and relaxed. Others may have mild, moderate, or severe pain, which makes them unhappy and stressed.
The factors that influence the frequency and method of repositioning are the things that affect how often and how you need to move the person. Some of the factors are:
Skin integrity: This means how healthy the skin is. It has good integrity if the skin is intact, smooth, and moist. If the skin is broken, dry, or red, it has poor integrity. Poor skin integrity can lead to pressure ulcers, which are sores that form on the skin when there is too much pressure on one area. If a person has poor skin integrity, you must reposition them more often and gently.
Comfort: This means how well the person feels in their position. They are comfortable if the person is calm, relaxed, and happy. They are uncomfortable if the person is restless, tense, or angry. Uncomfortable positions can lead to pain, stiffness, and agitation. You must reposition the person more often and carefully if they are uncomfortable.
Safety: This means how well the person is protected from harm. They are safe if the person is stable, secure, and supported. They are unsafe if the person is unstable, loose, or unsupported. Unsafe positions can lead to falls, injuries, and infections. You need to reposition the person more often and more firmly if they are unsafe.
You can use standardized tools and scales to assess the patient’s needs and abilities. These are ways to measure and record the patient’s condition using numbers, words, or pictures. Some of the tools and scales you can use are:
The Braden Scale: This tool measures the risk of developing pressure ulcers. It has six categories: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. Each category scores 1 to 4, with one being the worst and four being the best. The total score ranges from 6 to 23, with 6 being the highest risk and 23 being the lowest risk. You can use the Braden Scale to decide how often and how to reposition the person to prevent pressure ulcers.
The Mini-Mental State Examination (MMSE): This is a tool to measure cognitive impairment. It has 11 questions that test the person’s orientation, memory, attention, language, and visual skills. Each question scores from 0 to 1 or 0 to 3, depending on the difficulty. The total score ranges from 0 to 30, with 0 being the most impaired and 30 being the least impaired. You can use the MMSE to decide how to communicate and involve the person in repositioning.
The FAST Scaleis a tool for measuring the stage of dementia. It has seven stages that describe the person’s abilities and behaviors. Each stage has a number from 1 to 7, with one being the mildest and seven being the most severe. You can use the FAST Scale to decide how much help and supervision the person needs during repositioning.
The PAINAD Scale is a tool for measuring pain in people who cannot speak. It has five categories: breathing, vocalization, facial expression, body language, and consolability. Each category scores 0 to 2, with 0 being the best and 2 being the worst. The total score ranges from 0 to 10, with 0 being no pain and 10 being severe pain. You can use the PAINAD Scale to decide how to relieve and manage the person’s pain during repositioning.
The Numeric Rating Scale (NRS) measures the pain of people who can speak. It has a scale from 0 to 10, with 0 being no pain and 10 being the worst pain imaginable. You can use the NRS to ask the person how much pain they have and how it changes during repositioning.
Tip 2: Choose the Appropriate Equipment and Environment
Another way to help someone with dementia who has lost trunk control is to choose the right equipment and environment for repositioning. This means you must pick the things and places that make moving the person easier, safer, and more comfortable.
Some of the equipment you can use for repositioning are:
Beds: These are where the person sleeps and rests. You can choose beds with special features like adjustable height, electric controls, or side rails. These can help lift, lower, or tilt the person to different positions. You can also use beds with alarms or sensors that alert you if someone tries to get out of bed or falls off.
Mattresses: These are what the person lies on in bed. You can choose mattresses with different firmness, softness, or thickness levels. You can also choose mattresses with special materials like foam, gel, or air. These can help reduce the pressure on the person’s skin and prevent pressure ulcers. You can also use mattresses with heaters or coolers, which can adjust the temperature of the person’s body and keep them warm or cool.
Pillows: These are what the person puts under their head, neck, or other body parts in bed. You can choose pillows that have different shapes, sizes, or fillings. You can also choose pillows with special covers, such as waterproof, washable, or hypoallergenic. These can help support, cushion, or align the person’s body and prevent pain, stiffness, or allergies.
Cushions: These are what the person sits on in a chair, wheelchair, or sofa. You can choose cushions with different designs, colors, or patterns. You can also choose cushions with special features like straps, handles, or pockets. These can help secure, lift, or carry the person to different places. You can also use cushions with pressure-relieving, friction-reducing, or temperature-regulating properties, which can help prevent pressure ulcers, skin tears, or infections.
Sheets: These are what the person covers themselves with in bed. You can choose sheets with different fabrics, textures, or weights. You can also choose sheets with special qualities, such as breathable, absorbent, or antibacterial. These can help keep the person dry, clean, or healthy. You can also use sheets with contrasting colors, patterns, or labels to help the person recognize, locate, or use them.
Blankets: These are what the person wraps themselves with in bed or on a sofa. You can choose blankets that have different materials, styles, or sizes. You can also choose blankets with special functions, such as electric, weighted, or sensory. These can help warm, calm, or stimulate the person. You can also use blankets with familiar smells, sounds, or pictures to help the person remember, relax, or enjoy them.
Lifts: These are what you use to move the person from one place to another, such as from the bed to the chair or from the chair to the toilet. You can choose lifts of different types, such as manual, mechanical, or hydraulic. You can also choose lifts with different parts, such as slings, straps, or hooks. These can help you transfer, position, or support the person safely and easily.
Some of the things you need to consider when choosing the equipment and environment for repositioning are:
The person’s needs and preferences: You must consider the person’s likes, dislikes, wants, or needs. For example, some people may prefer softer or firmer mattresses or warmer or cooler blankets. You need to ask the person for their opinion, observe their behavior, or look for clues, such as facial expressions, gestures, or sounds. You must respect the person’s choices or explain why you must change them.
The caregiver’s abilities and limitations: You need to think about what you can or cannot do or what you need or do not need. For example, some caregivers may have difficulty lifting or moving the person or need extra help or guidance. It would be best to be honest, ask for feedback, or seek advice. You must use the equipment and environment that suit your skills, improve your knowledge, or get support.
The cost and availability of the equipment and environment: You need to consider how much money you can spend or where to get or find the equipment and environment. For example, some equipment or environments may be expensive or complicated to obtain or need maintenance or repair. You must compare the prices and quality, look for discounts or donations, or apply for grants or loans. You must use the equipment and environment that fit your budget, save money, or find resources.
You can use evidence-based guidelines and best practices to choose the appropriate equipment and environment for repositioning. These recommendations and tips are based on the latest research and expert opinions. Some of the guidelines and best practices you can use are:
The National Pressure Ulcer Advisory Panel (NPUAP) is a group of experts who provide information and education on preventing and treating pressure ulcers. Their website provides information about the causes, risk factors, and prevention strategies of pressure ulcers. You can also access their tools and resources, such as the pressure ulcer staging system, the pressure injury prevention points, and the support surface standards initiative.
The European Pressure Ulcer Advisory Panel (EPUAP) is a group of experts who provide guidance and leadership on improving the quality of care for pressure ulcers. Their website provides information about the best practices and standards of care for pressure ulcers. You can also access their publications and products, such as the international guidelines, the quick reference guide, and the educational slides.
The Pan Pacific Pressure Injury Alliance (PPPIA): This is a group of experts who collaborate and coordinate to reduce the burden of pressure ulcers. Their website provides information about pressure ulcers’ current issues and challenges. They also offer events and activities, such as the biennial conference, webinars, and awards.
Examples of using Squishmallows as a beautiful tool
On Reddit, u/general_irma_jewelry shared her story about how she repositions her grandmother, who is greater than 100 years with her Repositioning Tip post:
My grandmother is well over 100 and receiving hospice care. She has end-stage dementia and is in a state of cachexia, so she is skeletally thin and weak, and therefore a huge pressure sore risk.
My cousin had gotten her a large Squishmallow before she deteriorated, and I bought her a little 5″ one to place in her hand to ease some of the edema from her contractures without forcing her hand open uncomfortably.
As she started to decline and lost the energy to shift her weight and lift her arms fully, I improvised and started using the Squishmallows to reposition her, support her, and cushion her pressure points.
It felt silly at first, but her hospice RN case manager loved it! Here’s why:
Squishmallows can be squished (duh) to conform to whatever space they need to fill
They’re velvety soft (my grandma’s skin is tissue paper thin and prone to tears)
They come in different shapes and sizes–the 5″ fits comfortably between her knees, which are very bony and pressed together nearly all the time.
They can be washed (hand or machine washed in cool water on the gentle cycle, though the manufacturer says not to machine wash).
Other positives:
They are adorable and come in a seemingly endless variety. I think particularly of children, but they could also be matched to hobbies, interests, favorite colors, or whatever things the person likes.
They can be given as gifts and therefore hold some sentimental value and/or provide some emotional comfort.
They’re conversation starters. Though she is non-verbal and typically not very alert, my grandmother does relax when spoken to, so I think I will get her a Halloween Squishmallow to invite some engagement from the other residents and visitors at her assisted living facility when I’m not able to be there.
Anyway, point being, Squishmallows are surprisingly useful!
Tip 3: Apply the Correct Techniques and Principles
The third way to help someone with dementia who has lost trunk control is to apply the correct techniques and principles for repositioning. This means moving the person in a way that is safe, comfortable, and effective.
Some of the techniques and principles you can use for repositioning are:
Alignment: This means keeping the person’s body in a straight line without twisting or bending. Alignment can help prevent pain, stiffness, and pressure ulcers. To achieve alignment, you must ensure the person’s head, shoulders, hips, knees, and ankles align. You can use pillows, cushions, or rolled towels to support the person’s body parts and keep them aligned.
Support: This means holding the person’s body parts firmly and gently without squeezing or pulling. Support can help prevent injuries, falls, and skin tears. To provide support, you need to use your hands, arms, or legs to hold the person’s body parts, such as their head, neck, trunk, or limbs. You can also use equipment, such as slide sheets, transfer belts, or lifts, to support the person’s weight and reduce friction.
Stabilization: This means keeping the person’s body steady and balanced without shaking or tipping. Stabilization can help prevent accidents, spills, and infections. To ensure stabilization, you must ensure the person’s body is secure and stable on the surface, such as the bed, chair, or toilet. You can also use equipment, such as side rails, straps, or locks, to stabilize the person’s position and prevent them from sliding or falling.
Some of the types of repositioning you can do are:
Side-lying: This means moving the person to lie on their side, either left or right. Side-lying can help relieve pressure on the back and buttocks and improve blood flow and breathing. To do side-lying, you need to roll the person gently to one side using a slide sheet or a reducing sheet. Placing pillows or cushions under the person’s head, neck, shoulder, arm, hip, knee, and ankle would be best to maintain alignment and support. You must change the person’s side every two hours or as needed.
Supine: This means moving the person to lie on their back, facing up. Supine can help relax the muscles and joints and allow the person to see their surroundings. To do supine, gently roll the person to their back, using a slide sheet or a reducing sheet. It would be best to place pillows or cushions under the person’s head, neck, shoulders, arms, lower back, legs, and feet to maintain alignment and support. You must change the person’s position every two hours or as needed.
Prone: This means moving the person to lie on their stomach, facing down. Prone can help stretch the chest and abdomen and improve lung function and digestion. To do prone, you need to roll the person gently to their stomach, using a slide sheet or a reducing sheet. It would help to keep pillows or cushions under the person’s head, chest, abdomen, pelvis, legs, and feet in alignment and support. You must closely monitor the person’s breathing and comfort and change their position every two hours or as needed.
Sitting: This means moving the person to sit up, either in bed or in a chair. Sitting can help stimulate the brain and senses and promote social interaction and activity. To do sitting, you need to lift the person gently to a sitting position using a slide sheet, a transfer belt, or a lift. It would help if you placed pillows or cushions behind the person’s back, under their arms, and between their legs to keep them aligned and supported. You must check the person’s skin and comfort regularly and change their position hourly or as needed.
You can use clear and simple instructions, cues, and demonstrations to communicate with the person and involve them in repositioning. These can help the person understand what you are doing, why you are doing it, and how they can help. Some of the ways you can communicate are:
Instructions: These are words that tell the person what to do or what to expect. You can use short and simple sentences, such as “I’m going to help you roll to your side”, or “Please lift your arm for me”. You can use a calm and gentle tone of voice and speak slowly and clearly. You can repeat or rephrase the instructions if the person does not understand.
Cues: These are signs that remind the person what to do or what to expect. You can use gestures, such as pointing, nodding, or smiling, or sounds, such as clapping, humming, or singing. You can also use objects, such as pictures, symbols, or colors, or touch, such as tapping, stroking, or hugging. You can use cues that are familiar and meaningful to the person and match them with your instructions.
Demonstrations: These are actions that show the person what to do or what to expect. You can use your body, such as moving your arm, leg, or head, or the person’s body, such as lifting, bending, or turning their arm, leg, or head. You can also use equipment, such as a slide sheet, a transfer belt, a lift, or the environment, such as the bed, the chair, or the toilet. You can use simple, safe demonstrations and match them with your instructions and cues.
Tip 4: Monitor and Document the Outcomes and Complications
The last way to help someone with dementia who has lost trunk control is to monitor and document the outcomes and complications of repositioning. This means you must check and record how the person’s health and well-being change after repositioning.
Some of the outcomes and complications you can monitor and document are:
Skin condition: This refers to how a person’s skin looks and feels. You can check the person’s skin for signs of pressure ulcers, such as redness, swelling, blisters, or wounds. You can also check the person’s skin for signs of skin tears, such as cuts, bruises, or bleeding. You can use the Braden Scale to measure the risk of developing pressure ulcers. You can use the Skin Tear Audit Research (STAR) tool to measure the severity of skin tears. You can write down the person’s skin condition on a chart or a form and take pictures if needed.
Pain level: This means how much the person hurts and where. You can ask the person how much pain they have and where it is using the Numeric Rating Scale (NRS) tool. You can also observe the person’s behavior and expression for signs of pain, such as moaning, grimacing, or frowning. You can use the Pain Assessment in Advanced Dementia (PAINAD) Scale to measure the pain in people who cannot speak. You can write down the person’s pain level on a chart or a form and use stickers or symbols if needed.
Mobility status: This means how well the person can move and balance. You can check the person’s ability to walk, sit, stand, or change positions. You can also check the person’s muscle strength, joint range, and posture. You can use the Functional Independence Measure (FIM) tool to measure the person’s mobility status. You can write down the person’s mobility status on a chart or a form and use numbers or letters if needed.
Quality of life: This means how happy and satisfied the person is with their life. You can ask the person how they feel about their health, comfort, activities, and relationships. You can also observe the person’s mood and behavior for signs of happiness or sadness, such as smiling, laughing, or crying. You can use a tool called the Quality of Life in Alzheimer’s Disease (QoL-AD) to measure the person’s quality of life. You can write down the person’s quality of life on a chart or a form and use words or pictures if needed.
Some of the common outcomes and complications of repositioning are:
Pressure ulcers are sores on the skin when there is too much pressure on one area. Pressure ulcers can cause pain, infection, and tissue damage. They can also make it harder for the person to heal and recover. Pressure ulcers can be prevented by repositioning the person regularly and using the right equipment and environment. Pressure ulcers can be treated by cleaning and dressing the wounds, relieving the pressure, and giving the person antibiotics or painkillers if needed.
Contractures occur when the muscles or joints become tight and cannot stretch. They can cause pain, stiffness, and deformity, making it harder for the person to move and balance. Contractures can be prevented by repositioning the person regularly and using the right techniques and principles. Contractures can be treated by massaging and stretching the muscles and joints, applying heat or cold, and giving the person anti-inflammatory or muscle relaxant drugs if needed.
Falls: These are when the person loses their balance and falls. Falls can cause injuries, such as fractures, bruises, or bleeding. They can also make the person afraid and anxious. Falls can be prevented by repositioning the person regularly and using the right equipment and environment. Falls can be treated by checking and treating the injuries, comforting and reassuring the person, and giving the person painkillers or sedatives if needed.
Infections: These are when germs enter the body and cause illness. Infections can cause fever, chills, cough, or diarrhea. They can also make the person weak and tired. Infections can be prevented by repositioning the person regularly and using the right equipment and environment. Infections can be treated by giving the person antibiotics or antiviral drugs, fluids, and nutrition if needed.
You can use regular and systematic evaluations, feedback, and adjustments to improve the repositioning practice and prevent adverse events. These can help you see what works and does not, and how to make changes and improvements. Some of the ways you can evaluate, give feedback, and adjust are:
Evaluations: These are ways to measure and compare the outcomes and complications of repositioning. You can use tools and scales, such as the ones mentioned above, to evaluate the person’s skin condition, pain level, mobility status, and quality of life. You can also use tools and scales, such as the Patient Safety Indicators or the Adverse Event Reporting System, to evaluate the occurrence and severity of pressure ulcers, contractures, falls, and infections. You can do the evaluations before and after repositioning and at regular intervals, such as daily, weekly, or monthly.
Feedback: These are ways to share and discuss the results and findings of the evaluations. You can give feedback to yourself, the person, and other caregivers, such as family members, nurses, or doctors. You can also receive feedback from them. You can use words, numbers, or graphs to show the feedback. You can also use praise, encouragement, or suggestions to improve the feedback. You can give and receive feedback verbally, in writing, or electronically, such as by phone, email, or online.
Adjustments: Based on the feedback, there are ways to change and improve the repositioning practice. You can adjust the frequency, method, or duration of repositioning. You can also adjust the equipment, environment, or communication used for repositioning. You can make small or big adjustments, depending on the feedback. You can also test and monitor the effects of the adjustments. You can make adjustments as soon as possible or as often as needed.
Conclusion
Repositioning is a way to help someone with dementia who has lost trunk control. Trunk control is the ability to move and balance the upper part of your body. Losing trunk control can make it hard for the person to sit up, roll over, or change positions. This can lead to problems such as pressure ulcers, contractures, falls, and infections.
In this article, we have shared some tips for repositioning dementia patients who have lost trunk control. These tips are:
Tip 1: Assess the patient’s needs and abilities. This means checking how well they can think, move, and feel. This will help you decide how often and how to reposition them.
Tip 2: Choose the appropriate equipment and environment. This means you must pick the things and places that make moving the person easier, safer, and more comfortable.
Tip 3: Apply the correct techniques and principles. This means moving the person in a safe, comfortable, and effective way.
Tip 4: Monitor and document the outcomes and complications. This means you must check and record how the person’s health and well-being change after repositioning.
Repositioning can have benefits and challenges for both the patient and the caregiver. Some of the benefits are:
Repositioning can improve the person’s comfort, skin health, and blood flow. It can also prevent or treat pressure ulcers, contractures, falls, and infections.
Repositioning can stimulate the brain and senses, promote social interaction and activity, and improve mood, behavior, and quality of life.
Repositioning can reduce the caregiver’s stress, fatigue, and injury and increase their confidence, satisfaction, and skills.
Some of the challenges are:
Repositioning can be complex, tiring, and time-consuming for the caregiver. It can also be confusing, scary, or painful for the person.
Repositioning can require special equipment, environment, or communication. It can also require regular and systematic evaluations, feedback, and adjustments.
Repositioning can have different outcomes and complications for different people. It can also have other effects depending on the frequency, method, or duration.
If you want to learn more about repositioning dementia patients who have lost trunk control, you can use additional resources and references. These are:
The Alzheimer’s Association: This group provides information and support for people with Alzheimer’s disease and other types of dementia. You can use their website to learn more about dementia, its symptoms, stages, and treatments. You can also use their services, such as the 24/7 helpline, the online community, and the local chapters.
The Bladder and Bowel Foundation Community: This group provides advice and support for people with bladder and bowel problems. You can use their website to learn more about bladder and bowel health and its causes, effects, and management. You can also use their forums, blogs, and podcasts to share your experiences and questions with other people.
The StatPearls: This group provides free online medical education and review articles. You can use their website to learn about medical topics like pressure ulcers, contractures, falls, and infections. You can also use their quizzes, videos, and images to test your knowledge and skills.
We hope this article has helped you understand and practice repositioning dementia patients who have lost trunk control. We hope you and your loved one enjoy a better and happier life. Thank you for reading.
