What is cognitive decline?
Cognitive decline refers to a decrease in mental abilities such as memory, reasoning, and language, which can be part of normal aging or indicate more serious conditions such as dementia. Let’s start with its meaning to better understand the characteristics and useful tips for best supporting people affected by this condition.
The home environment as a comfortable place for cognitive decline
Most people with early Alzheimer’s or other forms of cognitive impairment want to stay at home or in their neighborhood (garden, nearby parks) for as long as possible, as these places provide valuable support in managing symptoms and the progression of the disease.
The familiar environment also offers them points of reference that can remain in their memory even when everything else fades away: their favorite armchair, lifelong possessions, the faces of family members. Living is a challenge, but with appropriate adjustments and support, the quality of life of both the patient and their caregivers can be significantly improved. The main goal is to maintain as much autonomy, safety, and emotional well-being as possible in the daily life of elderly with cognitive problems.
A “Dementia-Friendly” Home: Ergonomics and Safety
Adapting the home environment is the first step in making a home “dementia-friendly,” reducing frustration and danger. Let’s look at the main elements to consider in situations of senile dementia:
Eliminating the risk of accidents
Key measures include removing slippery rugs, installing handrails and support handles (in bathrooms and corridors), and ensuring good lighting, as poor lighting increases confusion and the risk of falls.
A tidy, uncluttered space facilitates orientation. Home ergonomics means providing solutions that make the elderly more independent: labeling doors with pictures so that they can recognize them, for example, an icon for the toilet on the bathroom door; or furniture and items can be clearly marked with labels on cabinets: “Linen,” “Pots and Pans.”
Door and access management: preventing wandering
Many Alzheimer’s patients tend to wander. Possible solutions include door security systems (alarms if they open at night, simple locks that prevent unattended exit) and geofencing with sensors to alert caregivers in case of wandering. This allows freedom of movement in the home and garden, but protects against uncontrolled exit.
Reduce disorienting stimuli
Noisy or stimulus-rich environments can agitate people with dementia. It is preferable to create quiet spaces, keeping the volume of radios and televisions low, as some sounds may be misunderstood, and avoiding too many voices overlapping simultaneously. On the contrary, familiar music can have a calming and soothing effect: preparing a playlist with songs from the elderly person’s youth and playing them in the background can elicit positive reactions.
Reassuring objects in sight
Keeping cherished objects and photographs in sight can awaken pleasant memories and strengthen the sense of identity. A “memory board” with old labeled photographs (e.g., “Maria and Giovanni’s wedding 1960”) can stimulate conversation and help the person recognize family members, perhaps by placing photos from their youth alongside current ones. This helps improve mood and reduce anxiety related to “not remembering who you are.”
Technology to aid in cases of cognitive decline
To prevent elderly people from wandering off unchecked, security systems, door alarms, and devices with geofencing functions can be installed, such as the Healthcare Watch CAD. Technological solutions such as the latter, with geolocation and immediate alerts to the operations center, promote a safe environment and freedom of movement. Safe Bed Monitoring CAD, a sensor under the mattress, detects nighttime movements, heart rate, and breathing, improving safety and comfort, all connected to the 24-hour operations center. CAD technology can also provide support through digital reminders on the Healthcare Watch, which remind users to hydrate or take medication, increasing daily autonomy.
Discover our home care technology devices
Cognitive decline and structured daily activities
People with cognitive decline benefit from a regular daily routine, which gives them a structure they can understand. Repeating schedules and sequences every day helps the patient feel more oriented and reduces agitation. Family and caregivers should maintain this routine even if with dementia does not consciously recognize it—they still perceive its regularity.
Appropriate initiatives for cognitive decline
It is also important to offer activities suited to the person’s remaining abilities, to avoid inactivity and internal isolation.
- Simplified household activities: involve the person in household chores such as folding clothes, dusting easy surfaces, and watering plants. Even if they may not do it perfectly, they will feel useful and part of the family.
- Gentle cognitive stimulation: play simple games (puzzles with large pieces and few pieces, bingo with help, simplified memory games, perhaps using the same family photos), read short stories or poems aloud together, leaf through illustrated magazines, and comment on the pictures. These activities keep the brain stimulated without stressing it and can be enjoyable. Alzheimer’s Switzerland has developed guidelines on cognitive activities for moderate stages of dementia to prolong residual functioning.
- Music therapy and art: Many people with Alzheimer’s, despite gradually losing their words, retain the ability to sing familiar tunes. Singing popular or religious songs together that are linked to memories can bring joy and positive emotions. Drawing or coloring mandalas can also be relaxing and beneficial. In Ticino, there are interesting experiences of “narrative cafés” where people recount episodes from their lives—even if sometimes inaccurate—while volunteers listen attentively, making them feel valued and important.
- Adapted physical activity: a daily (accompanied) walk in the fresh air promotes sleep and stimulates appetite. Light exercise that can be done at home includes repeatedly standing up and sitting down from a chair (when possible), moving your arms as if washing windows, or slow dancing to music. Keeping the body active helps slow cognitive decline and stimulates the production of endorphins, thereby improving overall mood.
Specialized home support for cognitive decline in older adults
To improve the quality of life at home, the support of specialized professionals is essential:
- Geriatric/psychiatric nurses. These professionals can make home visits to assess the specific situation and provide family members with targeted behavioral strategies. For example, they teach how to manage episodes of delirium or fixed ideas by avoiding direct confrontation and instead using distraction techniques or validation therapy, which consists of entering the person’s perceived reality to reassure them. In addition, they provide support in managing drug therapy, including anti-dementia and anti-anxiety medications, by closely monitoring any side effects.
- Occupational therapists. They work directly with the person to preserve daily skills for as long as possible, suggesting specific aids and adaptations. For example, an occupational therapist can teach caregivers how to break tasks down into simple steps, allowing the person to continue dressing independently with minimal support by presenting items in the correct order of wearing. In addition, they can develop personalized programs to maintain and stimulate manual skills through targeted activities.
- Psychologist or specialized educator. They can organize reminiscence interventions (recalling past memories with photo albums, vintage objects) that often bring to light memories that are still alive and give the elderly person satisfaction in recounting them. Or they can conduct short reality orientation (RO) sessions in which, gently, they remind the person of the date and season using a clearly visible calendar and link them to personal events (“Today is Monday the 10th, and like every Monday, your grandson is coming to visit you in the afternoon”). This can help provide a minimal anchor in time.
- Caregivers. The presence of a qualified person who spends a few hours each day with the older person is a valuable relief for the primary caregiver and ensures constant company for the person being cared for. These caregivers can patiently devote themselves to personal hygiene and meals, also offering the kind of undivided attention that is often difficult to provide in a family setting with its many daily tasks. Their presence allows the caregiver spouse to run errands, take breaks, or simply rest. If properly trained, these assistants can also carry out the activities described above, such as walks, cognitive stimulation games, and reading.
Emotional well-being of the elderly: managing depression and cognitive decline
Alzheimer’s causes cognitive confusion, but the person often remains aware of their deficits, especially in the early stages of the disease, which can trigger anxiety, anger, or depression. Even in the more advanced stages, they may experience frustration when they encounter difficulties in expressing themselves or performing certain actions. Improving quality of life therefore means addressing these emotional aspects:
Creating a peaceful emotional environment
Caregivers should—as difficult as it may be—maintain a calm and reassuring tone of voice. Avoid correcting abruptly or dwelling on what the elderly and sick person does not remember. For example, if they repeatedly ask, “Where is Mom?” (who has presumably been deceased for decades), it is best to respond kindly each time: “Don’t worry, Mom just went out to do some shopping, she’ll be back soon” rather than “I’ve told you a thousand times that your mother is no longer with us,” which would cause new pain each time. This validation technique reduces anxiety and agitation.
Stimulate positive emotions
Many people with dementia respond remarkably well to pet therapy. If they loved animals in the past, the presence of a dog or cat—even a robotic one, such as the Paro puppy used in some nursing homes—can make them smile, calm them down, and awaken fond memories. Music therapy has similar effects: it can evoke positive emotions, stimulate memory, and reduce problematic behaviors. Dancing an old waltz with her husband, for example, can light up the eyes of a woman with Alzheimer’s, even if she now speaks very little
Avoid stress
For example, too many visits all at once can be confusing. It is better to have few, frequent, and regular visits. It is also important to reduce changes in the environment: keep the decor the same and do not move furniture, as any changes can be disorienting and cause them to lose the few points of reference they still have. If it is necessary to change caregivers (for example, due to a shift change), it is helpful to introduce the new person gradually, pairing them with the person already known for a few days.
Involve the social network
It is important to encourage visits from friends and relatives, provided they are patient and know how to interact, perhaps with the support or guidance of the caregiver. Social isolation can accelerate cognitive decline and aggravate behavioral disorders. Even in the advanced stages of dementia, the presence of loving people—who may sing together, hold hands, or simply share a moment of closeness—can have a calming effect and contribute to emotional well-being.
Supporting family members also helps patients with cognitive decline
A tired and frustrated caregiver may, even unintentionally, have less patience and respond abruptly or hastily to the Alzheimer’s patient, creating tension. On the contrary, a calm caregiver is able to be more empathetic and emotionally present, helping to create a positive family atmosphere in which the elderly person feels loved and accepted, not a burden. In Ticino, there are Alzheimer’s courses for family members, organized by Alzheimer Ticino, which also offer useful tools for improving communication and managing stress. A better-prepared family member means better care for the elderly and fewer conflicts.
Cognitive decline in the elderly: community initiatives and therapeutic day centers
To improve quality of life at home, it is also useful to integrate external opportunities. One example is the therapeutic day centers for dementia in Lugano, Bellinzona, and other locations in Ticino. In these protected and stimulating spaces, elderly can spend the day participating in group activities and socializing, then return home in the evening. This type of support helps maintain residual functions and combat apathy. According to Alzheimer Switzerland, the use of respite services such as day centers contributes to a better course of the disease and reduces the emotional and practical burden on families. Intergenerational meeting projects—for example, kindergarten children regularly doing crafts with elderly people with dementia—also bring joy and strengthen the sense of inclusion.
Advanced stages of Alzheimer’s and end of life at home
Even in the advanced stages of the disease, when the elderly person is bedridden and no longer communicative, the home can continue to be the place of care. With nursing support, the family can learn how to care for their loved one: turning them in bed, feeding them semi-liquid food, if still possible, or managing artificial nutrition. Staying at home allows for a more intimate and personalized end of life: listening to favorite music, petting the family cat until the very end, having family members nearby without time restrictions. Even if the patient is not fully conscious, these gestures help to create a peaceful atmosphere. Many families who have chosen to accompany their loved one with Alzheimer’s at home until the end, while recognizing the enormous commitment required, say they have never regretted that choice because they feel they have given them the utmost love and respect.
Find out more about palliative care at home
Conclusions: “Surviving” or living with senile dementia?
Living with cognitive decline does not just mean surviving the disease, but still being able to life with moments of joy, affection, and meaning. Improving quality of life at home requires a 360° approach: adapting the environment, structuring the day, stimulating the mind and body, preventing accidents, treating symptoms, supporting caregivers, and involving the community. And the home—a treasure trove of memories—remains the best setting for those memories to resonate, helping the elderly person feel at home, in their heart, until the very end.
Contact us for advice and to request CAD support in cases of emotional decline.
FAQ
What are the symptoms of cognitive decline?
Symptoms of cognitive decline may include memory problems (forgetting names or recent events), language difficulties, disorientation, difficulty performing familiar tasks, and mood or behavior changes.
What are the different types of dementia?
Alzheimer’s disease is one form of cognitive decline. Vascular dementia is another common type, often caused by problems with blood flow to the brain. Other forms include frontotemporal dementia and Lewy body dementia.
What are the stages of Alzheimer’s disease?
The stages of Alzheimer’s disease progress from mild cognitive decline (mild memory problems, still able to perform daily activities) to moderate cognitive decline (increased confusion, difficulty with complex tasks, personality changes, wandering) to severe cognitive decline (loss of ability to communicate, need for complete assistance with hygiene and meals, bedridden).
What causes cognitive decline?
There are many possible causes of cognitive decline, including Alzheimer’s disease, vascular problems (as in vascular cognitive decline or vascular dementia), head trauma, nutritional deficiencies, side effects of medications, and other medical conditions.
What are the remedies for cognitive decline?
The article outlines approaches to improving quality of life, including:
- Environmental adaptations for safety and orientation.
- Use of monitoring and reminder technologies.
- Creation of structured daily routines.
- Engagement in meaningful and stimulating activities (physical, cognitive, artistic).
- Support from specialists such as nurses, occupational therapists, psychologists, and home care workers.
- Emotional well-being management and stress reduction through validation and positive stimulation (e.g., pet therapy, music therapy).
- Involvement of the social network and support for family members.
- Participation in community initiatives and day centers.
What is cognitive assessment and how is it performed?
Cognitive and behavioral assessment of the patient is important in order to calibrate the role of geriatric/psychiatric nurses and specialized psychologists/educators in order to implement the most appropriate strategies. The assessment is carried out through observation, interviews with the patient and family members, and often specific tests.
Sources and further reading:
- Tian, Y. J., Felber, N. A., Pageau, F., Roulet Schwab, D., & Wangmo, T. (2024). Benefits and barriers associated with the use of smart home health technologies in the care of older persons: A systematic review. BMC Geriatrics, 24, 152. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-04702-1
- Chimamiwa, G., Giaretta, A., Alirezaie, M., Pecora, F., & Loutfi, A. (2022). Are smart homes adequate for older adults with dementia? Sensors, 22(11), 4254. https://doi.org/10.3390/s22114254
- Yin, G., Macaden, L., Sivaramakrishnan, D., Wang, Y., Zhu, L., & Chong, H. (2025). Home-based end-of-life care for people with dementia: A systematic review of quantitative and qualitative evidence. Dementia (London), 24(4), 794–831. https://doi.org/10.1177/14713012241308625
- Spira, A. P., et al. (2024, 11 marzo). Wrist device that monitors activity could help provide early warning of Alzheimer’s. Johns Hopkins Bloomberg School of Public Health News.
- Kellett, A. (2025, 18 febbraio). Advanced wearable technology improves support for people with dementia and their caregivers. Texas A&M University School of Public Health.
