The challenge of maintaining supplemental oxygen on a person with dementia is a common difficulty for caregivers, balancing the necessity of life-sustaining treatment with the patient’s confusion or agitation. Dementia affects memory, reasoning, and perception, meaning a person may not understand why a foreign object is being placed near their face, leading to attempts to remove it. This resistance is rarely willful disobedience but rather an instinctive reaction to discomfort or misunderstanding. Low oxygen levels can worsen confusion and stress on the heart and lungs, making continuous oxygen therapy important.
Understanding Resistance to Oxygen Therapy
Resistance to oxygen delivery devices stems from a combination of sensory discomfort and cognitive inability to process the equipment’s purpose. The tactile sensation of the nasal cannula or mask against the skin is often perceived as an irritating foreign object. This discomfort can be exacerbated by the drying effect of oxygen flow on the delicate mucous membranes of the nose, causing irritation.
A person with dementia may have no recollection of why they need the oxygen, making the device seem like an unnecessary restraint. When the device is removed, the resulting shortness of breath or anxiety is not linked back to the missing oxygen, reinforcing the desire to keep the device off. This confusion can lead to increased agitation, especially during periods of “sundowning” or restlessness.
For many, the physical presence of a mask or tubing can trigger feelings of claustrophobia or fear of confinement. They may misinterpret the equipment as a threat or an attempt to restrict their movement. Understanding these root causes—sensory, cognitive, and emotional—is the foundation for implementing successful strategies.
Environmental and Communication Strategies
Effective care begins with validating the patient’s feelings rather than arguing about the need for the device. Acknowledge that the cannula or mask is annoying or uncomfortable, which validates the patient’s reality without agreeing to remove the oxygen. Use a calm, slow, and reassuring tone of voice, maintaining gentle physical contact to convey safety and trust.
Distraction is a powerful tool to redirect attention away from the oxygen device and onto a more pleasant activity. Try engaging the patient with familiar, simple activities such as listening to favorite music, looking through old photo albums, or watching a beloved, non-agitated television program. The goal is to occupy the hands and mind during the initial application and for a period afterward.
Timing the application of oxygen during periods of natural calm can greatly increase compliance. Introducing the device when the person is already relaxed, such as after a meal or during an established rest time, can reduce the likelihood of resistance. Establishing a simple, predictable daily routine helps to lower overall anxiety, which in turn makes the oxygen application less likely to be perceived as a sudden, startling event.
Practical Solutions for Securing Delivery Devices
Selecting the right delivery mechanism can significantly improve tolerance and retention. Soft, specialized nasal cannulas with cushioned ear loops or cheek pads are generally more comfortable than stiff plastic tubing. If a mask is necessary, choosing a model with a soft, pliable seal and a lightweight design can minimize the feeling of a heavy, confining object.
To physically secure the device without resorting to restraints, various gentle methods exist. Specialized headgear or soft straps are available that wrap around the head and anchor the cannula or mask more securely than standard tubing. If gentle taping is used, apply non-irritating, fabric-based medical tape to points away from the face, such as securing the tubing behind the ears or on the cheekbone, after consulting with a healthcare professional.
Managing the lengthy tubing is also important, as loose cords can become a hazard or a focus for agitation. Consider using retractable oxygen tubing reels, which automatically manage the excess cord length and reduce the risk of tripping and entanglement. Running the tubing discreetly under a blanket or loosely tucked into clothing can help camouflage the line, making it less visible and less likely to attract the patient’s attention.
Safety Measures and Recognizing Urgent Needs
The presence of supplemental oxygen in the home elevates the risk of fire, as oxygen vigorously feeds combustion. All open flames, including candles, cigarettes, and gas stoves, must be kept at least ten feet away from the oxygen equipment. Caregivers should post “Oxygen In Use” signs prominently and inform the local fire department.
A highly specific fire hazard involves the use of petroleum-based products like petroleum jelly or oil-based lotions. These substances are combustible and can ignite intensely when exposed to concentrated oxygen, even from a small spark. Only use water-based lubricants or moisturizers on the lips, nose, or skin near the oxygen delivery system to prevent this serious risk.
Caregivers must be vigilant in recognizing signs that the patient’s underlying condition is worsening or that oxygen removal has caused an acute medical emergency. Signs of severely low oxygen levels, known as hypoxemia, include a sudden increase in confusion, blue discoloration of the lips or nail beds (cyanosis), or a rapid, labored breathing pattern. If these signs appear, or if the patient is unable to speak more than a few words without gasping, immediate medical attention is necessary.