Some ideas to consider when discussing your concerns with your person:

*Broach the topic gently. It may help to remind them that memory issues don’t always point towards dementia.

*Be kind and supportive during the conversation. Listen to their reasons and any fears they raise.

*Let them know that you’re worried about them. Give examples of issues like missing appointments, misplacing items, forgetting names.

*Break down the larger issue into smaller ones. Pick one to focus on, such as, ‘I’ve noticed you’ve been forgetting names of friends. Maybe the GP will be able to help.’

*Keep a diary of events. This will help you show someone you’re worried about that you have ‘evidence’ for your worries. The diary will also support you both if you see a doctor as they may want to see a record of issues.

*Turn the focus towards getting support for their friends and family. For example, ‘If you visit the GP, we might be able to get extra help that would give me a break...’

There are a few things you can do to support someone who is in denial about their dementia diagnosis or refusing to accept help.

*Keep a diary of events – examples of issues, dates, times, locations – and what happened. This record can support you in approaching the person diagnosed with dementia, if it feels appropriate. You can use it to show them you care and are concerned for them.

*Find out more about local support groups and therapies. Attending these may help the person come to terms with their diagnosis. Talking and art therapies are popular choices.

*Try to stay calm when talking about your concerns. Getting angry or upset can make conversations uncomfortable for everyone involved. The person you’re worried about may be more hesitant to talk to you in the future.

It's important to try talking to the person you're worried about and to encourage them to see a doctor themselves.

Where this doesn’t work, you might consider speaking to the person’s doctor yourself. If doing so, it is best to get the person’s consent, or at least inform them that you are going to speak to their doctor. It will then be for the doctor to decide whether they disclose the information to the person.

Prepare the bathroom in advance

Encourage the person to do as much as possible, but be ready to assist when needed. In the earlier stages, the person may only need a reminder to bathe. As dementia progresses, he or she will require more assistance. Prepare the bathroom in advance:

*Gather bathing supplies. Have large towels (that you can completely wrap around the person for privacy and warmth), shampoo, soap and a bath stool/bench ready before you tell the person that it's time to bathe.

*Make the room comfortable. Pad the shower seat and other cold or uncomfortable surfaces with towels. Check that the room temperature is pleasant.

*Place soap, shampoo and other supplies within reach. Try using hotel-sized plastic containers of shampoo, and have a washcloth ready to cover the person's eyes to prevent stinging.

*Monitor water temperature. The person may not sense when the water is dangerously hot or may resist bathing if the water is too cool. Always check the water temperature, even if the person draws his or her own bath.

Making the bathroom safe

It's important to make the bathroom as safe and comfortable as possible. Provide supervision as needed in the bathroom, especially if the person is unsteady. Lower the thermostat on your hot water heater to prevent scalding injuries. Always check the water temperature, even if the person draws his or her own bath. Place a non-skid mat in the tub or shower. Install grab bars and use a seat in the tub or shower. Make sure there are no puddles on the bathroom floor.

Help the person feel in control

You may need to experiment to determine if the individual prefers showers or tub baths.

*Give the person choices. For example, ask if he or she would like to bathe now or in 15 minutes, or take a bath or a shower. Try saying “Let’s wash up,” instead of “Let’s take a bath.”

*Fill the tub with 2 to 3 inches of water. Then assess the person's reaction to getting in. It may be better to fill the tub after the person is seated.

*Be sure the person has a role in the bathing process. For example, have the person hold a washcloth, sponge or shampoo bottle.

*Be aware that the person may perceive bathing to be threatening. If the person is resistant, distract him or her and try again later.

*Have activities ready in case the person becomes agitated. For example, play soothing music or sing together.

*Always protect the person’s dignity, privacy and comfort. Consider covering the person with a bath towel while undressing to decrease feelings of vulnerability.

*Try having a familiar person of the same sex help with bathing if that is more comfortable for the person living with dementia.

*Try different approaches to coax the person into the tub or shower. For instance, allow the person to get into the tub or shower with a towel on to reduce embarrassment or to help the person feel warmer.

Adapt the bathing process

*Try bathing at the same time of day the person is used to. If the person is usually a morning bather, a bath in the evening may be confusing.

*Use simple phrases to coach the person through each step of the process, such as, “Put your feet in the tub.” “Sit down.” “Here’s the soap.” “Wash your arm.”

*Use other cues to remind the person what to do, such as the “watch-me” technique where you demonstrate the action, putting your hand over the person’s hand, gently guiding the washing actions.

*Use a tub bench or bath chair that can adjust to different heights so the person can sit while showering, if easier.

*Washing the person’s hair may be the most difficult task. Use a washcloth to reduce the amount of water on the person’s face.

*Be sure the person’s genital areas are washed, especially if incontinence is a problem, as well as between folds of skin and under the breasts.

*Simplify the process. Sew pockets into washcloths to hold soap. Use an all-purpose gel to wash both hair and body. Use a nylon net sponge, which requires less work to make suds.

Consider bathing alternatives

*Be open to adjusting your bathing standards. Your preferences regarding bathing may not match the needs or realities of the person for whom you are caring.

*Wash one part of the body each day of the week.

*Shampoo hair at another time or on a different day.

*Give the person a sponge bath with a washcloth between showers or baths.

*Use a non-rinse soap product with warm, wet towels to clean the person. Research shows that regular, thorough use of this type of product, which can be purchased at a pharmacy or drug store, is equally effective.

*Have a trained caregiver or nursing assistant come to the house to bathe the person.

After-bath care

*Check for rashes and sores, especially if the person is incontinent or unable to move around.

*Seat the person while drying and putting on fresh clothes.

*Make sure the person is completely dry. Pat the person dry instead of rubbing.

*Use cotton swabs to dry between the toes.

*Gently apply lotion to keep skin soft.

*Use cornstarch or talcum powder under the breasts and in the creases and folds of skin. If the person will not use deodorant, use baking soda.

Provide reassurance: This can occasionally work, and it's worth a try. Remind her of how much you love her and are committed to her. Be aware, however, that the person's delusion may be so fixed that you could reassure her repeatedly and get nowhere.

Take a time out: Remind yourself that the disease—not your loved one—is responsible for these thoughts and behaviors. Delusions, though clearly not accurate to everyone else, feel extremely realistic to the one who is experiencing them. Do your best to not take it personally by understanding that dementia warps the reality for your loved one. It can make it a little easier to cope if you understand that those hurtful words are coming from the disease, rather than your loved one.

Reminisce: You can try to direct the conversation to a special shared memory, such as when you proposed and she accepted, the birth of a child or a special trip you took together.

Distract: If you aren't able to reassure or reminisce, try distracting her. You can bring a favorite snack over to her or turn the television on to her show that she enjoys.

Validation: In general, I wouldn't encourage lengthy conversations about the accusation, but in some situations, it could be helpful to ask questions about what she feels you did. Perhaps she's fearful of a particular situation or person. Let her speak about her fears and work on not becoming defensive in response. This may be difficult emotionally but could help her process her fears.

Call reinforcements: Occasionally, some people respond well to one particular person in the family. For example, Is there one son who will be listened to and believed when others are not? If that's the case and your loved one is distressed because she continues to believe that you are being unfaithful, try having that son reassure your spouse or partner that you love her and will continue to be there for her.

Sense of humor: Sometimes, no matter what you try, it just doesn't help. The delusions and fear are so strong that you can't reassure her. You could try to use humor in this situation, perhaps by being self-deprecating. Try pointing out a funny fault of yours and say how glad you are that she puts up with you because you know that no one else could. As with the other possibilities, this may or may not be effective, but it has the potential to diffuse the anger, fear and hurt that she (and you) may feel at the moment.

Ask the physician: If this is an occasional accusation, do your best to roll with it. But if you're seeing persistent paranoia or distressing delusions, ask the doctor if medication is appropriate. Antipsychotic medications do have the potential for significant side effects, but they also can be helpful in relieving paranoia and delusions.

Rummaging, Hiding, and Hoarding Behaviors

Persons with dementia experience memory loss, mental confusion, disorientation, impaired judgment and behavioral changes. One of these changes may include “hoarding”. While hoarding is often harmless, it can become a health and safety issue for the person with dementia. Some people are natural “collectors” who have accumulated things that are important to them over the years. They may have difficulty getting rid of items because of the personal meaning they hold. Compulsive hoarders collect many items that they are not able to discard. As the hoarding increases over time, their living areas become unsafe and the behavior may lead to health risks and financial strain. Hoarding for a person with dementia may be more likely to happen in the early and middle stages of dementia and often stems from trying to have some control in their lives. People with dementia may be driven to search or rummage for something that they believe is missing.

Possible Causes Psychological or Medical Causes

*Physical changes in the brain cause memory loss, impaired judgment, and confusion.

*Inability to remember taking items, unable to remember where the items were placed or hidden

*Loss of control over behaviors

*Rummaging, hiding, and hoarding are all things an individual does to gain a sense of security. For example, individuals may hoard items out of fear that they may “need” the items some day. Individuals may begin to hide items when they are not able to recognize the people around them any longer. Individuals may rummage through items because seeing and touching the items reminds them that they are there and gives them comfort.

Environmental Causes

*Fear of being robbed or losing items; hiding or hoarding items in an attempt to make them safe.

*Inability to distinguish between items that should be kept or thrown away.

*Lack of stimulation, boredom, or difficulty initiating new activities.

Coping Strategies Addressing Clutter and Hoarding

In most cases removing all clutter can cause severe emotional upset, and it is usually not beneficial to remove everything that a person hoards. This is because the items that the person collects give them a sense of security and safety. Also, individuals may have emotional attachments to items that appear to others to be worthless and/or useless.

When removing clutter

*Only remove what is needed to eliminate safety and health hazards. Leave behind as much safe clutter as you can. Organize it in large bins or baskets away from walking pathways, stairs, stoves, and heaters.

*Give the individual a good reason to part with their items. They may be more willing to let go of something if they are told that the item will be given to a charity, church, family member, etc.

*Negotiate. Trade a year’s worth of newspapers for a month’s worth. Trade rotten or expired food for fresh food.

*Be Creative. Take pictures of items that are given away, and allow the person to keep the pictures. Allow the person to take time to say goodbye to items that you may perceive as worthless.

*Remove discarded items immediately because the person may rummage through the garbage and bring items back into their home. o If the individual agrees to help de-clutter, give them one box of items to sort through at a time. Start slowly and take breaks frequently.

*Be prepared for the person’s reaction and have support for the person and yourself. You may want to involve family, friends, clergy, or a social worker. Have activities planned and ready to divert the person’s attention from the removal of their items.

*Reduce the amount of clutter coming into the home by reducing spending money and monitoring purchases. Consider blocking home shopping channels. Stop junk mail and catalog mailings by visiting www.dmachoice.org, www.catalogchoice.org, and www.optoutprescreen.com. Consider getting bills sent to another address, if needed.

*What you view as cluttered and disorganized may help the individual function and cope. Some individuals keep belongings out in the open or in unusual places because they may forget where they are if they cannot see them. If the clutter is not posing a safety or health hazard, then leave it as is.

Make Rummaging Productive

*Restricting access to all drawers and cabinets can be distressing for a person who enjoys rummaging. Many individuals will rummage or constantly reorganize items because they feel a need to be productive.

*Provide the individual with an opportunity to rummage and make rummaging a stimulating activity. This can be done by providing easy access to some closets, drawers, or portable boxes that contain safe items that the individual can rummage in. They can contain random items or be themed: sewing drawer, sports closet, jewelry box, etc.

*If the individual enjoys sorting and organizing items, make this an activity. Ask the person to help you fold and sort items like socks, napkins, and scarves. This may help the person fulfill their desire to be productive.

Focus on Safety

*Fire Prevention: Check for and remove items stored or hidden in or on the stove, microwave, radiators, kerosene heaters, etc. Check for overloaded extension cords. Check that smoke alarms have batteries and are in working order.

*Prevent poisonous ingestion: The individual may not be able to recognize things that are harmful to eat. Lock up cleaning fluids, medications, glue products, etc. Check for and throw away rotting food.

*Prevent falls: Ensure that there are clear pathways between rooms. Clear all clutter from stairways. Remove throw rugs.

Protect Valuables

*Put items that cannot be easily replaced in a safe, locked location. These items may include birth certificates, passports, tax records, cash, jewelry, medical records, sentimental photos and letters, etc.

*Get duplicates or “dummies” of items that are commonly misplaced such as glasses, hearing aids, medication, keys, remote controls, cell phones. Identify and Eliminate Hiding Places

*Identify the hiding places. Common hiding places include under cushions, under the mattress or bed, under carpets, inside shoes, purses, coat pockets, under stove burners, inside washers and dryers, dishwashers, trash compactors, trash bins, sink drains, and garbage disposals.

*Alarms, battery operated wireless doorbells, and other wireless trackers can be attached to items that are frequently misplaced or hidden and can help to find the item and identify where the person is hiding it. If hiding is a serious problem and hiding places cannot be found, surveillance cameras or “nanny cams” can help identify where an individual is hiding items.

*Check hiding places frequently for lost items. Check the trash before you bring it outside, it is common to find “lost” items in the trash.

*Eliminate some common hiding spots by introducing drain traps, disposal strainers, and drain screens, and disconnecting trash compactors and disposals.

*To discourage hiding and rummaging in certain drawers or closets you may need to install hard-to-open latches or locks on the doors. Placing a STOP sign on the drawer or closet, or camouflaging the door with paint or wallpaper so that it blends in with the room may also discourage a person from using that area for hiding or rummaging.

*Turning a cabinet towards the wall or covering it with a sheet can have an “out of sight, out of mind” effect and eliminate hiding, hoarding, and rummaging in that cabinet.

*Many individuals will hide items or rummage in mailboxes. This can be managed by purchasing a lockable mailbox. Dealing with challenging behavior can be frustrating and overwhelming. You are not alone

Plan to discuss how retirement from driving will be handled before it becomes an issue. Be sympathetic as you address the topic because retiring from driving and the perceived loss of independence is difficult for many. It is important to acknowledge a person's feelings and preserve his or her independence, while ensuring the person's safety and the safety of others.

Starting the conversation

*Initiate a dialogue to express your concerns. Stress the positive and offer alternatives.

*Address resistance while reaffirming your unconditional love and support.

*Appeal to the person's sense of responsibility.

*Ask your physician to advise the person not to drive. Involving your physician in a family conference on driving may be more effective than trying to persuade the person not to drive by yourself. Ask the physician to write a letter or prescription stating that the person with Alzheimer’s must not drive. You can then use the document to remind your family member what’s been decided.

*Consider an evaluation by an objective third party.

*Understand that this may be the first of many conversations about driving.

When the conversation does not go well

Some people give up driving easily, but for others this transition can be very difficult. Be prepared for the person to become angry with you, due to the memory and insight issues that are part of Alzheimer's.

*Be patient and firm. Demonstrate understanding and empathy.

*Acknowledge the pain of this change and appeal to the person's desire to act responsibly.

*Ask a respected family authority figure or your attorney to reinforce the message about not driving.

*If the conversation does not go well, do not blame yourself. The disease can impair insight and judgment, making it difficult for people to understand that their driving is no longer safe. Also the disease can cause mood and personality changes that make reactions more pronounced.

*As a last resort, take away the car keys, disable the car or consider selling the car. When you do any of these things, be sure to provide safe, reliable alternative transportation.

Plan ahead before driving becomes an issue. This provides an opportunity to make choices and maintain independence and safety.

For people in the early stages of Alzheimer's, it is never too soon to plan ahead for how you will get around when you can no longer drive. Putting a plan in place can be an empowering way to make your voice heard.

Tips for planning ahead

Remember that each situation is unique. What works for one person may be different from what works for another. You can get the information and support you need from the Alzheimer's Association at 800.272.3900.

*Involve family and close friends in the plan.

*Confront resistance. Empathize with those who are uncomfortable having the conversation and stress the importance of preparing for the future.

*When the person is still in the early stage of Alzheimer’s, ask them to sign a driving contract that gives you his or her permission to help them stop driving when the time comes.

Transportation options

Driving is not the only transportation option available. There are many options people can explore that will allow them to continue to travel independently and remain in control of their mobility.

Transition driving responsibilities to others. Arrange for family members and friends to provide transportation.

*Arrange a taxi service.

*Use special transportation services for older adults. Access local resources using our free Community Resource Finder or Eldercare Locator to search for transportation services.

*Reduce the need to drive by having prescription medicines, groceries or meals delivered.

Signs of unsafe driving

Determining when someone can no longer safely drive requires careful observation by family and caregivers. The following list provides warning signs that it's time to stop driving:

*Forgetting how to locate familiar places

*Failing to observe traffic signs

*Making slow or poor decisions in traffic

*Driving at an inappropriate speed

*Becoming angry or confused while driving

*Hitting curbs

*Using poor lane control

*Making errors at intersections

*Confusing the brake and gas pedals

*Returning from a routine drive later than usual

*Forgetting the destination you are driving to during the trip

At the earliest stages, a person with Alzheimer's disease may begin to have difficulty with complex tasks such as driving. Although family and caregivers can watch for signs of unsafe driving, a proactive strategy would be to get a comprehensive driving evaluation by an occupational therapy driving rehabilitation specialist.

The evaluation provides a more objective understanding of the current impact of the disease on driving capacity and results in a plan of options. The goal is always to retain the highest level of independence and mobility in the community. Initial recommendations may include strategies to reduce driving risk during the early part of the disease.

The occupational therapist can offer strategies specific to the individual's goals and needs. The American Occupational Therapy Association website includes a national database of driving specialists as well as a wealth of resources for both persons with Alzheimer's disease and their families.