Promoting independence safely

The principle

Use it or lose it applies to cognitive and functional abilities. Doing things for the person, even when well-intentioned, hastens loss of those abilities. The aim is calibrated support: enough to keep the person safe, no more than necessary.

Calibrated support

For any task, four levels of support exist:

• Independent: the person does it themselves;
• Verbal prompts: a reminder ("It is time to take your tablets");
• Set-up: the task is prepared, the person does it (Dosette box opened, breakfast laid out);
• Hands-on assistance: physical help to complete the task.

Start at the lowest level that works. Reassess every few months as needs change.

Where to support and where to step back

Step back where possible

• Choice of clothes, meals, activities (offer options, not orders);
• Tasks the person still does competently;
• Conversation: allow time without finishing sentences;
• Familiar self-care (with prompts if needed);
• Decisions about their own day (within safety limits).

Step in where needed

• Medication safety (Dosette box, supervision);
• Finances when these become unsafe (under Lasting Power of Attorney);
• Driving when DVLA process indicates;
• Dangerous tasks (hot cooking, complex machinery) where capacity is reduced;
• Decisions requiring complex cognitive demands when capacity is impaired.

Assistive technology

A growing range of assistive technology supports independence:

• Dementia-friendly clocks (showing day, date, time of day);
• Medication reminders (automatic pill dispensers);
• Voice-controlled devices (Alexa, Google Home) for reminders, calls and music;
• Tracking devices (GPS keyrings, smartwatches);
• Telecare (personal alarms, fall detectors);
• Reminder apps;
• Picture-based phones for easier calls.

Many local authorities provide free or subsidised telecare. The Alzheimer's Society and Age UK can advise.

Environmental adaptation

• Good lighting throughout (particularly evenings);
• Clear, uncluttered walkways;
• Picture signs on doors;
• Contrasting colours (toilet seat, plate vs table) for visual clarity;
• Removal of trip hazards;
• Single-action taps to reduce hot water risk;
• Familiar items kept in fixed places.

Outdoor independence

Going out alone may continue safely for many people in mild dementia. Practical supports:

• Identification card and address tag;
• GPS locator device (a discreet keyring or shoe insert);
• Registration with the Herbert Protocol via local police;
• Phone with emergency contacts pre-set;
• A well-known walking route.

Reassess as the disease progresses. The transition from independent outings to accompanied outings should be made together, not imposed.

Work and meaningful activity

Many people with mild dementia continue meaningful occupation: volunteering, part-time work, hobbies, family roles. The Equality Act 2010 supports reasonable adjustments at work; see work and employment.