Health and function

Consider impacts of cognitive impairment         

Good management of blood pressure, cholesterol and diabetes is needed

A cognitive impairment can impact on self-management of chronic disease

Possible supports to maintain independence

• Practice Nurse and GP monitoring
• Regular care plan reviews
• Health education with written information provided (consider the person’s health literacy)
• Check use of medical aids e.g. blood glucometers, asthma puffers
• Consider use of prompts or written instructions for correct use of medication and equipment
• Can self-management tasks be simplified or can support from community service providers be offered

Consider impacts of cognitive impairment         

Understanding and management of prescribed medications

Use of over the counter medications     

Possible supports to maintain independence

• Home Medication Review
• Medication administration aids
• Prompts and reminders
• District Nursing Services or Community Care Providers to support self-administration

Consider impacts of cognitive impairment

Poor mental health may be a result of:

• Depression
• Anxiety
• Fear
• Low self-esteem
• Inability to do previous tasks
• Social isolation 

Possible supports to maintain independence

Have a conversation about how person managed difficult situations in the past. Understanding their strengths and achievements may help them with developing confidence and strategies with managing current stressors.

The following may be useful to support a person to do activities that they enjoy

• Community Service Providers can provide a carer to assist a person participate in hobbies or go on outings
• Carer Gateway have information on local support and activity groups
• Dementia Australia offers individual and family counselling, education and support groups

Consider impacts of cognitive impairment

In addition to poor nutrition knowledge, poor nutrition may result from:

• too much, too little foods
• poor quality foods
• foods that are too difficult to eat
• loss of ability to cook, follow recipe or using cooking equipment
• change in food likes and dislikes
• difficulty managing cutlery or crockery
• poor dental health or not using dentures
• loss of ability to shop for groceries         

Possible supports to maintain independence

• Use of signs, prompts and reminders, such as how to use the microwave
• Having tasty, nutritious foods easily accessible
• Simple presentation of meals
• Keeping meal time quiet with minimal clutter or distraction at the table

The following referrals may be helpful

• Dietary advice – Dietician
• Swallowing difficulties – Speech pathology
• Eating difficulties – physical reasons– Occupational Therapy
• Eating difficulties – cognitive reasons – Dementia Australia
• Dental Health – local dental services
• Shopping assistance – local community services
• Meals provision – Local meals on wheels service

Poor dental health can affect a person’s comfort, appearance, eating, nutrition, behaviour and general health. Every person with dementia needs an individualised preventive approach to dental care that should ideally begin as soon as dementia is diagnosed.

People with dementia are susceptible to dental problems for a number of reasons, including:

• Reduced saliva - Taking medications that reduce the production of saliva by the salivary glands. Saliva is essential to maintain a healthy mouth and to prevent the onset of dental decay and other oral lesions. Or having a reduced flow of saliva, even when not taking medications.
• Medications - Or taking long-term, sugar based medications which can lead to tooth decay, dry mouth and difficulties using dentures.
• Changed diet - Changed eating habits such as the replacement of main meals with small snacks, sucking boiled lollies or drinking sugared tea
• Reduced dental care - Reduced abilities over time to maintain their toothbrushing and denture care.

The key to maintaining good dental health for someone with dementia is:

• Help with dental care - Reminding and assisting people with their toothbrushing and denture care.
• Reduce sugar intake - Monitoring and reducing sugar intake where needed for people with natural teeth.
• Use flouride - Regularly using fluorides on natural teeth. This includes fluoridated tap water, toothpastes, mouth rinses and gels.
• Regular dental check-ups - Regular dental visits with dental professionals who understand and are experienced in caring for someone with dementia.

Many people with dementia are unable to express discomfort or pain verbally. They rely on family and carers to understand any changes in behaviour that may indicate dental problems, such as not eating or constant pulling at the face, refusing oral hygiene care or other behavioural problems. 

Consider impacts of cognitive impairment

Is the person drinking adequate amounts of fluids? Especially in hot weather

Possible supports to maintain independence

• Signs, prompts and reminders
• Have glasses or jugs of water or other fluids easily accessible

Consider impacts of cognitive impairment

Concerns with continence may arise from poor pelvic tone, but also consider:

• difficulty locating toilet
• loss of ability to remove clothing appropriately
• difficulty using continence aids
• loss of sensation to urinate or use bowels    

Possible supports to maintain independence

• Use of signs to locate toilet
• Using different coloured toilet seat so it can be easily seen
• Cotton pants with inbuilt pads may be more familiar and easier for person to use
• Chair and bed protectors may minimise embarrassment and anxiety
• Simple clothes without complex fasteners
• Support person to prompt use of toilet

Financial assistance for continence aids may be available - CAPS application form

Confidential advice and information is available from Continence Foundation of Australia. Contact the National Continence Helpline on 1800 330 066 or visit Continence Foundation of Australia website.

Consider impacts of cognitive impairment

Difficulties may arise with maintaining personal hygiene including grooming and foot care

Possible supports to maintain independence

• Working with person and support person to simplify tasks
• Break down complex sequences into smaller steps
• Set out clothing in order to be used
• Minimising need to make decisions to a few options
• Allow time to complete tasks

Referrals that may be useful to support the person’s independence include:

• Community Service Providers
• Local District Nursing Service
• Occupational Therapy
• Podiatry

Consider impacts of cognitive impairment

It is important to try to recognise what may be causing the problem – is it the environment, a physical problem, the dementia or medications?

Consider impacts of cognitive impairment

Consider ease of mobility and falls risk

If there may be an issue of concern ask about:

• History of falls
• Chronic or acute pain
• Medication use that may contribute to poor balance
• Correct use of mobility aids
• Securely fitting foot wear
• Use of glasses and hearing aids
• Check if environmental clutter including pets and rugs
• Are grab rails available or needed?
• Is it easy to get out of bed and seating?
• Urge incontinence

Possible supports to maintain independence

Useful referrals to maintain mobility include:

• Physiotherapy
• Exercise therapy
• Falls and Balance Clinics through local health services
• Occupational therapy (home safety assessment, home modification, aids, task modification)

Safety pendants may be accessed through

• Safety Link 1800 813 617
• MEPACS 1800 451 300
• Personal Alarm Victoria (funded) 1800 451 300

Changing the pattern of, or ceasing, driving is usually a difficult decision for people to make. Understanding what driving means to a person can help with having this conversation.  It may also help to start considering transport alternatives early to reduce the worry of isolation and being unable to attend daily or social activities.

People have described the following as important to them when considering driving:

• status
• rite of passage
• independence
• self-image
• role
• attending daily activities
• participating social activities

If driving, safety can be improved by only driving when you are well, have had a good sleep, are feeling calm and not rushed. 

For more information about driving and dementia see here.

People living with dementia are at an increased risk of loneliness and depression. Support your patients to maintain social connections through formal and informal social activities.

If your patient ceases participating in previously enjoyed activities try and find out why. There may be reasons due to a change in cognition, for example:

• Embarrassment due to forgetting people’s names or word-finding difficulties
• Anxiety as feels easily disorientated when out of the home environment
• Loss of confidence as making mistakes with familiar activities

A family member or trusted friend may be able to go with the person and provide reassurance and support. Formal support services may also be of benefit to facilitate on-going social connections and participating in enjoyable and meaningful activities.

Local Neighbourhood Houses, Community Health Centres and libraries are good places to find out about local groups and activities.

Participating in respite programs can also provide an opportunity to engage socially with others.