The Benefits of Routines for People With Dementia

Because Alzheimer's disease and other types of dementia can make it difficult to learn new things, using established, consistent routines can be calming and reassuring, for both the person with dementia and those around her.

Routines are often associated with our procedural memory (how we do things) and long term memory. So, since Alzheimer's typically first affects the short-term memory, the memory of a routine will often remain well into the middle stages of Alzheimer's.

In the early stages of dementia, people may be very well aware of routines and they may verbally object if that routine is ​possibly going to be altered. In the middle stages of dementia, routines often consist of an almost automatic physical motion, such as brushing your teeth.

Routines are the things that regularly happen, often on a daily basis. Routines can be comprised of eating breakfast, reading the newspaper or a magazine, getting your hair done on Friday's, going for a walk every day together, setting the table for dinner, drying the dishes after lunch, or using a certain table cloth on Sunday's.

Routines may also consist of the order in which tasks are completed. If you're getting ready for bed, you might start by walking into the bathroom and proceed with brushing your teeth, using the toilet, washing your hands and then going to bed.

In building a routine for someone with dementia, you should aim to include activities that require physical exercise, such as a morning walk, as well as activities that may fall into a more therapeutic category such as music, art, puzzles, and more.

• Maintains Functions: Practicing an activity regularly, whether it's a physical or mental task, may increase the likelihood of that ability remaining.
• Reduces Anxiety: The predictability of a routine can decrease anxiety. The person with dementia may feel more comfortable and confident if he knows what to expect.
• Decreases Caregiver Stress: Routines can lessen the stress for those caring for people with dementia by making the day more organized and possibly decreasing the chance of challenging behaviors.
• Allows for Some Independence: Activities that have been practiced regularly, such as daily folding the laundry, can increase self-esteem and confidence because the person can perform it independently. Especially in the earlier stages of dementia when people are more likely to be aware of cognitive deficits, independence in a task can be an encouragement to them.

In a nursing home, assisted living, or other type of care facility, it's possible to have a different person every day caring for those living with dementia. However, as much as possible, it's important to staff a care facility with consistent caregivers, as opposed to constantly rotating caregivers. This allows a trusting relationship to develop between the staff member and the resident, which has a host of benefits for all involved.

Consistent caregivers can potentially prevent or reduce challenging behaviors by knowing how best to respond to their residents. These caregivers can also quickly notice if their residents might be sick or if something is just "not quite right" because they know their residents so well.

From a facility perspective, while you do have to guard against burnout with certain residents, consistent staffing as a routine can improve staff satisfaction because caregivers generally know what to expect in their shift and they often find meaning and enjoyment in the relationships they develop with their residents.

Routines may need to be simplified as dementia progresses. For example, if your wife always washed the dishes after dinner, you may need to reduce the amount of dishes or use plastic ones. You might also need to rewash the dishes at a later point if she's less able to wash them fully or have her wash them again if she needs something else to do.

If your father always chooses the same clothing to wear in the morning, you may need to rotate the location of certain clothing or purchase a duplicate favorite sweater so that the other one can be washed.

There's certainly no "one size fits all" path in the journey of dementia care, but establishing and practicing routines can be a helpful approach to optimize functioning and quality of life, both for those living with dementia as well as for their loved ones and caregivers.