Routines are things that happen regularly, often daily such as washing, dressing, eating, reading the newspaper and going for a walk. Health experts encourage us to go to bed and get up at the same times, eat regular meals and do regular exercise. I don’t generally work unsociable hours, but if I change my routine and get up at 4 a.m or stay up till the wee small hours, it takes me ages to feel “normal” again, which can result in grumpiness, forgetfulness and poor concentration. If my husband interrupts my morning routine, I’m quite likely to go to work without any makeup on and forget my phone and packed lunch. Routines can also be the order in which tasks are completed and no two people would have the same routine. Most people feel comforted by their own routines and people with dementia are no exception.
Routines are associated with our procedural memory (how we do things) and long-term memory. As dementia typically affects short-term memory, the memory of routines can remain well into the mid stages of the disease. It’s like that old saying about riding a bike, you never forget because it is ingrained into your procedural memory.
People with dementia may feel like they are losing control of their lives. Their thinking abilities slow down, and it becomes more difficult to plan, initiate and complete tasks that they once took for granted. Well-meaning family members and care-givers inadvertently take over tasks that reduces their independence and knocks their confidence and self-esteem. Moving into residential care can be a frightening experience for someone trying to hold onto the last bit of control they have in their lives. The environment is unfamiliar, and all their comforting routines go out of the window. The anxiety this causes may manifest itself in increased agitation and troublesome behaviours like wandering or aggression. It could also lead to depression and withdrawal. Introducing familiar comforting routines can help to alleviate this. If you are feeling lost and confused it can help to know that certain daily events will always happen at a certain time. The familiarity of their own personal routines can bring comfort and improve confidence.
The routine in a care home is unlikely to be the same as someone’s home routine but with a bit of work the two can be amalgamated. It is so important to find out from family and friends about your resident’s previous routines, including preferences and irritations. Small details count, no matter how silly they might seem. If having a cup of coffee at the same time every day in the same mug with the same biscuits provides comfort and a smile, then it is well worth it. If someone likes to have a nap at 3 p.m then there is no point trying to get them to join in with a quiz. Predictable routines can prevent someone with dementia being distracted or forgetting what they are doing. A reminder of the day’s activities stuck on the wall can be useful, but remember it is just a guide and not meant to control them or you. Disruptions to routines (unexpected family visits or outings, illness or demands in the care home) are unavoidable, but reintroducing the familiarity of well known routines can help to reduce the anxiety this may cause.
There is no one size fits all for someone with dementia but establishing person-centred routines, sharing them and practising them can go a long way to maintaining independence, reducing anxiety and improving quality of life both for the person with dementia and their carer-givers.