1.5 Explain why the abilities and needs of an individual with dementia may fluctuate

This guide will help you answer 1.5 Explain why the abilities and needs of an individual with dementia may fluctuate.

Dementia is a progressive condition that impacts memory, thinking, emotions, and day-to-day functioning. While its effects steadily worsen over time, an individual’s abilities and needs can vary from day to day—or even hour to hour. Fluctuations are a normal part of dementia, and understanding why they happen helps care workers support individuals with patience and compassion. Identifying the causes of these changes makes it easier to adapt care and maintain the person’s dignity, safety, and quality of life.

Changes in Cognitive Abilities

The way dementia affects the brain can lead to “good days” and “bad days.” On some days, a person with dementia may seem alert and communicate well. On other days, they might struggle more significantly with confusion, memory, or concentration.

Impact on Memory and Thinking

The brain damage caused by dementia doesn’t happen evenly. Different areas of the brain are affected by different types of dementia. For instance:

• Alzheimer’s Disease: This mainly damages memory and reasoning areas of the brain, which can result in inconsistency in recalling events or carrying out familiar tasks.
• Vascular Dementia: This is caused by blood flow problems in the brain. Individuals might experience sudden dips in abilities following small strokes or blocked blood vessels.

Some moments may seem clear and focused, while others feel more confusing. This can vary during the day, sometimes referred to as “sundowning” (discussed later).

Temporary Gaps in Ability

People with dementia don’t forget everything all at once. For example, they may temporarily remember forgotten information, like a past event, then lose this memory again. This can appear as a sudden improvement or decline in their cognitive abilities.

Physical Health Factors

Physical health directly affects how an individual with dementia experiences their day. Even minor problems can lead to noticeable changes in ability and need.

Fatigue

Tiredness can significantly impact a person’s cognitive and physical abilities. Someone who had a good night’s sleep may perform activities more easily, while sleep deprivation can lead to confusion and irritability. Fatigue builds up throughout the day, which is why symptoms sometimes worsen in the evening.

Infections and Illnesses

Infections—even common ones like colds, flu, or UTIs—can temporarily lower abilities. For instance, an infection might make someone unusually tired, confused, or less mobile. Ongoing illnesses, such as diabetes or heart disease, also affect energy levels and contribute to “bad days.”

Dehydration or Malnutrition

If someone doesn’t eat or drink regularly, this can lead to poor concentration, dizziness, or slower responses. Dementia itself might make it harder for an individual to recognise when they are hungry or thirsty, causing their condition to fluctuate.

Pain Levels

Chronic pain conditions, like arthritis, can cause distress and physical discomfort. When pain is poorly managed or not recognised, it might affect mobility or concentration, making tasks seem more difficult.

Medication

The medications someone takes can influence their abilities and create fluctuations throughout the day.

Side Effects

Some medications cause drowsiness, dizziness, or confusion. For example, sedatives or strong painkillers may temporarily alter a person’s ability to communicate or move around independently.

Timing of Medication

Medication schedules can make a significant difference. For example, if a drug helps control agitation, a person may seem calmer after taking it. If the effects wear off before the next dose, symptoms can return or worsen, causing variability in behaviour or needs.

Emotional and Psychological Factors

Emotions and mood play a large role in how someone with dementia functions. Dementia often makes it harder for people to express or process emotions in the same way they did before.

Stress and Anxiety

Dementia can make people feel overwhelmed or frustrated by situations they don’t fully understand. For instance, being in a noisy environment or unfamiliar place might raise their anxiety, leading to changes in ability or behaviour. Removing the source of stress often helps them return to a calmer state.

Depression

Feeling low or sad can reduce motivation and impact abilities like concentration or decision-making. Depression is common in individuals with dementia, and their fluctuating emotional state may result in days when they need more understanding and reassurance.

Agitation and Frustration

Frustration might build if the person is struggling to recall information, perform tasks, or make themselves understood. This agitation can temporarily worsen symptoms, such as contributing to confusion or withdrawal from activities.

Environmental Factors

Dementia makes it harder to interpret or adapt to the world around us. Environmental factors often influence a person’s ability to function and can cause fluctuations.

Changes in the Environment

A change in surroundings, such as staying in hospital or moving house, can affect behaviour and mood. An unfamiliar place may feel confusing or overwhelming, resulting in agitation. People with dementia rely on familiar routines to help maintain stability, so disruptions can temporarily make daily life harder.

Over- or Under-Stimulation

People with dementia may feel unsettled by loud environments (e.g., busy care homes, bustling family gatherings) or lots of activity around them. On the other hand, too little engagement can lead to boredom, isolation, or lack of focus. Finding the right balance is important to manage their fluctuating needs.

Time of Day (Sundowning)

The term “sundowning” describes when symptoms worsen during the afternoon or evening. This might include increased confusion, restlessness, or agitation. Causes can include tiredness from the day’s activities, changes in light levels, or the disruption of usual patterns like meals or social interaction.

Social and Relational Factors

Social interactions and relationships also contribute to fluctuation in abilities and needs.

Communication Barriers

Struggling to communicate can create misunderstanding or frustration. A good day might involve easy conversations and connection, while a bad day could include miscommunication, making the person feel withdrawn or upset.

Level of Support

Being looked after by a compassionate, calm caregiver often helps people feel safe and reassured. If the person is left alone or dealt with impatiently, they may become distressed, confused, or disoriented, which affects how they manage throughout the day.

Progression of Dementia

As dementia progresses, fluctuations may become more pronounced. Over time, individuals may become less predictable in their abilities and more reliant on caregivers to adapt to changing needs. Certain triggers that might not have impacted them in early stages of dementia may begin to play a larger role.

Supporting a Person Through Fluctuations

Understanding that fluctuations are normal can help care workers provide responsive, person-centred care. Strategies to support someone on their “bad days” include:

• Creating Stability: Maintain consistent routines and environments wherever possible, helping the person feel secure.
• Observation: Monitor physical and emotional needs for signs of fatigue, hunger, thirst, pain, or distress.
• Patience and Reassurance: Take time to reduce their stress and frustration, and provide reassurance.
• Professional Input: Report changes, seek medical advice if issues like infections or medication side effects are suspected, and follow care plans.

Final Thoughts

The abilities and needs of a person with dementia fluctuate naturally due to a variety of causes. These include fatigue, infections, side effects of medication, emotions, and environmental factors. By paying attention to these influences and understanding their role in fluctuation, care workers can provide tailored support and improve quality of life. Recognising patterns of fluctuation allows care teams and families to take proactive steps, ensuring individuals are treated with empathy and respect on both their good and bad days.