What is Middle Stage Dementia?

Middle stage dementia is the phase where symptoms become more noticeable and begin to significantly impact daily life. At this point, the person may need more support to manage everyday tasks and maintain their independence. The cognitive and behavioural changes experienced in this stage are usually more severe than in the early stage.

While individuals in the middle stage of dementia can still participate in certain activities, they may struggle with recognising people, communicating, or understanding their surroundings. This stage often requires carers or family members to become more involved to ensure the safety and wellbeing of the individual.

Middle stage dementia typically lasts several years, though its progression depends on the individual and the type of dementia they have. Regular assessments, support, and care planning are crucial during this phase.

Symptoms

The symptoms of middle stage dementia are more pronounced and start to interfere heavily with daily activities. Common signs include:

• Worsening memory loss: Forgetting recent events or even significant life details like their address, phone number, or names of loved ones.
• Communication problems: Increased difficulty finding words, repeating phrases, or confusing sentences.
• Disorientation: Difficulty recognising familiar places or people. Getting lost or confused even at home is common.
• Changes in behaviour: Frequent mood swings, agitation, restlessness, or feelings of confusion. The person might also express unfounded fears or delusions (believing things that aren’t true).
• Difficulty with personal care: Struggling with grooming, dressing, or managing hygiene independently.
• Poor judgement and decision-making: Making inappropriate choices, such as wearing unsuitable clothing for the weather.
• Sleep problems: Sleeping more during the day or experiencing disrupted sleep patterns at night.
• Reduced mobility: The physical coordination and ability to move may worsen over time.

The progression of symptoms in this stage may vary, but consistent support and adjustments become essential as difficulties increase.

Impact on Daily Living

Middle stage dementia often significantly affects how someone navigates their daily life. At this point, they usually need assistance with essential activities. Key areas impacted include:

Personal Care

Tasks that were once simple, such as brushing teeth, dressing, and bathing, may become overwhelming. The person might forget how to perform steps or may resist help due to embarrassment or frustration.

Eating and Drinking

The individual might forget to eat, drink, or recognise food. They may also struggle to use cutlery, increasing the risk of malnourishment or dehydration.

Communication

Conversations can become difficult and repetitive. The person may forget words, lose their train of thought, or struggle to follow the flow of dialogue.

Safety

Safety becomes a major concern in middle stage dementia. The person may leave the stove on, wander away from home, or attempt risky activities like climbing stairs without proper support.

Relationships

The person might no longer recognise close friends or family, leading to emotional distress for everyone involved. This can create new challenges in maintaining meaningful relationships.

Emotional Wellbeing

Loss of independence, confusion, and fear of the unknown can lead to depression, anxiety, or aggressive behaviour. They may become withdrawn or seem uninterested in activities they previously enjoyed.

Examples of Support

Support during middle stage dementia focuses on maintaining dignity, providing structured routines, and ensuring safety. Appropriate care can dramatically improve wellbeing.

Professional Care

In this stage, more structured care from professionals may be required. Examples include:

• Regular medical appointments: Healthcare professionals monitor health changes and adjust treatment plans.
• Occupational therapists: They can suggest practical tools or adjustments to make daily activities easier.
• Medication management: Prescribed drugs might help lessen behavioural symptoms like agitation or depression.

Routine and Structure

Creating a daily routine helps limit confusion and anxiety. Routines can include fixed times for waking up, meals, activities, and bedtime.

Practical Assistance

Assistance with tasks like dressing, grooming, and meal preparation is vital. Strategies such as breaking tasks into smaller steps or offering clear instructions can help.

Home Adaptations

Making practical changes to the living environment ensures safety and comfort:

• Installing grab bars in the bathroom for support
• Using brighter lighting to reduce disorientation
• Labelling drawers and cupboards with pictures or words
• Securing hazardous items like sharp objects or cleaning products
• Using locks or alarms to prevent wandering outside

Technology and Tools

Technology can provide additional safety and organisation. Helpful examples include:

• Fall sensors: Devices that alert carers in case of a fall
• Wander alarms: Systems that detect if the person has left their home
• Simple mobile phones or tablets: Designed for people with dementia and easy to use
• Medication reminders: Ensuring they take their meds on time

Emotional Support

Providing reassurance is essential. The person may often feel misunderstood or insecure, and calm, compassionate communication can ease their anxiety.

Families can help by:

• Spending quality time together
• Encouraging conversations, even if they are repetitive
• Using touch, such as holding hands, to offer comfort
• Avoiding long, complicated explanations during confusion

Carers and families may also benefit from speaking with dementia care advisors or joining support groups.

Social Activities

Though participation may decline, involving the person in stimulating activities can still be highly beneficial. Ideas include:

• Music therapy: Listening or singing along to familiar songs can trigger positive emotions.
• Art and crafts: Guided painting sessions or simple crafts can enhance mood.
• Identifying objects: Show them familiar objects like old photos or letters to provide sensory stimulation.

Respite Care

Caring for someone in middle stage dementia can be extremely demanding, and carers may need breaks. Options for respite care include:

• Short-term care homes
• Day centres offering dementia-friendly activities
• Professional carers visiting at home while the family takes a break

Support for Families and Carers

Families and carers play a vital role in middle stage dementia care, but they often face immense challenges. To support carers:

• Training and resources: Many organisations, like Age UK or Alzheimer’s Society, offer workshops on dementia care.
• Financial help: Carers might qualify for benefits like Carer’s Allowance to ease financial pressure.
• Respite services: These services give carers a chance to rest and recharge.
• Counselling: Therapy services can help carers cope emotionally.
• Support groups: Connecting with other carers provides valuable advice and a sense of community.

Final Thoughts

Middle stage dementia requires a team approach, combining medical support, practical care, and emotional wellbeing. Addressing the challenges with appropriate care allows individuals and carers to navigate this phase while maintaining dignity and improving their quality of life.