Tips for Supporting Individuals with Blindness/ Low Vision and Dementia

This content is also available in: Español (Spanish)

In the case of someone with Alzheimer’s Disease, independence can be thought of as the ability to perform and engage in activities that foster quality of life for as long as possible. You as a family member play a vital role in this goal, but you need to be able to recognize limitations and declining abilities and be ready to make adjustments as needed. Alzheimer’s dementia causes a continual decline in visual and cognitive functioning, with your loved one struggling to make sense of their world. You can provide a safe, calming and supportive environment by understanding the visuoperception component (link to article) of dementia and the types of visual changes that occur in the visual field.

Use these tips to minimize the distress that you and your loved one may feel as you go through this process.

General Tips

• Establish a daily routine. Try to schedule key activities such as meals for the same time each day.
• Be mindful of your relative’s safety, enjoyment, and dignity.
• Foster as much independence as abilities allow. Not using skills means losing them.
• Abilities will change from day to day
• There is nothing “typical” about dementia. Each person is different.
• You may have to be a “detective” to understand your relative’s behavior.
• It may be difficult for your relative with dementia to distinguish between reality and fantasy.
• You may need to limit television time, particularly violence and news shows with disturbing content.
• Avoid allowing your relative to sleep too much. Focus instead on activities in which he/she can safely participate and enjoy, such as singing, playing a musical instrument, listening to music, crafts, folding laundry, washing vegetables, washing dishes, and watering plants, to name just a few.
• Supervise outdoor activities to prevent accidents and wandering.
• Ensure that your relative has identification with them at all times. Consider using a tracking device as a safety precaution against wandering and getting lost.
• A designated quiet space may help to calm anxiety.
• Give simple one-step directions when assisting your relative.

Tips Related Specifically to Blindness/ Low Vision

• The degree to which a person with dementia can cope is likely influenced by vision loss.
• Research shows that changes in vision and visual processing may be relevant to a diagnosis of dementia.
• Tips for making the environment accessible for persons with eye conditions may not always work. However, deliberate use of color may help (see tips for decreasing visual and perceptual confusion in the home) such as using a dark plate for serving mashed potatoes, a white toilet with a black toilet seat, or a color to identify a bathroom door.
• You may need to proceed by trial and error to determine if tips and techniques for use by persons who are blind or low vision will work with your relative.
• Persons with vision changes may have learned to rely on auditory signals. Be aware that dementia may have altered perception of auditory signals.
• Depth perception may also be altered.
• Shiny flooring may be mistaken for water. Patterned floors are easily misinterpreted and may create fear and anxiety.
• Keep furniture and other objects in familiar places.
• Help the individual identify people by telling others to say their names.
• Explain what is occurring, who is with them and where they are.
• Ensure the person has regular eye checkups and tell the eye doctor that the individual has dementia.
• When the person cannot identify an item correctly, it is best to avoid arguing with them or saying too much. If possible, give the item to them and calmly explain its name and use.
• Reduce clutter, changes in floor surfaces, and busy patterns on floors and walls.
• Consider reading to the person or using audiobooks if the person is unable to read print.
• Use simple adapted devices such las large print phones, a large print calendar, and large TV remotes.
• Create a memory book with words or pictures to cue how to do a task. Use simple, bold colored pictures or signs like “wash hands” or “brush teeth.”

Hydration and Bodily Functions

• Make access to fluids convenient to prevent dehydration. Monitor liquid intake and avoid caffeine.
• Provide a safe route to the toilet.
• Make sure clothing is easy to take on and off. Replace difficult buttons and zippers with Velcro fasteners.
• Limit fluids before bedtime. Consider using a bedside toilet during the night.
• Remind your relative to go to the bathroom every few hours. Look for cues of needing to go such as tugging at clothing.
• Install grab bars in the bathroom. Install a raised toilet seat if necessary.

Medication

• Medication may alter thirst and body temperature. Discuss medication side effects with your relative’s doctor.
• Keep medications in a secure place.
• Enlist a home health care nurse or trusted friend or neighbor to administer medication if your relative is still able to live alone.
• Medication minder alarms may cause agitation and confusion.
• If your relative has swallowing difficulties, ask the pharmacist if the medication is available in liquid form, patch form or if the medication may be crushed and mixed with food.
• Keep a medication log.

Bathing and Grooming

• Follow existing bathing patterns (morning, afternoon or evening)
• Maintain previous grooming routines (e.g.-weekly manicures). You may need to provide distractions such as involving your relative in singing
• Never leave your relative unattended during bath time.
• Adjust hot water heater to a safe temperature.
• Explain what you will do, such as “I am going to brush your hair”.
• Make sure the bathwater is warm enough as the ability of body’s thermostat may not be working correctly.
• Allow plenty of time for bathing and be respectful.
• Encourage self-dressing. Lay out clothing in the order to be put on.
• Select loose-fitting, comfortable clothing. Replace buttons with Velcro. Provide slip-resistant shoes.
• Allow your relative to select personal grooming products. You may try marking them with bump dots.
• Make sure grooming aids are safe (e.g.-electric razor)

The Home Environment

• Looking into a mirror may be upsetting for your relative as he/she may remember a younger self and may not recognize the image in the mirror. Consider covering mirrors or removing them.
• Remove small rugs that may present a tripping hazard.
• High contrast flooring (such as checkered tile) may be frightening due to distorted depth perception.
• De-clutter the home and make sure furniture is stable. Eliminate wheels on furniture.
• Monitor your relative’s home for hoarding behaviors and assess whether they can safely continue to live alone.
• If the house needs cleaning, clear out the accumulated mess slowly so as to reduce anxiety. Work one on one with your relative to prioritize what to keep and what to dispose of.
• Keep frequently used items within easy reach.
• As a caregiver learn transfer and lifting techniques.
• Be aware that pets may present a tripping hazard so weigh the risks of companionship versus falls
• Wipe up spills immediately to prevent slipping.
• Install safety latches on cabinets and drawers where hazardous items are stored.
• Check the trash frequently to make sure items such as dentures and hearing aids have not been thrown away by your relative.
• Use colors that are calming to your relative and non reflective surfaces.
• Large print signs may help the persons with dementia know where they are and find their way.
• Use lighting, smells and sounds to stimulate those with dementia. Lighting to mimic the time of day may help with orientation to time of day.
• Large photos of local scenes from the past may be familiar to persons with dementia and help them feel connected to the past.

Mealtime

• If your relative is afraid to sit down, place your hand on his/her backside and speak descriptively and reassuringly as in “the chair is right behind you and I’m going to hold your arm for support as you sit down.”
• Make mealtime pleasant and minimize distractions.
• You may need to offer several small meals a day rather than 3 large ones. Taste changes with dementia, so that may affect what the person wants to eat.
• Describe food on the plate at mealtime. Your loved one may not be able to see the plate, depending on the progression of their visual changes related to dementia and/or eye condition they may have.
• Encourage self feeding but cut food into bite size pieces to avoid choking.
• Sit with the person while they eat as a precaution against choking.
• Check food temperature before serving.
• Prepare favorite foods to encourage good nutrition. Loss of sense of smell and taste may result in decreased appetite, weight loss and malnutrition.
• Use finger foods when possible, to eliminate the need to use utensils.
• Substitute bowls for plates.
• Serve only one or two foods at a time and limit utensils to one or two.
• Enlist your relative’s help in the kitchen such as assigning tasks such as washing dishes, mixing ingredients and setting the table.

Ten Tips for Self Management of Alzheimer’s (to share with the individual with Dementia)

1. Stick with the tried and true. For example, don’t try using a microwave or cell phone if you have never used them before
2. Keep expectations in check. Take things one simple step at a time
3. Adapt your home to make it easier to navigate using environmental tips in this article.
4. Avoid monochromatic color schemes. Use contrast between the floor and walls, doors, etc.
5. Reduce glare.
6. Designate room landmarks such as using a sofa or cabinet to orient yourself to the room.
7. Avoid busy patterns for walls, floors, and cabinets.
8. Establish a daily routine with meals and other activities scheduled for the same time.
9. Understand that your visual perception may be affected by your Alzheimer’s. You may not be able to interpret what you are seeing. For example, a coat hanging in a closet may look like a person.
10. Be aware that your depth perception and visual field may be affected by the disease. You may not be able to see the floor or your plate when you are looking down.

References

Understanding People Living with Dementia and Vision Loss – The National Research & Training Center on Blindness & Low Vision (instructure.com)

Living with Dementia and Sight Loss

Cataracts and dementia factsheet