As a caregiver, you may be worried about whether a loved one, diagnosed with dementia, should still be driving. You may have questions about whether they also should be using other motorized devices like a lawn mower or a snowmobile.

Unsafe driving can lead to an accident. If you’re worried, you must do something!

Your loved one’s doctor should always be involved in deciding if your loved one can still drive. People with mild dementia may still be allowed to drive. But if the disease is starting to progress, the answers to these questions will help you determine whether it’s time to reassess the situation.

Safety Concerns about Driving

Has your loved one:

• Had any accidents?
• Scratched or dented the car?
• Become lost while driving?

Do they:

• Drive very slowly?
• Have to slow down to see signs?
• Ignore road signs?
• Easily get angry with other people?
• Get easily distracted?
• Seem to take them a long time to get somewhere?
• Have trouble knowing what to do when there’s a problem?
• Have trouble driving on the highway and at night?
• Seem very slow to react?
• Have problems using a power mower or snowmobile?

Most importantly:

• Are you afraid to ride with your loved one?

How You Can Help

The doctor can’t check in on your loved one every day, but you probably do. You should:

• Watch for any signs of unsafe driving.
• Check the car for signs of a bump or an accident.
• Go out with your loved one and see how they drive.
• Ask them not to drive at night. It’s more difficult to drive in the dark.
• Ask them to keep off the highway. They have to react very quickly.
• Watch them use the power mower. See if they manage safely.
• Watch them on the snowmobile. See if they use good judgment.
• Tell the doctor immediately if you’re worried.

If the doctor decides your loved one is not fit to drive:

• Ensure they don’t drive.
• Remind them they’re not allowed to drive.
• Arrange rides for them.
• Show them the letter from the Ontario Ministry of Transportation.
• Take away their keys.
• Disable the car so that it won’t start.
• Remove the car.
• Sell the car.

Things to Remember

• Remind your loved one that accidents can happen easily and may hurt or kill someone.
• Your loved one may not know or remember they have a problem.
• You must do something if you see that they are unsafe.
• If your relative drives without a licence, they will not have insurance.
• People with dementia can easily get lost.
• Your loved one may forget instructions.
• It’s very hard for people to accept that they lost their driver’s licence. You will need to help your loved one work through this loss of independence.
• If you drive, never leave your loved one alone in the car.
• Use child locks as your loved one may try to open the car door when the car is moving.
• There are many services you can arrange to help your relative get around.

When to Ask a Professional

• If you are worried about your loved one driving, tell the doctor. The doctor will assess the situation.
• If the doctor decides your loved one is unfit to drive, he or she will write to the Ontario Ministry of Transportation.
• The Ontario Ministry of Transportation will take away their driver’s licence and will send a letter from the Ontario Ministry of Transportation to tell them not to drive.
• Call the Community Care Access Centre (CCAC) about agencies that offer transportation.

The person you are caring for may live alone and now the doctor has decided it’s no longer safe you’re your loved one to drive. Or perhaps they used public transportation and cannot manage that now. Depending on the stage of your loved one’s dementia, you may need to seek out other transportation services.

Take a look at some of these common transportation problems and what solutions are available to help your loved one live more independently.

Transportation Issues to Consider

Here are some questions to think about when looking for transportation services for your loved one:

• What modes of transportation are available where they live?
• Can they call and book their own transportation?
• Will they remember when to get ready for the transportation?
• Do they need help to get in and out of a vehicle?
• Do they need to take a walker or wheelchair with them?
• Do they need to have someone with them?
• Can they afford to pay for transportation?

Transportation Options

Taxi

• Call a regular taxi for a ride as needed.
• Call a Wheelchair Accessible Taxi.
• Set up an account with a taxi company for frequent rides. They can bill you every month.

Transit for the Disabled

• Public transportation for physically disabled. Use is based on an assessment and usually focuses on physical limitations. In other words, it’s for people who can’t walk or can only walk a short distance.
• This is wheelchair accessible transportation and is available in some areas of Ontario.
• There will be a charge for each ride—usually the same cost as regular public transportation.

Community Agency Transportation

• Some agencies have volunteer drivers.
• Some have wheelchair accessible mini vans.
• There may be a charge for each journey. There may be a subsidy.
• An escort may be available.

As a caregiver, you may worry about whether your loved one can prepare meals and feed themselves safely on their own. Or, if you’re helping with feeding, you might be concerned about choking and other hazards. Here are some ideas to help ensure your loved one stays safe in the kitchen.

Signs your loved one is having trouble with meal preparation and are at risk include:

• Traces of burns or fires in the kitchen.
• Burnt pots or a kettle boiled dry.
• Melted plastic containers.
• Burns on your loved one or on their clothing.
• A cluttered and untidy kitchen.
• A poorly lit kitchen.
• Frayed electrical cords.
• Unsafe electrical plugs or outlets.
• Rotten food in the fridge.
• Food that has been kept past its safe “use by” date.
• Food is being left out uncovered in the kitchen.
• Food not being heated enough and could be unsafe to eat.

Try to determine the cause of the problem. Maybe the person you’re caring for:

• Doesn’t see well enough to cook safely.
• Is unsteady and may fall when cooking.
• Drops things often.
• Has shaky hands making it hard to do things.

Safety Concerns When Eating

You may be worried about the safety of your loved one while eating if they:

• cough when they eat
• don’t chew their food properly
• don’t wear dentures
• forget how to feed themselves
• don’t want to eat
• forget to eat
• have lost weight
• are constipated
• are very messy when eating

Feeding Tips

Here are some feeding tips to help your loved one enjoy the foods they like.

• Make sure the chair holds them upright.
• Make sure they’re well supported and comfortable.
• Don’t let them use a reclining chair.
• Face them when you are going to feed them.
• Sit down and make eye contact when you’re feeding them.
• Use a small spoon and feed your loved one slowly.
• Let them chew and swallow each mouthful.
• If they can’t chew, give them soft foods.
• Tell them what you are giving them to eat.
• Offer them a drink often during the meal.
• Talk slowly and calmly.

When to Ask a Professional

You should consider getting outside support or advice from an occupational therapist if:

• You worry about how safe your loved one is in the kitchen and don’t feel able to handle it alone. Ask for an occupational therapist to visit. An occupational therapist will do an assessment and give you some practical ideas to make the kitchen safer.
• you need help to get them sitting comfortably to eat.
• you need help with special cutlery or cups.

Take them to their family doctor right away if they:

• Keep coughing or choking when they eat.
• Are losing weight.
• Won’t eat or drink enough.
• Suffer from constipation. A nurse or dietician may also be able to help.

Accompany your loved one to a dentist if:

• Their dentures don’t fit as it can cause discomfort or even infection.

Caring for someone with dementia is a 24/7 job. Sometimes people with dementia may have problems going to the toilet. They may forget to go, they may not be able to manage by themselves or they may have accidents. Here are some common problems and useful ideas to help you make this essential task easier.

Problems with Toileting

There may be things your loved one has trouble with, such as:

• Not getting to the toilet in time.
• Leaking when they laugh or cough.
• Falling in the bathroom.
• Not knowing what to do when they get to the bathroom.
• Urinating in the wrong place, like into the waste bin.
• Forgetting to wipe.
• Wetting the bed.

Reasons for Problems

Your loved one may have an infection and this can make it difficult to go to the toilet. Problems with the prostate gland in older men can also be a cause. For women, weak pelvic muscles can sometimes be the culprit.

Your loved one may have trouble with going to the toilet because they:

• Are experiencing a side-effect caused by medication.
• Walk slowly and can’t get to the bathroom in time.
• Aren’t able to get up from their chair to go to the bathroom.
• Forgot where the bathroom is.
• Find the toilet too low. They may not be able to get down or up easily.
• Aren’t able to understand the message from the brain to say they need to go to the toilet.

Tips to Help With Toileting

Medical problems

• Always check with the doctor first. It may be a medical problem a physician can identify and help with.

Environmental problems

• Check that your loved one can get up and down from their chair. Chairs with arms can help.
• If the toilet is too low, a grab bar can help. You may need to ask a professional to help install it. They can suggest other ways to solve this problem.
• If your loved one can’t get to the toilet in time, a nurse or an occupational therapist may help you choose a commode. A commode is like a chair with a bucket under it. You can also put a commode by the bed to use at night.
• Always leave a light on in the bathroom. This helps make the room easier to find and see as they go to the toilet.

Memory problems

Forgetfulness and difficultly reading cues are commonplace. Help your loved one avoid “accidents” and:

• Remind them to go to the toilet every few hours.
• Take them to the bathroom if they can’t find the way or forget where it is
• Put a sign saying “Bathroom” on the door. Or use a word they will understand best. If reading is a challenge, try posting a picture of a toilet.
• Provide clear instructions about what to do. For example, “lift your skirt,” “undo your pants” and/or “sit down.” They may have forgotten the order of how to do things. Speak slowly and clearly and use short sentences. Keep calm and don’t raise your voice.
• Take away large buckets and waste bins that may look like a toilet.

Coping Ideas

• It’s important that your loved one has enough to drink. Make it a routine to give them a drink at set times during the day.
• Don’t offer big drinks just before bedtime.
• Ensure you take your love one to the toilet before and after meals and before going to bed.
• Make sure they’ve actually urinated before getting up from the toilet.
• Running a tap in the bathroom can help with urination.
• Your loved one may feel embarrassed to use the toilet when you’re in the room. If you feel comfortable that your loved one will be safe while alone inside, step outside. If you stay outside the bathroom, don’t leave the area.
• Make sure they can see the toilet paper. They may use something else like a towel if they see it in front of them.
• Make sure their clothes are easy to manage. Elastic waistbands are easier than buttons.
• Choose clothes that are easy to wash. They may wet themselves and need to have their clothes washed often.
• Help your loved one wash and towel off if they wet themselves to prevent rashes or sores.
• If they wet the bed, put a plastic cover on the mattress.There are lots of pads and diapers made for adults. Ask a professional to help you choose the best one.
• Your loved one may be able to manage the pads by themselves. Check how they are doing. You may need to help them.

Things to Remember

While toileting can be a challenging job for caregivers, it’s important to remember your loved one:

• Is not having accidents on purpose.
• May be embarrassed by what is happening.
• May try to hide wet clothes. Check their room to ensure your loved one hasn’t stashed soiled clothes in a hiding spot.
• May be suffering from incontinence as part of the dementia’s progression. Ask a doctor if you are not sure.
• Will be able to understand you better if you speak slowly and clearly. Keep calm and don’t raise your voice.

When to Ask a Professional

• If they are incontinent, tell the doctor so he or she can look for an underlying medical condition causing the problem.
• If they have a fever, tell the doctor. It may be an infection of the urinary tract. This can be dangerous if it’s not treated.
• A nurse is also a good person to talk to about incontinence problems for help.
• If their chair or the toilet is too low, ask an occupational therapist to suggest the best way to help with this problem.
• If you need a commode, a nurse or an occupational therapist can help you to choose the right one.
• Ask a nurse to help you choose the best pads or diapers. The nurse can show you how to change the diapers. You will find a whole section in the drug store.
• Ask a pharmacist about special soaps and creams to protect your loved one’s skin from rash and sores.

It‘s very important for your loved to take medication correctly. You may wonder if they can do this on their own or if you’ll have to help them. Here are some key points to think about and some ideas to help you deal with this challenge.

Safety Concerns about Medication

Remembering to take pills can be difficult at the best of times. But when you’re dealing with a loved one with dementia, managing medications can become that much more challenging. You may worry that:

• You don’t know what pills they should be taking.
• There are lots of old pill bottles around the home.
• Some of the pills are in the wrong bottles.
• Your loved one seems to be taking too many much medication.
• They won’t take their medication.
• They’ll forget to take their pills.
• You’re loved one is buying lots of over-the-counter medication that may be dangerous if taken with their prescriptive medications.
• The medication seems to be upsetting them or causing negative side effects.

Tips to Make Taking Medication Safer

• Check with the doctor to confirm which medication you’re loved one should be taking and confirm the dosage and timing.
• Take away any medications that aren’t being used.
• Keep a written list of current medications, when they should be taken and whether they need to be taken with food or on an empty stomach. Also note any special instructions.
• Check the home for any hidden medication.
• Count the pills in a bottle. Check to see how many have been taken.
• Only leave enough medication for the day or for the week.
• Ask the doctor if the times medication has to be taken can be made easier, like once a day.
• Ask the drug store for bottles that are easy to open. Use these special bottles only if your loved one can take their own medication without help.

Remembering to Take Medications

If you can organize medication—and pills in particular—you can check if your loved one has been taking them. Here are some ways to do this:

• Use an egg carton and put out the pills for the day. You can separate them into “morning,” “lunch,” “supper” and “bed time.”
• Buy a pillbox at the drug store with sections for the pills for each day. This is called a dosette. Some hold pills for up to four times in one day. Some can be set up for a week.
• In Ontario, some drug stores will pre-pack pills in a special package. This is called a Blister Pack or a Bubble Pack. The days and times are printed on it. They just have to push the pills out.

Other ways to help your loved one to remember:

• Phone to remind them to take their medication.
• Leave a note to remind them.
• Set a timer to remind them.
• Ask a neighbour to stop in to remind them.

Managing Medication Problems

Your loved one may not like taking pills. Here are some ideas to help you:

• Explain what the pills are for.
• Offer food they enjoy with the pill.
• Stay with them until they have swallowed. They may try to spit the pills out.
• Try again later. They may agree to take the pills.
• Ask gently. Speak calmly.

If they refuse to take their medication:

• Ask the doctor if pills can be crushed and mixed with food.
• Some pills can be given as a liquid.
• Sometimes it may help if the doctor writes a note to say that they must take the pills.

Things to Remember

• Read the instructions. Make sure they are followed.
• Watch for side effects from medication.
• Let the doctor know if there is a problem with any of the medication.
• Put away medication for other family members.
• If the doctor stops use of any medication, be sure to take it away. This will ensure your loved one doesn’t take it by mistake.
• The doctor may change the amount of medication needed. . Make sure your loved one knows this and remind them often.

When to Ask a Professional

If they have mistakenly taken a lot of medication, call 9-1-1. Talk to your loved one’s doctor if:

• You are worried about what medication you’re loved one should be taking.
• You notice side effects.
• Your loved one refuses to take their medication.
• They can’t swallow the pills.
• The pills don’t seem to be helping.
• Your loved one seems to be getting worse.

Poor memory is one of the tell-tale signs of dementia. As a caregiver, you can play a critical role in reminding your loved one of dates and appointments and helping them organize day-to-day items/information so they manage better. Here are some of the problems, which can arise, and some ideas that may help you.

Memory Problems

Common problems you may run into with your loved one include:

• Missing appointments
• Losing keys
• Losing glasses
• Forgetting emergency numbers
• Forgetting telephone messages
• Forgetting to take pills
• Taking too many pills
• Forgetting to have meals
• Forgetting to put out the garbage
• Losing bills and important letters
• Forgetting to pay bills

Tips for Memory Problems

• Set up a “memory centre” by the phone. Post emergency and family phone numbers. In that memory centre you should have a calendar, hooks for keys, a note pad and pencil. Try to keep all important things in one place.
• Use only one calendar to put important dates on. Choose one with big spaces to write important information and appointments on and be sure to write in big, clear letters that are easy to read. Mark regular events on the calendar like “garbage day.”
• Make sure there is a clock with the correct time that has clear numbers and is located in a place that is easy to see.
• Put glasses on a necklace or eyeglass band so they are not so easily lost.
• Consider enlisting Meals on Wheels or another food delivery service to ensure your loved one regularly eats.
• Use a “dosette” for pills. These small plastic cases have sections for pills with the day and time marked on them and can be found at most drug stores.
• Set a timer to ring when medication needs to be taken.
• Set phone call reminders for things like pills or appointments.
• Notes stuck on the fridge with reminders can be helpful.
• It’s easier to find things in a tidy house. Remove clutter.

Things to Remember

• Do not get angry if your loved one forgets the same thing over and over. While it can be frustrating, it’s the fault of the disease and not your loved one.
• Try to find solutions that work to the strengths of your loved. Visual reminders may work for some, while sounds (e.g. an alarm or phone call) may work better for others. Each person is different.
• Simplify things so there is less to worry about. For example, set up regular bill payments through the bank.

When to Ask a Professional

• Ask for an occupational therapist to help you set up a “memory centre.”

It’s sometimes difficult to talk to someone with dementia. They don’t always understand what you are saying. They often forget what you have said and may not be able to do what you ask. This can get very frustrating as a caregiver. Here are common problems and solutions to help your loved one better understand you.

Problems with Talking and Understanding

You may experience some of these problems when you are trying to talk with your loved one. They may:

• Not realize you are talking to them.
• Start to listen and then lose interest.
• Forget what you have said to them.
• Not seem to understand what you are saying.
• Ask the same question again and again.
• Try to answer but the wrong words come out.
• Not say anything that makes sense.

Help Them Understand

Things to think about when you talk:

• Approach your loved one from the front. Do not startle them.
• Talk in a quiet place. Turn off the radio or TV.
• If your loved one uses a hearing aid, make sure it’s in. Check the battery.
• Look at you’re loved one directly when talking. Make eye contact so they know you are talking to them.
• Address your loved one by name.
• Keep your voice calm and friendly.
• Speak slowly and clearly.
• Use short sentences.
• Don’t shout, even if your loved one doesn’t seem to understand.
• Try saying things another way.
• Use familiar words.
• Don’t ask a lot of questions. Just ask one thing at a time.
• Ask a question so they can answer yes or no.
• If you smile and touch your loved one gently, they may listen better.
• Talk to them like an adult. Do not treat them like a child.

Things to think about when you want your loved one to do something:

• Tell them what you want them to do.
• Break the job down into simple steps.
• Only tell them one thing at a time, or else they will forget.
• Show them as well as tell them. They may understand better if they see what you want them to do. For example, show them how to use a toothbrush.
• Praise your loved one when they get it right.
• Don’t expect too much. Remember, dementia makes understanding and doing tasks much more difficult.

Things to Remember

• Never talk about your loved one to someone else in the room as if they weren’t there. Your loved one may understand more than you think and may upset them.
• If your loved one is easily distracted you can help by keeping their surroundings quite when they’re trying to concentrate.
• Don’t be embarrassed if you find it difficult to talk to them. Just try a different way.
• It’s better to have short conversations if your loved one tires quickly.
• Don’t let them think they have failed. This will make the situation worse.
• They may enjoy looking at things from the past like photos. You can talk about the pictures and let them join in if they can.

When to Ask a Professional

• If you’re having trouble finding ways to talk with your loved one as the dementia progresses, a nurse, occupational therapist, speech therapist or social worker may be able to provide tips and new ideas for better communication.

Those with dementia sometimes find it difficult to sleep well at night for different reasons. Here are some of the common problems family caregivers face and some ideas to help you overcome them.

Problems with Sleeping

Some of these things could be getting in the way of your loved one sleeping well at night. He or she may:

• Frequently wake up throughout the night.
• Not be able to sleep at bedtime.
• Get very upset just before bedtime.
• Wake up in the middle of the night and think it’s time to get dressed.
• Fall out of bed.
• See imaginary people and may talk to them.
• Think they are someone else.
• Believe this is not their bed.
• Wander around the house at night.
• Try to get out of the house at night.

Why There Are Problems

• Your loved one’s sleep challenges may happen because they:*
• Experience this symptom as part of the disease.
• Aren’t physically active enough during the day to be tired at night.
• Fear being left alone.
• Are looking for you or for someone else.
• Fear something bad is going to happen to them.
• Feel hungry or thirsty.
• Are too cold or hot.
• Feel pain.
• Don’t know if it’s day or night.
• Need to use the bathroom.
• Can’t find the bathroom.
• Fear night shadows.

Night Time Tips

Daily Routine:

• Create a regular routine before bedtime. For example: Watch the news and then feed the cat. Then change into pyjamas and wash face, hands and brush teeth. Take bedtime pills and get into bed. Be sure to keep the schedule the same every night.
• Try to stay as calm as you can.
• Don’t give big drinks near bedtime.
• Discourage your loved one from napping during the day.
• Try to encourage some exercise every day.

In the room:

• Keep the room warm on cold days and cool on hot days.
• Remove daytime clothes so they can’t see them.
• Put a clock where your loved one can see it.
• Cover the mirror if seeing a face in it is upsetting.
• Darken the room but avoid shadows.

Home Safety:

• Have a night light in the washroom.
• Keep walkways clear so your loved one doesn’t trip.
• Put padding on furniture with sharp corners.
• Hang a bell on the door so you can hear if they leave.
• Use a baby alarm with the microphone in their room and the receiver in your room so you can hear them if they get up.
• Lock doors of rooms you don’t want them to go into.

How to prevent falls out of bed:

• Put the bed against a wall.
• Use a lower bed.
• Put a soft mat with non-slip backing beside the bed.
• Use a double bed rather than a single bed.
• Remove the bed frame and place the mattress on the floor.

How you can help:

• Keep calm even if you feel upset—a strong reaction will make the situation worse.
• Reassure your loved one that they’re okay.
• Distract your loved with something pleasant like calming music.
• Try to understand that they may be afraid.
• Try different things like quiet music or singing to them.
• Don’t raise your voice. Talk calmly and slowly.

Things to Remember

• They are not being difficult on purpose.
• It can be the disease that makes them behave like this. Ask the doctor if you are not sure.
• Stay calm. Talk slowly with a gentle voice.

When to Ask a Professional

An occupational therapist can help you make your home safer. They can also give you ideas to help with problems at night and with sleeping. Your doctor may suggest some pills to calm your loved one and to help with sleep.

When it comes to helping your loved one take a bath or shower, it can often be the most challenging task. A person with dementia may resist or deny needing help.

Common Bathing Problems

You may be worried if your loved one:

• Refuses to take a bath.
• Tells you they have washed, but have not.
• Fights you when you try to bathe them.
• Has body odour.
• Refuses to change their clothes.
• Puts dirty clothes back on.
• Has difficulty getting into the bath.
• Is too heavy for you to help them.
• Is at risk of falling in the tub.

Why There Are Problems

Your loved one may:

• Fear the bath.
• Be afraid of the water.
• Have fallen while in the bath or shower and is afraid of falling again.
• Not be able to see very well.
• Forget when they had a bath last.
• Not remember how to bathe themselves.
• Have forgotten how to work the taps.
• Not want you to help them.
• Be having a bad day.

Tips for Bathing

Here are some useful tips to help you create a more comfortable environment for your loved one, when it comes bath time.

Try to find out what the problem is:

• Ask them to tell you what is upsetting them about taking a bath.
• Did they just forget to take a bath?
• Did they have a fall or scare at any time
• Do they like taking a bath or having a shower?
• Are they afraid of water on their head?
• Are they shy about taking a bath with someone looking?
• Do they find it difficult to get into or out of the bath?
• Are they unsteady and at risk of falling?

Make the bathroom safer by:

• Using non-slip bath aides.
• Putting a rubber safety mat in the bottom of the tub.
• Choosing non-slip bath aides that are a different colour from the rest of the room. This helps them see the tub better.
• Putting in a stool or grab bar if needed.
• Removing the shower doors if they get in the way.

Make the bathroom less frightening and:

• Make sure the bathroom is warm.
• Check the water temperature.
• Tell your loved one what you are going to do.
• Get a hand held shower.

How you can help:

• Phone to remind them about taking a bath, if they live alone.
• If you live with them, politely remind them about taking a bath.
• Keep yourself calm.
• Talk slowly. Don’t raise your voice.
• Don’t rush your loved one.
• Choose a time of day when they are relaxed to help them have a bath.
• Explain why it’s important to bathe.
• Have something for them to look forward to after the bath, like a treat or an outing.
• Let them wash their private parts.
• Set up a routine. Choose a bath day, mark it on the calendar and show it to your loved one.
• Do not make them bathe every day. Sponge wash in between.
• Remove dirty clothes when they change to bathe.
• Put out clean clothes after they have washed.
• Suggest a haircut that is easy to manage. It will make hair washing easier.

Other options

• Try asking another family member to help with bathing.
• Get Help in the Home to bath them.
• Try to find an Adult Day Program that offers a bath in its program.

When to Ask a Professional

• If you are worried about the safety of your loved one in the bathroom, ask for an occupational therapist. They will assess your loved one and the bathroom to give you ideas on how to make it safer.
• You may think you need equipment like a stool or a grab bar, ask for an occupational therapist. They will assess and suggest the best items.
• You may find it too much for you physically. Ask for Help in the Home. A trained worker can offer you extra help.
• You may need help getting your loved one to take a bath, ask for an occupational therapist or nurse. They will try to work out the best way to solve the problem.
• Sometimes a note from the doctor will help to get someone to take a bath.