Mobility & Transfers
A Deep-Dive Explanation for Supporting Dementia

What “Mobility” Actually Means in Dementia Care

Mobility refers to the person’s ability to move their body safely and confidently through space, including:

• Standing up from any surface

• Sitting down with balance and stability

• Turning or adjusting their posture

• Walking short or long distances

• Getting into or out of bed

• Moving onto or off a toilet or shower seat

• Stepping over thresholds or navigating stairs

• Reaching, bending, or shifting weight

For dementia caregivers, mobility is not just physical.
It’s mental, emotional, environmental, and relational.

Mobility is tied to:

• Independence (the person’s sense of identity)

• Safety (fall prevention)

• Dignity (preserving function)

• Emotional security (trusting the caregiver)

• Health (preventing pressure sores, stiffness, decline)

When mobility becomes harder, the person may feel scared, powerless, or embarrassed.
Understanding mobility deeply helps the caregiver avoid misinterpretations like:

• “They’re being stubborn.”

• “They don’t want to help themselves.”

• “They’re acting difficult.”

These reactions are symptoms, not personality traits.

How Dementia Changes the Brain’s Relationship With Movement

Dementia affects multiple brain systems responsible for mobility, including:

1. The Balance System (Vestibular Function)

The brain has trouble knowing where the body is in space.
Effects:

• Leaning too far forward or backward

• Wobbling

• Taking short, hesitant steps

• Fear of starting a movement

2. Depth Perception

The person misjudges height, distance, lighting, shadows, and flooring patterns.
Effects:

• Thinking a dark rug is a hole

• Believing shiny floors are slippery

• Feeling stairs look “steeper”

• Freezing at thresholds or doorways

3. Memory and Motor Planning (Apraxia)

The brain forgets how to perform movement steps in order.
Effects:

• Sitting when asked to stand

• Standing when told to sit

• Unable to coordinate feet and hands together

• Needing much more time to respond to instructions

4. Body Awareness (Proprioception)

The person doesn’t fully sense where their legs, hands, or feet are positioned.
Effects:

• Missing the chair while sitting

• Placing feet unevenly

• Misjudging steps

• Feeling unsteady during standing

5. Emotional Regulation

Emotions become more intense while the ability to understand them decreases.
Movement triggers fear faster.
Effects:

• Panic

• Clinging

• Refusal

• Sudden yelling

• Crying

• Freezing

Here is a direct breakdown of what causes a behavior and what outcome it creates, so a caregiver can identify issues instantly

Scenarios: These are teachable stories

Scenario 1: The “I Can’t Stand Up” Moment

Mrs. L is asked to stand from her recliner.
She pushes but immediately falls backward into the chair and looks terrified.

What most caregivers assume:
“She’s weak.”
or
“She’s not trying.”

What’s actually happening:
Her brain cannot coordinate the steps of:

• Leaning forward

• Weight shifting

• Pushing through the legs

Her fear takes over before her body moves.

Correct caregiver response:
The caregiver kneels in front of her and says:
“Let’s do this slowly together. Scoot forward first… good. Now lean toward me… perfect. On three, we stand.”

Outcome:
She stands on the first try.
Not because her body suddenly improved —
but because her fear decreased and her brain was guided step-by-step.

Scenario 2: The “Freezing at the Doorway” Situation

Mr. D walks confidently until he reaches the hallway.
He suddenly stops and refuses to move, clutching his walker.

Possible misinterpretations:

• “He’s being stubborn.”

• “He doesn’t want to go.”

Actual cause:
The darker shade of flooring in the hallway looks like a step down.
His brain believes he will fall.

Correct caregiver approach:
The caregiver steps onto the hallway floor first and says:
“Watch my feet. The floor is even. It’s safe.”
She moves slowly so he has time to process visually.

Outcome:
He begins walking again once he sees the floor is safe for her.

Scenario 3: The “Why Are They Pacing?” Mystery

Mrs. B has walked 12 laps around the living room.
A caregiver may worry she is agitated or trying to leave.

Actual causes may include:

• Searching for someone from her past

• Reliving old routines

• Restlessness from anxiety

• Understimulation

• Needing the bathroom

• Feeling unsure of the environment

Correct caregiver approach:
Walk beside her and ask:
“Are we looking for something?”
She replies, “My mother.”
The caregiver responds:
“You miss her. Tell me about her.”

Outcome:
Her pacing slows.
She feels safe and emotionally met.

Scenario 4: The “I’m Going to Fall!” Panic

Mr. R begins shaking halfway through a transfer.
He clings tightly and says: “I’ll fall, I’ll fall!”

Cause:
The movement felt too fast or unexpected.
His brain immediately sounded the “danger” alarm.

Correct caregiver approach:
Slow everything down.
Make eye contact.
Say:
“You’re safe. I won’t let you fall. Let’s pause for a moment.”

Outcome:
His fear drops.
He completes the transfer safely.

Understanding Constant Movement in Dementia

Pacing • Wandering • Walking Without Purpose • Repetitive Movement

What Constant Movement REALLY Means

Constant movement—including pacing, walking in circles, repeatedly getting up, or checking doors—is communication, not “wandering” or “misbehavior.”

The person is expressing something their brain can’t put into words.

Constant movement is a message.
Your job as the caregiver is to interpret it safely.

Why People With Dementia Move Constantly

There are 8 major reasons, all rooted in brain changes:

1. Internal Restlessness

The nervous system becomes hyperactive.
Movement lowers the discomfort they can’t explain.

Effect:
They walk constantly, unable to settle in chairs or beds.

2. Emotional Dysregulation

They may feel uneasy, worried, or scared without knowing why.

Effect:
Movement helps release emotional tension.

3. Memory Loops

The brain retrieves old routines, tasks, or habits.

Examples:

• “I need to go to work.”

• “I need to pick up the kids.”

• “I’m supposed to check the oven.”

These are deeply ingrained procedural memories.

Effect:
They walk with purpose — even if the purpose is outdated.

4. Searching for Something Familiar

They may feel lost in their own home.
The brain says:
“Find something recognizable.”

Effect:
They open doors, drawers, closets, or walk hall to hall.

5. Physical Discomfort

Pain or discomfort triggers movement because sitting still increases it.

Examples:

• Constipation

• Hip/knee/foot pain

• Hunger

• Needing the bathroom

• Clothing too tight

Effect:
They walk because their body is asking for relief.

6. Sensory Needs

Movement regulates the sensory system.

Effect:
Walking helps them feel grounded and “in their body.”

7. Understimulation or Boredom

If the environment offers little stimulation, the brain creates its own activity.

Effect:
They walk because there’s nothing else to engage with.

8. Anxiety From Unpredictability

If the environment or routine feels unsafe, movement becomes safety-seeking behavior.

Effect:
They stay on the move to stay in control.

Scenarios: These are teachable stories

⭐ Scenario 1: The Repetitive Hallway Walk

Mr. P walks from the living room → hallway → back → repeat.
His daughter thinks he's “wandering for no reason.”

Caregiver observation:
He keeps touching his stomach slightly.

Correct interpretation:
This might signal discomfort, constipation, hunger, or bathroom needs.

Caregiver approach:
Walk beside him and ask gently:
“Do you need the bathroom or a snack?”

He says, “Bathroom.”
Once he goes, the pacing decreases dramatically.

Lesson:
Movement expressed a physical need.

⭐ Scenario 2: The “Looking for Work” Loop

Mrs. N keeps checking the front door with urgency.

Family assumes:
“She’s trying to leave the house.”

Actual cause:
She used to leave for work through that same door every morning for 40 years.
Time-of-day triggers the routine.

Caregiver approach:
Stand beside her and say:
“Work called—you’re off today. But I could use help folding these towels.”

This replaces her need to act with a safe, purposeful task.

Lesson:
Old routines live long after memory fades.

⭐ Scenario 3: The Unsafe Scatter-Walk

Mr. J keeps standing up and sitting down repeatedly.
He looks anxious, hands shaking.

Possible misinterpretation:
“He won’t stay put!”

Actual cause:
Internal anxiety is peaking.

Caregiver response:
Sit next to him (NOT in front).
Offer your hand slowly.
Say:
“I’m right here. Let’s take a breath together.”

His breathing slows, and the getting up stops.

Lesson:
Anxiety was communicating through movement.

⭐ Scenario 4: The “I’m Lost in My Own Home” Loop

Mrs. T wanders room to room and says: “Where is everyone?”

Cause:
Disorientation + emotional insecurity.

Caregiver approach:
Never say “You’re in your own home.”
Instead say:
“Let’s sit together for a minute. You’re not alone—I’m right here.”

Her wandering slows because her emotional need is finally met.

Lesson:
Movement expresses fear of being alone or confused.

Anxiety and Agitation

https://www.alz.org

How Caregivers Should Respond to Constant Movement

✔ Walk WITH them, not against them

Joining them communicates safety and partnership.

✔ Never force them to sit “because they’re tired”

Their brain may need movement to cope with internal distress.

✔ Ask supportive questions

• “Are we looking for something?”

• “Would you like company?”

• “Are you comfortable?”

• “Do you want water or the bathroom?”

✔ Check for physical needs

Most pacing is rooted in unmet needs.

✔ Create a safe walking route

Clear hallways, stable furniture, good lighting.

✔ Offer meaningful redirection

Folding towels, wiping tables, looking at photo books — safe “purposeful tasks.”

✔ Validate their emotional world

Never dismiss or correct their reasons for walking.

Recognizing and Responding to Fear of Falling

What Fear of Falling REALLY Is

Fear of falling in dementia is not a simple fear —
it is a full-body, full-brain warning alarm that activates instantly, often without clear cause.

To the person, the fear is REAL, intense, and physical.

The brain’s “safety system” struggles to judge balance, height, and stability, so it overreacts to protect the person.

This fear drives MOST mobility problems in dementia care.

How the Brain Creates Fear of Falling

1. Misjudged Distance

The brain cannot correctly interpret how far the floor or chair is.

Effect:

• Refusing to stand or sit

• Grabbing tightly

• Sudden dropping into chairs

2. Misinterpreted Vision

Depth perception declines.

Effect:

• Carpet = hole

• Tile = cliff

• Threshold = step

• Shower floor = slippery danger

• Black mat = pit

3. Loss of Balance Awareness

The brain can’t feel whether the body is stable.

Effect:

• Leaning backward suddenly

• Clutching the caregiver

• Panicking mid-step

4. Past Falls Stored as Trauma

The body remembers danger, even if the mind forgets the event.

Effect:
Strong freeze or panic response whenever movement is expected.

5. Overwhelmed by Instructions

The person can’t process multiple steps at once.

Effect:

• Freezing

• “No!” responses

• Panic

• Refusal

6. Caregiver Moves Too Quickly

Fast motions are interpreted as threats.

Effect:

• Flinching

• Clinging

• Fear spike

• Resistance

HOW TO RECOGNIZE FEAR OF FALLING INSTANTLY

Common signs include:

• A sudden halt or freeze

• Widened eyes

• Shallow breathing

• Repetition of “Wait, wait!”

• Reaching for walls/furniture

• Leaning backward

• Grabbing caregiver tightly

• Whimpering or crying

• Shaking knees

• Saying “Don’t let me fall!”

• Refusing to move

Remember:
Fear is not defiance. Fear is protection.

Scenarios: These are teachable stories

⭐ Scenario 1: The Transfer Panic

Mrs. C needs to stand from her recliner.
When the caregiver begins the transfer too quickly, Mrs. C screams, “STOP!”

What’s happening internally:
Her brain lost track of where her body is.
Standing felt like falling.

Correct caregiver approach:
The caregiver pauses and kneels to her eye level:
“We’re not rushing. You’re safe. Let’s breathe together.”
Then:
“First we wiggle forward… good. Now lean your chest toward me.”

Outcome:
Her fear decreases.
She stands successfully — not because she got stronger, but because she felt safe.

⭐ Scenario 2: The Bathroom Threshold Freeze

Mr. L stops at the bathroom door and refuses to enter.

Cause:
Bathroom tile is shiny — his brain sees it as slippery or wet.

Incorrect response:
“Come on, it’s not slippery.”

Correct response:
Step onto the bathroom tile yourself and say:
“Look, it’s safe. I’ll go first and hold your hand.”

You demonstrate slowly — giving his brain confidence.

Outcome:
He follows safely.

⭐ Scenario 3: The Sudden Backward Lean

Mrs. U leans backward every time someone tries to help her stand.

Cause:
Her brain senses she is falling forward, even when she isn’t.

Correct caregiver approach:
Place one hand on her upper back (not pulling — just reassuring),
and say:
“I’ve got your back. Lean forward with me… nose over toes.”

Outcome:
She shifts weight safely because the fear center in her brain feels supported.

⭐ Scenario 4: The Walker Panic

When walking, Mr. S keeps saying, “I’m slipping! I’m slipping!” even though the floor is clean and dry.

Cause:
His brain misreads floor texture OR he feels dizzy from medications.

Correct caregiver approach:
Slow the pace.
Place your hand near his elbow (not gripping).
Say:
“You’re steady. I’m right beside you. Let’s take slow steps.”

Outcome:
His panic decreases and walking becomes smoother.

HOW TO RESPOND TO FEAR OF FALLING

✔ Slow everything down

Fear drops as speed decreases.

✔ Validate the fear

Invalidating fear increases panic.
Say:

• “I know this feels scary.”

• “I’m right here.”

• “We’ll do this together.”

✔ Use one clear step at a time

The brain needs simple, predictable direction.

✔ Approach from the front

Unexpected touch increases fear.

✔ Create stability with your posture

Your body must look balanced and calm.

✔ Let the person hold YOU (not the other way around)

It increases their sense of control.

Fall Mitigation: Creating a Safe, Predictable Environment

Why Falls Happen in Dementia

Falls are rarely caused by weakness alone.
They happen because the environment becomes confusing to the brain.

A person with dementia may misinterpret:

• Shadows

• Patterns

• Carpets

• Steps

• Reflections

• Furniture positioning

This creates huge fear spikes and hesitation during movement.

Environmental Triggers That Increase Fall Risk

1. Poor Lighting

Dim areas create shadows that look dangerous.

2. Sudden Light Changes

Bright → dim = disorientation
Dim → bright = overwhelm

3. Floor Pattern Changes

Dark → light flooring looks like a step.

4. Clutter

Shoes, papers, cords, pet toys all become hazards.

5. Loose Rugs

Even a tiny corner lifted ¼ inch can cause trips.

6. Noise

Sudden noise causes the person to stop or turn suddenly.

7. Furniture Rearrangement

The brain relies heavily on routine; changes cause confusion.

Scenarios: These are teachable stories

⭐ Scenario 1: The Hallway Shadow

Mrs. Y refuses to walk down the hallway.

Cause:
A dark shadow falls across the middle of the floor — her brain sees it as a hole.

Correct caregiver approach:
Turn on lights.
Stand in the shadow and say:
“It’s solid — look, I’m standing on it.”
Walk slowly across it.

Outcome:
She follows with confidence.

⭐ Scenario 2: The Invisible Pet Hazard

Mr. K walks carefully because he senses something underfoot.

Caregiver observes:
A small dog toy is half under the couch.

Correct response:
Remove all small objects from his walking path daily.

Outcome:
His gait speeds up because he trusts the flooring again.

⭐ Scenario 3: The Furniture Rearrangement Issue

Mrs. Q almost falls near the kitchen.

Cause:
Her son moved the table two feet to the left.
Her brain expected it to be where it always is.

Correct approach:
Restore predictable pathways.
Never rearrange furniture without reason — predictability = safety.

⭐ Scenario 4: The Doorway Freeze (Again, But From Environment)

Mr. L stops at every doorway at night.

Cause:
Light inside room is off → doorway looks like a black square.

Correct caregiver strategy:
Use nightlights or leave the door cracked with gentle lighting.

Outcome:
Doorways feel safe again.

What Caregivers MUST Do to Prevent Falls

✔ Daily clear pathways

Morning and evening walk-throughs.

✔ Strong lighting

Bright, even, warm lighting in every area they move through.

✔ No loose socks or slippers

Only closed-back shoes with traction.

✔ Predictable environment

Same furniture. Same pathway. Same walker placement.

✔ Bathroom safety

Grab bars, nightlights, non-slip mats.

✔ Slow-paced movement

Fast movement = higher fall risk.

✔ Check for fatigue

Tired legs fall quickly.

SECTION 4 Summary

Caregiver must know:

• Common environmental hazards

• How dementia changes perception of flooring and shadows

• How lighting affects mobility

• How consistency reduces falls

• Why rearranging furniture is unsafe

• Practical daily safety steps

⭐ SECTION 5

Supporting Safe Transfers

Standing • Sitting • Bed Mobility • Toilet Transfers • Shower Transfers

Why Transfers Are Difficult in Dementia

Transfers look simple to an observer, but to a person with dementia, a transfer is actually multiple complicated steps, all of which require:

• Balance

• Weight shifting

• Depth perception

• Muscle coordination

• Memory of how to move

• Understanding instructions

• Emotional confidence

• Trust in the caregiver

Dementia affects every single one of these ingredients.

This means transfers must be:
slow, predictable, steady, guided, and broken into tiny parts.

How The Brain Interferes With Transfers

1. The brain cannot break tasks into steps.

Transfers feel like a single lump of “movement,” which is overwhelming.

Effect:
The person feels panicked, confused, or stuck.

2. The person cannot feel where their body is positioned.

They may not know if they are leaning too far or too little.

Effect:

• Leaning backward

• Falling forward

• Sitting too early

• Standing too fast

3. Fear becomes physical resistance.

If the brain senses danger, muscles tense automatically.

Effect:

• Pulling back

• Gripping

• Refusing to move

• Sudden sitting

4. Misinterpreted vision impacts decision-making.

Transitional surfaces look unsafe.

Effect:

• Freezing

• Saying “No!”

• Stepping incorrectly

⭐ THE GOLDEN TRANSFER TECHNIQUE

“Nose Over Toes”

This is the MOST important rule for safe standing.

To stand safely, the person must:

• Scoot forward

• Bend at the waist

• Bring nose forward over knees

• THEN push up

If their torso stays upright, balance is impossible.

The 4-Step Transfer Method (Simple + Dementia-Friendly)

Step 1: Prepare the Surface and Body

• Check shoes

• Ensure walker is in place if needed

• Remove clutter

• Turn on lighting

Step 2: Explain BEFORE touching

Use one-step instructions:
“Let’s scoot forward.”
“Now bring your chest toward me.”

Step 3: Create stability with your stance

• Feet shoulder width apart

• One foot slightly behind

• Arms at mid-back or trunk, NOT pulling arms

Step 4: Rise together

Say:
“On three… 1… 2… 3…”
Stand slowly and steadily.

Scenarios: These are teachable stories

⭐ Scenario 1: The “Falling Back” Stand Attempt

Mrs. E tries to stand and drops back into the chair.

Cause:
Her torso didn’t lean forward enough (no “nose over toes”).

Correct caregiver approach:

• Gently place your hand on her upper back

• Say:
  “Lean toward me… good… now we stand together.”

Outcome:
She stands safely because weight has shifted forward.

⭐ Scenario 2: The Bed Transfer Freeze

Mr. J sits on the edge of the bed but won’t stand.

Cause:
Multiple steps at once feel overwhelming.

Correct caregiver approach:
Break it down:
“Feet flat on the floor.”
(wait 3 seconds)
“Scoot to the edge.”
(wait 2 seconds)
“Lean forward.”
(wait 2 seconds)
“Now we stand together.”

Small steps → Big success.

⭐ Scenario 3: The Toilet Transfer Terrified Response

Mrs. C stiffens and shakes when asked to stand from the toilet.

Cause:
Toilets are low, transfers feel unstable, bathroom echoes feel sharp.

Correct caregiver response:

• Place hand on her shoulder

• Say slowly:
  “I’m right here. We’ll go slowly.”

• Encourage forward lean

• Stand together on a count

Outcome:
Fear drops → control returns.

⭐ Scenario 4: The Shower Transfer With Sudden Resistance

Mr. S refuses to step into the shower stall.

Cause:
Shiny tile looks slippery.
Water sound triggers sensory overload.

Correct approach:

• Turn water DOWN

• Dry the floor in front of him

• Show your own foot stepping inside:
  “See? It’s dry and safe.”

Outcome:
He accepts movement once the environment feels trustworthy.

 Managing Anxiety and Building Trust During Movement

Why Anxiety Is So Intense in Dementia

People with dementia feel emotions more strongly while having fewer tools to understand or express them.

Movement adds pressure because:

• They don’t know what their body will do

• They feel vulnerable

• They rely on someone else for balance

• Instructions feel confusing

• Environments feel unpredictable

Anxiety becomes visible through the BODY.

Common Signs of Anxiety in Mobility

• Repeating “no”

• Pulling away

• Tight grip on clothing/furniture

• Panicked breathing

• Eyes darting around

• Sudden yelling or crying

• Leaning backward

• Refusing to move

• Body stiffening

• Sweating or trembling

These are NOT behavioral issues — they are fear responses.

How to Lower Anxiety During Mobility Tasks

✔ 1. Slow Your Pace Dramatically

Your slowness creates their safety.

✔ 2. Use a Warm, Calm Tone

Soft tones help regulate their nervous system.

✔ 3. Validate Feelings (Not Facts)

Never say “You’re fine” or “Don’t be scared.”
Instead say:

• “I know this feels scary.”

• “I’ll stay right beside you.”

• “We’ll go slowly.”

Validation lowers fear immediately.

✔ 4. Clarify Each Step

Overwhelm happens when instructions are too complex.

Break everything down:
“Stand.” → WRONG
“Scoot forward.” → pause → “Lean toward me.” → pause → “Now stand.” → CORRECT

✔ 5. Use Predictable Touch

Touch that is announced and slow increases trust.

✔ 6. Allow the Person to Control Pace

If they freeze, YOU freeze.
If they breathe fast, YOU breathe slower.

Scenarios: These are teachable stories

⭐ Scenario 1: The Sudden Panic Sit

Mr. K begins standing but suddenly sits down hard, shaking.

Cause:
He panicked mid-transfer because it felt too fast.

Correct caregiver approach:

• Sit beside him

• Softly say:
  “That felt too fast. Let’s take more time.”

• Help him reset

• Restart slower

Outcome:
Fear releases → cooperation increases.

⭐ Scenario 2: The Bathroom Crying Episode

Mrs. Y cries every time she approaches the bathroom.

Cause:
Bathrooms are overwhelming: echo, slippery tile, bright lights.

Caregiver approach:

• Dim one light

• Turn fan off

• Approach slowly

• Say:
  “I’ll stay with you the whole time. You’re not alone.”

Outcome:
Her crying decreases and trust increases.

⭐ Scenario 3: The Angry Reaction

Mr. T shouts, “Leave me alone!” when the caregiver touches his arm to walk.

Cause:
Touch came too suddenly, triggering fear.

Correct response:
Step back slightly, soften the voice:
“May I help you up? I’ll move slow.”

Outcome:
Anger dissolves once he feels control and consent.

⭐ Scenario 4: The Silent Overwhelm

Some anxiety is silent: stiff posture, shallow breathing, wide eyes.

Cause:
Too many instructions at once.

Caregiver approach:
Switch to ONE simple instruction.
“Let’s take one step.”

Outcome:
The brain calms because demands decrease.

⭐ SECTION 7

Caregiver Body Language, Tone, and Pace

The Non-Verbal Skills That Make or Break Every Transfer

Why Non-Verbal Skills Matter So Much

People with dementia rely far more on tone, posture, facial expression, and movement than on words.

Your body communicates safety — or danger.

Before the person understands what you SAY,
they understand what you FEEL.

The Non-Verbal Elements That Matter Most

1. Pace

Move at half your normal speed.
Slower movements = less fear.

2. Voice Tone

Speak:

• Low

• Warm

• Soft

• Steady

• Encouraging

Tone tells the brain:
“This is safe.”

3. Facial Expression

Never underestimate the power of a gentle smile.
Soft eyes lower tension.

4. Body Positioning

Always approach from the front.
Never grab from behind.

5. Predictability

All movement must be:

• Announced

• Slow

• Repetitive in method

• Familiar

6. Consistent Posture

Relaxed shoulders, steady feet.
Your stability becomes their stability.

Scenarios: These are teachable stories

⭐ Scenario 1: The Rushed Caregiver

The caregiver hurries toward Mrs. D saying, “Let’s go, we’re late!”

Effect:
Mrs. D panics, pulls away, and refuses to walk.

Correct approach:
Slow steps.
Soft voice:
“We have time. I’ll help you gently.”

Her body relaxes.

⭐ Scenario 2: The Comforting Approach

Mr. W looks nervous before standing.

Caregiver:

• Slows her breathing

• Softens her face

• Holds out her hand palm-up

• Says:
  “I’ll stay right with you.”

Outcome:
He stands confidently.

⭐ Scenario 3: The Touch Without Warning

The caregiver places a hand on Mrs. K’s back suddenly.

Effect:
She jumps and shouts, “Don’t touch me!”

Correct approach:
Announce first:
“I’m going to place my hand on your back for support.”
Then move slowly.

⭐ Scenario 4: The Towering Stance

A caregiver stands over Mr. H, towering above him.

Effect:
He feels threatened, becomes stiff.

Correct approach:
Caregiver kneels to eye level.
“I’m right here with you.”

He relaxes immediately.

⭐ SECTION 8

Fatigue, Pain, and Medical Factors Affecting Mobility

Why Physical Discomfort Impacts Mobility So Strongly

People with dementia often cannot articulate:

• “My hip hurts.”

• “My foot is sore.”

• “I’m dizzy.”

• “I feel weak.”

• “I didn’t sleep well.”

Instead, they express discomfort through behavior, especially during movement.

Common Physical Issues That Impact Mobility

1. Pain

Arthritis, back pain, hip pain, foot pain.

2. Fatigue

Little sleep = weak muscles and poor balance.

3. Medication Side Effects

Dizziness, low blood pressure, unsteadiness.

4. Illness

UTIs, dehydration, constipation, infections.

5. Muscle Weakness

From activity decline or illness.

6. Foot Problems

Corns, bunions, swelling, poor footwear.

Scenarios: These are teachable stories

⭐ Scenario 1: The Refusal to Stand

Mrs. F refuses to get out of her recliner.

Observation:
She rubs her knee repeatedly.

Cause:
Arthritis flare.

Correct caregiver approach:
Move slower, support her more, offer rest breaks, document pain.

⭐ Scenario 2: The Sudden Mobility Decline

Mr. S was walking normally yesterday but is unsteady today.

Cause:
Possible UTI or dehydration.

Correct action:
Observe symptoms → report → encourage fluids → move carefully.

⭐ Scenario 3: The Fatigue Wobble

Mrs. T barely slept overnight.
Today she leans heavily.

Cause:
Extreme fatigue decreases balance.

Correct approach:

• Offer sitting tasks

• Slow walking

• Frequent rest

• No long transfers

⭐ Scenario 4: The Foot Pain Shuffle

Mr. L begins shuffling feet and refuses shoes.

Cause:
Foot swelling or pain.

Correct approach:
Inspect feet, change footwear, notify team/family.