Dementia companionship — what really helps and what does not

Dementia is not one illness

“Dementia” is an umbrella term for more than 50 different conditions. The most common ones:

Alzheimer’s dementia (roughly 60–70 % of all cases):

slowly progressive, often beginning with short-term memory.

Vascular dementia (roughly 15–20 %):

caused by circulatory problems, often deteriorating in steps.

Lewy body dementia (roughly 5–10 %):

a mixed picture of dementia and Parkinson’s, often with hallucinations.

Frontotemporal dementia (roughly 5 %):

often with a change in personality as the first symptom, and younger patients.

Secondary dementias:

mixed forms, arising as a consequence of other illnesses.

The distinction matters, because the course of the illness and the pattern of symptoms differ considerably.

Four phases, four sets of needs

Phase 1: mild dementia:

Forgets things, searches for words, feels embarrassed. Needs discreet support in the background, familiar routines kept intact, and a respectful way of handling lost knowledge. A great deal is still possible alone at this stage.

Phase 2: moderate dementia:

Serious problems with orientation, a possible change in personality, help needed with self-care. Needs companionship by the hour or for half a day, a clear daily structure, and patient repetition.

Phase 3: severe dementia:

Loss of speech, full dependence on care, often incontinence. Needs 24-hour care or a place in a home, sensory stimulation (touch, music, scents) and calm surroundings.

Phase 4: the final phase:

Bedbound, difficulty swallowing, the process of dying. Needs palliative companionship, end-of-life care and palliative symptom control.

What really helps

Routines:

Dementia devours what is new. But it respects what is old. A fixed daily rhythm — breakfast at 8am, a walk at 10, lunch at noon, a nap at 2pm, coffee at 3.30pm — protects against confusion and aggression.

The senses:

When words and understanding fade, the senses remain. Music from their youth. The scent of lavender. A rough blanket. A warm tea that can be smelled.

Touch:

A hand on a hand. An arm around a shoulder. Dementia isolates — touch connects, even without words.

Validation rather than correction:

“I’m just going to see my mother,” says an 88-year-old. Wrong: “Your mother has been dead for 30 years.” Right: “Your mother matters to you. Tell me about her.”

What does not help

Reasoning:

Dementia does not argue. Anyone who comes armed with logic frustrates themselves and the person who is ill.

Contradiction:

“You have only just eaten.” It does not help — the person with dementia genuinely no longer knows.

Too much stimulation:

Television plus radio plus conversation plus the telephone — that is overwhelming and triggers agitation. Turn the background noise down.

Relatives taking on too much:

“I can manage on my own” is the most dangerous sentence a family carer can say. Get support before you are exhausted, not afterwards.

Frequently asked questions

• At what point does dementia need treatment?

  As soon as everyday life or safety change. An early diagnosis can help influence the course favourably and put structures in place in good time.
• Can people with dementia still live alone?

  In phase 1 often yes, with support. In phase 2 only with a clear daily structure and companionship by the hour. In phase 3, as a rule no longer.
• What does dementia companionship by the hour cost?

  Hourly rates depend on the qualification of the person assigned; supplements under § 3b EStG (25 % at night, 50 % on Sundays and public holidays) are added. We put concrete figures together in the free initial consultation.
• Does the Pflegekasse cover the costs?

  Not directly — we bill this as a private-pay service. The care allowance (Pflegegeld) and the relief allowance (Entlastungsbetrag) can, however, be put towards it in part.