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    Dementia Symptoms & Caregiver Strategies: Helping with Transferring and Movement in Cognitively Impaired Adults

    What's Your Unique Situation?

    Helping a person get in and out of a bed or chair is one of the most difficult tasks a caregiver faces. The best transfer technique depends upon your loved one’s abilities, your abilities, and the living environment. Here are some important questions to consider before helping a person transfer who has cognitive impairment.

    Care Receiver

    • Can the person help if you use simple instructions? It's better for the individual to participate in their own transferring because it helps maintain muscle strength. Sometimes he or she still has the physical ability but, due to cognitive difficulties, needs simple instructions and guidance.
    • Does he or she have the ability to bear weight in at least one leg and stand?
    • Does the person have good upper body strength and ability to sit upright?
    • Is the person cooperative all the time or at specific times of the day?
    • How much does he or she weigh? A heavy person may need two persons or a lift to get out of bed.
    • Does the person have pain? If so, is there a position that's the best?
    • Is the person's skin thin and frail? If so, this will also affect how you place your hands to help and the type of transfer that you do. You'll need to move gently and slowly, as older adults bruise easily and their skin tears easily.
    • Does he or she have special circumstances that may affect transfer tasks, such as abdominal wounds, knee or hip replacement, or one-sided weakness from a stroke? If so, you need to seek advice from your doctor.
    • Is he or she dead weight and not able to help with transferring? If so, you will need a mechanical lift.
    Most insurance policies cover a home visit consultation if the individual qualifies. For example, physical therapists and occupational therapists can offer specific transfer techniques, strengthening exercises, and the right equipment tailored to your care receiver. And you can get hands-on training for your unique situation. Ask your doctor for a referral, since a prescription is usually necessary.


    • How is your strength? Are you putting yourself at risk? You can easily injure your back when trying to lift the person. And falls can happen to both you and your loved one during transferring.
    • Are you helping the individual use his or her remaining strength so you don't have to lift the person?
    • Do you need special transfer devices or another caregiver to help? Most back injuries happen slowly over time, and you could be putting yourself at risk without knowing it.
    Living Environment

    • Is there adequate room to transfer your loved one safely? Do you need to remove clutter, carpets, or furniture?
    • Do you have the right equipment and know how to use it? Medicare and other insurances often will pay for helpful transfer devices and hospital beds if your care receiver meets special qualifications. Check with your health care provider.
    Tips on good body ergonomics

    • Tighten your stomach muscles during transferring to protect your back.
    • Bend your knees and hips. (If you're doing this right, you will stick your buttocks out). This way, your upper legs and stomach muscles do the work - NOT your back.
    • Keep your back straight (don't round your back).
    • Keep your feet about 9 to 12 inches apart, with one foot slightly ahead of the other. This will help you transfer the person by shifting your weight instead of lifting dead weight.
    • Assist the person at the hips if a moderate amount of assistance is needed - don't pull on or under the individual's arms. This is very painful for the person being transferred and can actually cause injury.
    • Keep the person close to you as you move.
    • Move your feet to turn your entire body. If you turn without moving your feet, you're twisting your back, which increases injury risk. Pick up your feet and turn (pivot) your whole body in the direction of the move.
    Golden Rules during a Transfer

    • Ask the person for his or her help, using simple step-by-step instructions, even if you think he or she will not understand you. Allow plenty of time to respond. You should only be assisting, not doing for the individual. Sometimes, all your loved one actually needs is a hand on the lower back and one on the shoulder to gently guide them forward.
    • Use transfer devices whenever possible to slide, push, and pull instead of physically lifting. You'll have better success at not injuring yourself.
    • Get equipment ready. Have the walker nearby or position the wheelchair close to the bed or chair and lock the wheels. If possible, remove the armrest and swing away or remove the leg rests in preparation for the transfer. Check the area for clutter on which you or your loved one might trip on.
    • Use your body properly. Take in account your body type as well as the body type of your care receiver. Where you place your hands and your approach will differ depending on your body type and your loved one's. But the golden rule is - get yourself in a position that allows you to maintain a "neutral" spine. Anytime that you lose the natural lumbar curve, you're putting your back at risk for injury. It's the small micro traumas that develop into an injury versus just one single isolated event.
    • Position the care receiver's body properly. For example, for standing transfers, make sure the person's feet are positioned slightly under his or her knees. For seated transfers, make sure the individual’s head/shoulders are bending away from the surface he or she is transferring. In other words, lead with the buttocks.
    • Know your loved one’s assets and deficits. You want to maximize the individual's assets so the person is doing the most he/she can do - and you as the caregiver do the least. Keep in mind that it's therapeutic for your loved one to help as much as possible because it helps the person maintain muscle strength and mobility.

      For example,if your loved one has a stronger left or right side, make sure to lead with that side. If the person tends to push or grab, lead with the individual's non-pushing /grabbing side or control the "pushing/grabbing arm(s)" by how you position your hands.
    • Communicate, giving simple step-by-step instructions, especially when you're ready to transfer. That's why counting to three is helpful - you and your loved one then move at the same time.
    • Use momentum, like rocking and counting to three, to transfer.
    • Give the person a moment to adjust to each new position. People with cognitive deficits react slower than we do, and rushing a person can be unproductive.
    • Get professional advice. Many insurance companies cover a physical therapy consultation for you to get specific strengthening exercises for your loved one and hands-on training for your unique situation. Of the numerous ways to help a person transfer, the safest may be unique to your care recipient's situation. Keep in mind that with individuals with progressive cognitive impairment, what works today may not be work a month from now, so it's important to get ongoing advice from a health professional.
    If the Person Refuses to Budge

    Some individuals, once in bed, are reluctant to get up again. Often it is due to pain, fear of falling, or the effects of cognitive impairment, as the person may no longer remember how to transfer without prompting. Approaching the individual with a positive attitude and providing a truly tempting reason to get up, however, can make all the difference. Here are seven ways to encourage a person to get out of bed:
    • Smile and say, "Good morning. It's a nice day today. Come on; let's go have pancakes / breakfast."
    • Say that you'll help the person freshen up and look his/her best.
    • Ask for your loved one's help setting the table for breakfast.
    • Ask the person to help you get the mail.
    • Phone a favorite grandchild together.
    • Invite the person to watch his/her favorite TV show – have a video tape or DVD of the show ready to watch – or to listen to the radio.
    • If your care receiver still refuses to budge, play his/her favorite music and try again later.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: