Caring for someone with a physical disability and a cognitive impairment can often present unique complex challenges for both the person you care for and for you as their carer. It might include supporting them with their physical needs, navigating challenges with communication or dealing with unpredictable behaviours, as well as trying to manage your own wellbeing. If you are caring for someone with a physical disability and they have a cognitive impairment, or their cognitive abilities seem to be declining over time, there is support available, and our article walks you through some general points to consider if this is your experience right now.
What is a physical disability?
A physical disability is a condition which affects someone’s mobility, coordination, energy level and ability to carry out certain tasks. It might have existed from birth, developed over time or been caused by an injury. There is more in-depth information in our introduction to caring for someone with a physical disability.
What is a cognitive impairment?
When someone has a cognitive impairment, it means that they struggle with certain mental processes. Whilst everyone’s experience will be unique, living with a cognitive impairment might mean they experience difficulties with remembering things or paying attention for a sustained length of time. Someone might struggle to recognise people, places or objects, and find it hard to have conversations or communicate clearly. Someone who has a cognitive impairment may find that experiencing unfamiliar people, places and situations (or people, places and situations that they perceive to be unfamiliar) can be disorientating. They may become confused, fearful and frustrated, which in turn could affect their behaviour.
Certain conditions which may result in a physical disability and cognitive impairment include brain injury, cerebral palsy, stroke and dementia.
There are also some conditions which result in a temporary impairment like an infection, vitamin deficiency or the effects of certain medications. A cognitive impairment can also make completing day to day tasks challenging, and for someone who already has a physical disability this can add to their confusion; they may forget they are unable to walk or do certain actions, understand important instructions or be able to communicate pain. They are also often more likely to fall and so sustain more injuries.
If you are caring for someone with a physical disability and a cognitive impairment, you may find that they struggle to understand how they developed their physical disability, or what their disability is. They might not be aware of their own needs or the ways in which they might need support.
Caring for someone with a physical disability and cognitive impairment
The specifics of your caring role will of course vary depending on the individual needs of the person you are caring for, their cognitive condition and the severity of their physical disability. In general, you may be offering practical support with daily activities such as personal care, administering medications, eating and drinking, and helping them to move around. Depending on their cognitive impairment, you may also be supporting them to communicate their needs, reassuring them when they become confused, or acting as their advocate in certain situations.
Monitoring any changes and reporting those to your medical and social care team will also form an important part of your role, ensuring that the provision and support you both receive continues to meet your needs as they evolve.
If you know that the cognitive impairment of the person you care for is likely to deteriorate, or if they are coming to the end of their life, talking with them as openly as possible about what is happening and what they want regarding their health care, finances and end of life care will be something to consider.
Whilst they still have capacity (the ability to make decisions for themselves) you can support the person you care for to make plans and decisions about their needs and future care wishes. You can also be named as a ‘proxy’ with power of attorney to speak on their behalf and ensure any advanced decisions are carried out.
Promoting the independence of someone with a physical disability and cognitive impairment
When thinking about helping someone with a physical disability or cognitive impairment to remain in their home, you may consider modifying their living space to enhance accessibility, considering ramps, handrails, and wider doorways for wheelchair access. You might also consider installing safety features like grab bars and non-slip flooring to help prevent accidents.
Mobility aids such as walking frames and smart canes can also enhance someone’s independence, and there are lots of assistive technologies available now that can be tailored to the cognitive abilities of the person you care for, from voice-controlled devices to sip-and-puff controls for your computer, and reminder apps and electronic calendars that can help manage daily routines and appointments. Our articles on home adaptations and equipment may be useful to read on this.
Someone with a cognitive impairment can sometimes forget where they are and be more vulnerable to getting lost; a medical bracelet or necklace containing their vital information is a simple and highly effective way to communicate who they are and their medical needs in the event of an emergency.
Maintaining a structured daily routine, whilst still allowing enough room for flexibility to adapt to changes in their energy levels and cognitive function, can be very useful in providing a sense of stability and predictability for someone with cognitive impairment.
It can also be beneficial to explore ways to involve them in practical tasks. To enable them to achieve this, they may need tasks to be broken down into manageable steps, using simple, clear language, visual aids and non-verbal cues to assist with understanding.
Understanding and managing behaviour that feels challenging
When someone has difficulty communicating or doesn't understand what is happening for them, they may feel frustrated, frightened or angry, and use certain behaviours to indicate their needs or how they are feeling. If the person you care for has a cognitive impairment, it can often lead to behaviour that feels very challenging to you as their carer at times. Perhaps they forget your name, ask you the same question many times, or use language that sounds unusual, inappropriate or crude. Whilst this can be extremely difficult and upsetting, understanding that this behaviour is not personal and that they are not intentionally meaning to provoke you can be a helpful first step.
In these situations, you may need to support the individual to deescalate the situation. This might be by offering them the answers they need, even if they have had these answers before, or allowing them to be ‘right’ to avoid further confusion or conflict. You can also support the person you are caring for to remain as relaxed as possible by keeping their surroundings calm, with their familiar objects in the same places, and supporting them to enjoy activities they like, like listening to soothing music, walking in the garden or gently stroking their hand.
Having a plan in place to support you both if things feel unmanageable is also important, so as well as talking to your medical and social care team about helpful strategies to deal with the everyday challenges, ensure you have the details on who to call if ever you need extra help or there is an emergency.
Accessing the right support to ensure your needs are met
It is important that both you and the person you care for are receiving the support you need. Individuals with complex needs require both physical and cognitive support, which can change and deteriorate over time. It is therefore necessary to ensure that their health is checked regularly. Their GP, health visitor or medical team are the first people to talk to if you feel their needs have change you want help and advice tailored to a specific situation. To ensure you’re able to access the most relevant support to help you care for the person you care for you might also find it helpful to request a Needs Assessment for the person you care for and a Carer's Assessment for you.