Dementia Solutions – Caregiving Advice, October Update

Dementia expert, Karen Tyrell, offers answers to visitors for their situation-specific questions.  Karen is a dementia consultant who can point you in the right direction, giving quick insight and personalized answers to help you with dementia care challenges.

Do you have a specific question relating to dementia that you need answered? Please submit your questions by email to: [email protected]

October, 2014 Update

1.    Does My Mom Have to Stick to a Routine of Getting Up At a Certain Time?


I live with my mom who has dementia and Im her primary caregiver. Due to all my roles and responsibilities, by the end of the day Im exhausted. Both my mom and I tend to sleep in a lot as a result. My sister doesnt approve of this, telling me that we should both be out of bed by 9am. The problem is I get so tired sometimes that I just cant lift my head off the pillow in the morning. Do you think I should follow my sisters advice?

~ Sleep Deprived Susan


Being a caregiver is no easy task. It is completely understandable that after a day of tending to the needs of someone else, you feel drained and in need of adequate rest to recharge your batteries.

Your sister is also right in bringing attention to the importance of routines for those with dementia. Getting up by a particular time everyday can create a sense of predictability and security for your mom, making her less prone to feeling upset or unsettled.

However, every person with dementia reacts differently, and routines may work for some but not all. Be flexible and adjust depending on the day you are having, whether strenuous or more relaxing, and also on your moms response. Your aim as a caregiver is keeping your mom comfortable and contented. If encouraging her to get out of bed at a certain time seems to cause her distress, then let her sleep until she feels ready to get up.

Caregivers also need care, which means that you must listen to your own body. If sleeping in makes you feel better and does not upset your mom, then it is not problematic. In fact, you can be more present and effective as a caregiver when you have more energy and arent feeling worn out.

Go with the flow of the person you are caring for, observe what timing works best for your mom, but also tune into your own needs to make sure you get the rest you deserve.

2.   Violent Behaviours – How Can I Keep Everyone Safe?


I have a client who has started becoming physically violent every time her paid caregiver enters her home in the morning around 6 a.m. This causes a lot of stress for the caregiver who is unable to go ahead with the routine of getting the client dressed and showered. What can we do to address this and keep everyone safe?

~ Wanting to Keep the Peace


It can be distressing for everyone whenever physical violence is exhibited by someone with dementia. Know however that the behaviour can be controlled, and the key to this is uncovering the cause. Put your detective hat on and do some digging into what is triggering the reaction.

Your client may not be expecting someone to enter her house in the morning, mistakenly thinking the caregiver is a burglar who is breaking in. The violence, therefore, could be motivated by self-defense. Is the caregiver knocking or asking permission from the client before entering? Does the client know why the caregiver is there? Has she had a traumatic experience in the past that is returning to haunt her? If the sun has not risen by 6 a.m., does she still think it is night and believe a thief is entering her house?

Once you have pinpointed the cause, creative solutions can be implemented. Many different visual and verbal reassurances can be used in conjunction with one another. For example, the caregiver should knock and ask for permission to enter, even if they have a key. They should wear light-coloured clothing, not black, to avoid being mistaken for a thief. When entering, the caregiver should also smile and use friendly words of reassurance to indicate why she/he is there, which will make your client feel safe. Bringing in a prop, such as knitting wool or a puzzle, can also be useful in clarifying in the mind of your client that the caregiver is not a threat in any way.

By investigating the triggers and trying out creative solutions, you will be better able to address your clients reactions to create a less stressful environment for all involved.

3. Continue With Medications Or Not?


Our mother is in an acute care unit of a hospital due to ongoing medical conditions from a recent prolapsed surgery. We knew she was diagnosed with vascular cerebral dementia prior to the surgery, but since being in the hospital her health has deteriorated and she is displaying unmanageable agitation and aggression. To manage these behaviours, she is being given Risperidone at various intervals every day, to a max of 2.5 mg daily. From what I have read, this antipsychotic drug is not for use in elderly patients with dementia, as it carries the increased risk of death. The hospital also gives her Halodal and she has atrial fibrillation and is on warfarin.

As a family, we are concerned about the antipsychotic medication because though we are told it is standard protocol, we are seeing a downward spiral. What should we do?

~ Distressed Daughter


It is great that you are doing your research to better understand the effects of the medications your mother is taking. Informed choices are the best choices. I cannot make the decision about your mother continuing with the medications or not, but I can suggest other avenues for you to explore.

Medications can be a necessary way to cope with behaviours but it is also important to be informed about non-drug creative strategies which can prove to be very effective. Having someone by your mothers side during the times of the day when she gets most agitated could soothe her. That person, whether a family member, close friend or paid caregiver, would be able to address her needs as they arise. When someone is present while your mother is displaying agitation or aggression, they can also observe the behaviour more closely and identify any triggers that can be addressed;maybe shes feeling too hot or too cold, is hungry, or feels disoriented in the hospital surroundings. The person present can keep her distracted and reassure her through creative communication techniques.

In making a choice relating to your mothers medication, gather as much information as you can and implement creative strategies, aside from the drugs, that can help curb the disruptive behaviour. Gage the effectiveness of the different strategies before moving forward with a decision. I know this must be a difficult time for you and your family and I commend you for being strong advocates for your mother.

Do you have a specific question relating to dementia that you need answered? Please submit your questions by email to: [email protected]

Karen Tyrell CDP, CPCA is a Dementia Consultant & Educator for Personalized Dementia Solutions ( and the author of the book Cracking the Dementia Code – Creative Solutions to Cope with Changed Behaviours. She offers her expertise on dementia care through speaking engagements, workshops and by working one-on-one with families and caregivers.