No-fail Environment in Dementia

Aka: No-fail Environment in Dementia, Dementia No-fail Environment, Calming Measures in Dementia

1. See Also
   1. Dementia
   2. Dementia Management
   3. Dementia Related Malnutrition
   4. Sleep Problems in Dementia
   5. Wandering Behavior in Dementia
   6. Home Adaptations for Dementia
2. Indications
   1. Behavior Problems in Dementia
   2. Agitation in Dementia
3. Background
   1. Patients with Dementia have Anosognosia
      1. Patient doesn't recognize their own deficits
      2. Common problem in Dementia
   2. Failure to perform tasks results in behavior problems
      1. Frustration
      2. Irritability
      3. Agitation if reminded that problem exists
4. Management
   1. Provide low demand environment
   2. Simplify tasks into easy steps
   3. Provide tasks that they are able to perform
      1. If patient unable to use utensils, use finger foods
   4. Calendars and clocks help orient to time
   5. Color code or graphically code environment
   6. Provide predictable routine (e.g. meals, bedtime)
   7. Explain activities simply before performing
   8. Make use of calming activities
      1. Music and dance
      2. Art
      3. Exercise (e.g. schedule daily walks)
      4. Montessori activities
   9. Ask close-ended questions:
      1. Example: Would you like chicken for dinner?
      2. Ask questions for which patient knows the answer
   10. Distract and redirect patient in problem situations
       1. React to emotion instead of patient's speach content
       2. Help patient remember prior pleasant experiences
       3. Calm with music, toys, familiar items
   11. Create a safe environment
       1. See Fall Prevention in the Elderly
       2. Remove weapons from home (guns, knives)
5. References
   1. Howell in Duthie (1998) Geriatrics p. 295-305
   2. Cummings (2002) Am Fam Physician 65(12):2525-34 [PubMed]
   3. Ham (1997) Postgrad Med 101(6):57-70 [PubMed]
   4. Stewert (1995) Am Fam Physician 52(8):2311-22 [PubMed]