Older people who suffer from the advanced cognitive impairment or some dementia require specific attention that needs to be increased as the disorder progresses.The nursing team of the María Gay Geriatric Center has prepared a series of tips for those caregivers who have decided to treat the person with advanced cognitive impairment or dementia at home.Nursing care for people with advanced cognitive impairment or dementiaFrom nursing care it is necessary to focus mainly on two aspects:• Maintain the primary activities of daily life (or BADL).• Providing the care that allows maintaining, as far as possible, the health status of the older adult with dementia.Maintain the Basic Activities of Daily Life with people with dementiaDressing or putting on shoes are essential activities of daily life.Older people with advanced cognitive impairment or dementia usually have problems carrying out essential activities of daily living (or BADL), which are those that encompass the most elementary self-care skills: food, hygiene, elimination of excrement and urine, dress and conservation of functional mobility.When we see that a person we love suffers or has a hard time doing any of these activities, we tend to try to “help” it by doing it ourselves. In the case of people with cognitive impairment or dementia, however, and to preserve their autonomy as long as possible, it is advisable to let them do so alone, provided that it does not involve over-exertion or overstimulation.Care to maintain the health of people with dementiaOlder people who suffer from the advanced cognitive impairment or some dementia have associated health risks that other people do not have. It is convenient to know them and avoid them as much as possible.Risks related to food and hydration• Malnutrition or poor nutrition. They may forget to eat or eat poorly, eating only the things they want or those that are more at hand, and aggravating other pathologies that may suffer such as type 2 diabetes, hypercholesterolemia, hypertension, etc. It can be useful to hide the food that harms them and to facilitate access to those who benefit from them.• Dehydration. In the same way that happens with food, older people with advanced cognitive impairment or dementia may forget to drink, among other things because they do not recognize the sensation of thirst. Some symptoms of dehydration can be dizziness, confusion or dry skin. Make sure they drink liquids throughout the day, adapting the texture if there are swallowing problems.• Problems of taking or dysphagia. As dementia or cognitive decline progresses most of the bodily functions are altered and, among them, the mechanism of swallowing. This leads to choking and death risk. When there are dysphagia problems, a series of hygienic, postural and dietary measures must be taken into account.Risk of fallsThe risk of falls in older people is higher than in the rest of the population because they have a harder time moving, due to vision problems, etc. In the case of people with dementia or advanced cognitive impairment, the risk is higher because they have more mobility problems. To avoid falls, we can take some preventive measures:• Avoid obstacles, objects or cables on the ground, to facilitate walking (walking), as long as it is possible and tolerated. On long trips, the use of wheelchairs is recommended.• Have good lighting: especially in the places of passage. Also, at night, it is convenient to have a light on in the bedroom, hallway, and bathroom.• Avoid carpets and surfaces that make them slip.Soon we will offer more advice regarding the adaptation of space in an article about occupational therapy care at home.Risk of infections and ulcersIt is necessary to watch especially the hygiene and the possible sores in older adults with dementia or advanced cognitive deterioration because there comes a time when they forget about health and every time they remain immobile. In this sense some tips are:• In case of immobility, anti-decubitus cushions should be used during sitting, heel protection, and anti-decubitus mattress during decubitus. If the person is in a recumbent position (stretched) and does not move, it will be necessary to make postural changes.• Take into account the daily hygiene of intimate parts, skin folds and mucous membranes (mouth, …), and keep the skin clean, dry and well hydrated. It is advisable to shower the person once or twice a week. In this way, we will control the risk of infections.• If diapers are used, they should be changed every 3-4 hours and try to sit the person in the toilet to facilitate the evacuation. You should always avoid urine retention for more than 4 hours and monitor bowel movements. It is the convenient fecal elimination every day and, in any case, every three at the most. If necessary, a laxative can be administered.About us:The quality standards apply to four types of entities: day or life centers, welfare centers for older adults (also called protection centers, geriatric homes or gerontological homes), home care centers and home tele-assistance centers.