Interventions to support older people around eating and drinking vary: changing the color of a plate, increasing exercise, altering the environment or changing knowledge or attitudes. Some interventions alter food and drink directly via oral nutrition supplementation, food modification, dysphagia management, eating assistance or supporting the social element of eating and drinking. Other interventions such as altering the dining environment, providing education and training for people with dementia and their caregivers, behavioral interventions, and exercise programs affect food and drink intake or experience indirectly

Assistive or adaptive tableware have been a mainstay for many years. Unfortunately, most assistive tableware lacks aesthetic appeal. Since people have different needs and abilities, and assistive tableware stands out from standard items, users of assistive table settings may feel stigmatized.

A common strategy as dementia advances and feeding difficulties develop is to simplify eating by providing just a plate and spoon with pureed or diced food that can be eaten without needing to be cut up by the client. The plate should have a high lip that helps to push the food onto the spoon as a person tries to scoop it up.

Well-designed assistive tableware can be used by people of all abilities and should resemble standard domestic tableware. Color contrasts should feature prominently for example royal blue plates provide a contrast both with a white table covering and food on a plate. The same approach can be used with cups; for example, royal blue and white can be used to help those with low visual acuity or agnosia locate the handle and rim. The sides of the cup should be angled to reduce the need to tip the cup, a large handle will assure a good grip, and the top should be wide enough to allow a person's nose to fit inside the cup when tipped.

Interventions that have shown particular promise include eating meals with caregivers, family style meals, soothing mealtime music, constantly accessible snacks, longer mealtimes, education and support for formal and informal caregivers, facilitated breakfast clubs, and multisensory exercise. More research is needed to help understand what types of interventions are effective in supporting adults with dementia to eat and drink well, and to remain actively engaged with food and drink.

Throughout our lives, bathing is a private, independent, and personal experience. For someone with dementia, having another person help with bathing can be uncomfortable and even threatening. Success depends on a caregiver's ability to help the person they are caring for feel a sense of control and independence. This is accomplished by including the person is the bathing decision, encouraging independence, protecting the person's privacy and dignity, and practicing flexibility.

Prepare for bathing by making sure the environment is safe and comfortable. Bathing supplies should be within reach and the water pre-heated to the proper temperature. Grab bars should be available as well as non-skid mats.

During bathing, techniques that comfort and reassure a person with dementia include:

• Set a regular time for bathing
• Be gentle with fragile skin, avoid scrubbing
• Simplify the bathing process, use assistive devices
• Coach or cue the person through each step, if needed
• Offer a bench or shower chair for comfort and safety
• Cleanse hard-to-reach areas
• Use a sponge bath in between baths or as an alternative to bathing

Incontinence is the involuntary leaking of urine or feces or both. For people with dementia living at home, incontinence can be embarrassing and stigmatizing. Incontinence adds to caregiver stress and depression and is a factor in the decision to admit a family member to a care home.

A number of issues are related to toileting and incontinence in people with dementia. Some are the result of the loss of cognition and memory, some from behavioral and psychological symptoms and some from the interplay of these with other comorbidities. Over-medicating with laxatives can be a problem. Toileting and incontinence issues can include:

• Unable to act in a timely way to the sensation of the need to void.
• Unable to locate, recognize and use toilets or undo locks on toilet doors once inside.
• Unable to manage things such as undoing and replacing clothing, for men how to direct the penis, and how to undertake cleansing and personal hygiene.
• Inappropriate management of soiled clothing as well as urine and feces, hiding soiled underwear, attempting to hand feces to the caregiver, wiping feces off hands onto clothing or furniture.
• Voiding in place without trying to remove clothes or move to a toilet or commode.
• Choosing to void in an inappropriate place such as defecating in the garden, standing by the bed at night, or in inappropriate receptacles such as waste bins.
• Resistance to others helping with toileting.

Techniques and strategies used by caregivers to manage toileting and incontinence in a person with dementia typically start with reminders to go to the toilet on a regular basis. As dementia progresses, other techniques are needed such as adult diapers, bedside commodes, and direct help from the caregiver.

To make it easier for a person with dementia to find and use the toilet:

• Clear the path to the bathroom by moving furniture.
• Keep the bathroom door open so the toilet is visible.
• Put colored rugs on the bathroom floor or put a picture of a toilet on the bathroom door.
• Make the toilet safe and easy to use. Raise the toilet seat, install grab bars on both sides, and use nightlights to illuminate the bedroom and bath.
• Consider a portable commode or urinal for the bedroom for nighttime use.
• Remove plants, wastebaskets and other objects that could be mistaken for a toilet.
• Remove throw rugs that may cause a person to trip and fall.
• Consider using glow-in-the-dark tape to create a direct line or path to the toilet.

Keep in mind that incontinence can be related to a medical problem such as urinary tract infection, constipation or prostate problems. Incontinence is also associated with diabetes, stroke, Parkinson's disease and physical disabilities that prevent the person from reaching the bathroom in time. Medications and diuretics (drugs that increase urination) can also cause incontinence. This includes sleeping pills, anxiety-reducing drugs that may relax the bladder muscles, and drinks such as cola, coffee and tea.

Effectively communicating with individuals with dementia.

Good communication starts with patience and thoughtfulness. Good communication builds trust, encourages independence, and leads to better outcomes. Caregivers must learn and believe that consistently trying to understand the needs of the person they are caring for will make their job easier. Good communication takes into account a person's ability to comprehend, their sensory abilities, and their culture.

In the home setting, communication may be easier because the environment is familiar with fewer distractions although caregivers are often alone and cannot turn to a co-worker for help. No matter what setting, a calm tone, short direct sentences, a slow rate of speech, and patience encourages independence in people with dementia.

Communication can be hard for people with Alzheimer's and related dementias because they have trouble remembering things. They also can become agitated and anxious, even angry. In some forms of dementia, language abilities are affected such that people have trouble finding the right words or have difficulty speaking. You may feel frustrated or impatient, but it is important to understand that the disease is causing the change in communication skills. To help make communication easier, you can:

• Reassure the person. Speak calmly. Listen to his or her concerns and frustrations. Try to show that you understand if the person is angry or fearful.
• Allow the person to keep as much control in his or her life as possible.
• Respect the person's personal space.
• Build quiet times into the day, along with activities.
• Keep well-loved objects and photographs around the house to help the person feel more secure.
• Remind the person who you are if he or she doesn't remember, but try not to say, Don't you remember?
• Encourage a two-way conversation for as long as possible.
• Try distracting the person with an activity, such as a familiar book or photo album, if you are having trouble communicating with words.