How do you make someone with dementia happy?

The best-known version of this list comes from the psychologist Tom Kitwood, whose model of five needs behind wellbeing in dementia, comfort, attachment, inclusion, occupation and identity, sits behind the principles of person-centred care that the NICE guideline for dementia asks every carer to follow: seeing a person's individuality, their life history and their relationships, rather than a set of symptoms to be managed.

None of these needs is met by a single grand gesture. They are met, or missed, dozens of times over an ordinary day, in how a question gets answered, whether the same face turns up for the morning wash, or whether there is a small job waiting to be done.

Identity is worth a word of its own, because it is easy to think there is little you can do about it once someone struggles to follow a conversation. Reminiscence, talking through old photographs, a former job, a wedding, or children when they were small, works on this need directly. It does not rely on short-term memory, so it can still reach somebody whose memory of yesterday has gone, and for a few minutes it can put them back in the position of an expert on their own life rather than someone being asked questions they cannot answer. 37 activities for someone with dementia has a fuller list of ways to bring the past into a conversation. The sections below go through what the rest of this looks like in practice, starting with the routine that holds the day together.

If the harder part of the day is consistently the evening, read what is sundowning: agitation that builds as daylight fades has a name, and a routine of its own that tends to help.

One approach, sometimes called validation, answers the feeling behind a statement rather than correcting the statement itself. If your relative asks for a parent who died years ago, telling them the truth again can cause the same grief every time, while asking what that parent was like, or saying they will be along soon, often settles the moment without a fresh loss. A Cochrane review of validation therapy found the trials done so far are too few and small to prove it works, but reassurance over argument is consistent with the Alzheimer's Society's own guidance on communicating with someone with dementia, which asks families to keep their voice, face and posture calm and matched to what they are saying, because tone reaches somebody who has lost the meaning of the words.

A task does not need to be significant to work. Folding washing, laying a table or watering a plant give a sense of having done something useful, and the NICE guideline on dementia recommends offering activities such as gardening, baking, music and reminiscence for exactly this reason, tailored to what a person still enjoys rather than run as a fixed programme. Music is one of the easiest of these to set up in advance: a playlist of songs from the years your relative remembers best, put together once and played on request, can settle somebody who is agitated within a few minutes, and it needs no supervision once it exists. 37 activities for someone with dementia goes through a fuller list grouped by what each one is good for, from movement to reminiscing.

A companionship carer builds this kind of task and conversation into a visit as a matter of course, rather than it being one more thing for a family to remember to arrange.

Meals matter for the same reason, even though there is no single official figure for how often to offer them. A skipped or forgotten meal tends to show up as low mood, tiredness or extra confusion well before anyone notices weight loss, so keeping meals at roughly the same times each day is worth as much as their content. Elderly hydration and elderly nutrition go through the signs of dehydration and poor eating in more detail, both common and treatable causes of a sudden bad afternoon. Exercise for older people has more on building safe activity into a week, including chair-based options for somebody who tires quickly or cannot get outside. If broken nights have become the harder problem, an overnight carer a few nights a week is often what restores everyone's sleep, your relative's included.

1. 1

   Search carers who list dementia experience

   Free

   Every profile shows the carer's rate, reviews and the kind of dementia experience they have, so you are not choosing blind.
2. 2

   Talk before you book

   Free

   Ask how they would handle a moment like the ones in this guide: a wrong memory, a refusal, a bad afternoon. The answer tells you more than a profile can.
3. 3

   Start with company, add personal care later if needed

   Whenever you are ready

   Companionship visits from £15 to £20 an hour cover routine, conversation and a shared task. Personal care can be added to the same arrangement once it is needed.
4. 4

   Every carer is checked before they appear

   Always

   Identity, right to work and an enhanced DBS on the Update Service are checked before a carer is listed, and every carer has interviewed online. Carers are self-employed, and PrimeCarers is an introductory service rather than their employer.

If your relative's needs have moved beyond company and are now about safety through the day or the night, at what point should someone with dementia go into care sets out the signs to watch for and what each level of help tends to cost.