Adapting the Environment and Navigating Changes from Dementia

As dementia progresses, mobility changes like the ability to walk or get out of bed, can occur.

Mobility changes can be caused by:

• Changes and reduction in vision
• Balance issues
• Loss of muscle strength
• Medication

To help manage the changes in mobility in a person with dementia, try to:

• Encourage physical activity to help manage muscle strength and weight.
• Keep their environment safe by reducing clutter and scenarios that might increase their risk of falling.

Persons with dementia may experience visual changes like:

• The ability to see things in three dimension
• Loss of peripheral vision
• Difficulty to understand distance
• Mistaking objects as something else
• Viewing items on the TV or in a painting as real
• Hallucinations

To help cope with vision changes in a person with dementia, try to:

• Use contrasting colors: Using bright colors can provide contrast and help people with dementia view objects easier. For example, using a bright red plate with food will help them identify food and a bright red cup will help them locate the drink. Alternatively, dark colored tape can be used in front of outward facing doors to reduce the risk of More a person with dementia from wandering outside unattended.
• Modify lighting: It is best to gradually light a room as they are slower to adjust to changes in light. To create a more peaceful environment, adequate lighting to reduce shadows and changing from natural light during the day to softer lighting at night should also be considered.
• Maintain familiarity and avoid clutter: Try to create a familiar environment and avoid rearranging the room layout. Removing and avoiding clutter will help reduce the risk of falls.
• Speak in front of them: As they may lose peripheral vision, you may consider standing in front of a person with dementia to help improve communication.

Persons with dementia often experience changes to their sleep patterns. Although changes in sleep patterns can also occur in normal aging, persons with dementia often experience more significant changes.

Sleep changes include difficulty sleeping, daytime sleeping and sundowning.

More research is needed to understand the sleep changes in persons with dementia.

In addition to medication, caregivers can try to adapt the environment to navigate sleep problems and sundowning in dementia.

People with dementia may experience anxiety, irritability or confusion that begins in the late afternoon or early evening. This change of behavior is referred to as sundowning and can continue into the night.

The exact cause is unknown, but may occur due to depression, boredom or unmet needs of hunger, thirst or being overly tired.

To navigate sundowning in dementia, in the early evening try to create an environment that has:

• Soothing music or reduced noise.
• More privacy from too many people being in the room or reduced clutter.
• Natural light during the day and softer lighting for the evening.

Caregivers may also consider creating an early evening schedule that includes:

• Listening to soothing music, reading or going for a walk.
• Having the person with dementia talk to a family member or friend.
• Doing a familiar activity or having a favorite snack.

To help prevent sundowning, try to:

• Get natural light during the day by going outside or sitting next to a window.
• Get physical activity.
• Avoid too many activities in one day to avoid being overly tired.
• If naps are needed, try to not to have them too late in the day.
• Avoid caffeinated drinks too late in the day and do not provide any alcohol.

As the disease progresses, a person with dementia will be unable to drive.

Signs a person should stop driving include:

• Forgetting the destination or how the directions to familiar places.
• Unable to follow traffic signs or traffic directions.
• Speeding or driving too slow.
• Difficulty controlling a vehicle by hitting curbs or unable to stay in lanes.
• New dents or scrapes on their car.
• Confusion between gas or brake pedals.
• Unable to quickly make decisions.
• Taking longer than needed when running an errand.

When a person loses the ability to drive, they can feel a loss of independence. This change and conversation can be difficult for both the person with dementia and their loved ones.

The Alzheimer’s Association has more information to help you plan for this conversation and transportation options.