Assisting the person with dementia with changing daily needs

People with dementia slowly become less able to take care of themselves.

At first, a person may need only prompting or a little help, but eventually caregivers will become responsible for all personal care.

Loss of independence and privacy can be very difficult for the person with dementia.

Caregivers must be aware of their loved one’s reactions, abilities and fears to provide the necessary daily care.

1 Bathing

Bathing is often the most difficult personal-care activity that caregivers face. Because it is such an intimate experience, people with dementia may perceive it as unpleasant or threatening. In turn, they may act in disruptive ways, like screaming, resisting or hitting.

Such behavior often occurs because the person doesn’t remember what bathing is for or doesn’t have the patience to endure such unpleasant parts of the task like lack of modesty, being cold or other discomforts.

To assist:

___Prepare the bathroom in advance___

Gather the supplies for bathing in advance, like towels, washcloths, shampoo and soap. That way you and the person can focus simply on bathing. Check the room temperature to make sure it’s not too cold.

Make the bathroom safe

To prevent falls, install grab bars on the wall and tub edge. Place non-slip mats on floors. Use a tub bench or bath chair that can adjust to different heights. Use only two or three inches of water in the tub, and test the temperature in advance to prevent burns. Never leave the person alone in the bathroom.

Help the person feel in control

Involve and coach the person through each step of bathing. You may need to experiment to find out if the person prefers tub baths or showers. Also, consider what time of day seems to be the best for bathing.

Include the person in the process

Be sure the person has a role in the steps of bathing. For example, have the person hold a washcloth or shampoo bottle.

Respect the person’s dignity

Some people may be self-conscious about being naked. Letting the person hold a towel in front of his or her body, in and out of the shower or tub, may ease this anxiety.

Don’t worry about the frequency of bathing

It may not be necessary for individuals to bathe every day. “Sponge baths” with a washcloth can be effective between showers or baths.

Be gentle

The person’s skin may be very sensitive. Avoid scrubbing, and pat dry instead of rubbing. You may want to install a hand-held shower to wash hard-to-reach areas.

Be flexible

Washing the person’s hair may be the most difficult task. Use a washcloth to soap and rinse hair in the sink to reduce the amount of water on the person’s face.

2 Dental Care

Proper care of the mouth and teeth can help prevent eating difficulties, digestive problems and extensive dental procedures down the road. However, brushing is sometimes difficult because a person with dementia may forget how or why it’s important to take care of his or her mouth or teeth.

To assist:

Provide short, simple instructions

“Brush your teeth” by itself may be too non-specific. Break down each step by saying: “Hold your toothbrush.” “Put paste on the brush.” Then, “Brush your teeth.”

Use a “Watch me” technique

Hold a brush, and show the person how to brush his or her teeth. Or, put your hand over the person’s hand, gently guiding the brush.

Monitor daily oral care

Brush teeth or dentures after each meal, and make sure teeth are flossed daily. Remove and clean dentures every night. Very gently brush the person’s gums, tongue and roof of the mouth. Investigate any signs of mouth discomfort during mealtime. The person may refuse to eat or make strained facial expressions while eating. These signs may point to mouth pain or dentures that don’t fit properly.

Keep up with regular dental visits for as long as possible

A dental care routine is essential for healthy teeth. Ask the dentist for suggestions or items that may help make dental care easier.

3 Dressing

Physical appearance contributes to a person’s sense of self-esteem. For the person with dementia, choosing and putting on clothes can be frustrating. The person may not remember how to dress or may be overwhelmed with the choices or the task itself.

To assist:

Simplify choices

A person may panic if clothing choices become overwhelming. Try offering just two choices of shirts and pants. Keep the closets free of excess clothing.

Organize the process

Lay out clothing in the order that each item should be put on. You may also hand the person one item at a time while giving short, simple instructions such as “Put on your shirt,” rather than “Get dressed.” Don’t rush the person. Haste can cause anxiety.

Choose comfortable and simple clothing

Cardigans, shirts and blouses that button in front are sometimes easier to work than pullover tops. Substitute Velcro® for buttons, snaps or zippers, which may be too difficult to handle. Make sure the person has comfortable, non-slip shoes.

Be flexible

If the individual wants to wear the same outfit repeatedly, try getting a duplicate of it or have similar options available. It’s all right if the person wants to wear several layers of clothing, just make sure he or she doesn’t get overheated. When outdoors, be sure the person is dressed for the weather. Offer praise, not criticism, if clothing is mismatched.

4 Eating

Proper nutrition is important to keep the body strong and healthy. Regular, nutritious meals may become a challenge for people with dementia. They may become overwhelmed with too many food choices, forget to eat or think they have already eaten.

To assist:

Make mealtimes calm and comfortable

Serve meals in quiet surroundings, away from the television and other distractions. Keep the table setting simple, using only the utensils needed for the meal. Avoid placing items on the table that might distract or confuse the person.

Offer one food item at a time

The person may be unable to decide among the foods on his or her plate. Serve only one or two foods at a time. For example, serve mashed potatoes followed by cooked meat.

Encourage independence

Make the most of the person’s abilities. Allow the person to eat from a bowl instead of a plate, with a spoon instead of a fork or even with his or her hands, if it’s easier.

Be flexible to food preferences

It is possible the person may suddenly develop certain food preferences or reject foods he or she may have liked in the past.

Be alert for signs of choking

The person may have trouble swallowing some foods. Guard against choking by avoiding foods that are difficult to chew thoroughly, like carrots.

5 Grooming

The person with dementia may forget how to perform grooming tasks, like combing hair, caring for fingernails or shaving. He or she may forget what the purpose is for items like nail clippers or a comb.

To assist:

Maintain grooming routines

If the person has always gone to the beauty shop or a barber, continue this activity. If the experience becomes overwhelming, it may be possible to have the barber or hairstylist make a visit to the home. Allow the person to continue using his or her favorite toothpaste, shaving cream, cologne or makeup.

Use safer, simpler grooming tools

Comb your hair, and encourage the person to copy your motions.

Perform tasks alongside the person

Cardboard nail files and electric shavers can be less threatening than clippers and razors.

6 Toileting

Many people with dementia have loss of bladder or bowel control (incontinence). Causes include inability to recognize natural urges, forgetting where the bathroom is or side effects from medicine. Have the doctor rule out medical problems as the cause.

To assist:

Remove obstacles

Make sure clothing is easy to remove. Clear the path to the bathroom by moving furniture.

Create visible reminders

Posting a sign or picture of a toilet on the bathroom door may help the person find it more easily. Using colored rugs on the bathroom floor and colored toilet lids may help the toilet stand out.

Offer reminders

Encourage the person to go regularly. Look out for signs of agitation, like facial expressions or pacing, that may indicate the need to use the bathroom.

Monitor incontinence

Identify when accidents occur, then plan for them. If they happen every two hours, get the person to the bathroom before that time. Limit fluids in the evening or schedule bathroom visits in the middle of the night. Consider a bedside commode.

Consider incontinence products

Rubber sheets or incontinence pads on the person’s bed may help. Padded undergarments or adult briefs are another option.

Be supportive

Help the person retain a sense of dignity. Reassure the person to reduce feelings of embarrassment.

Assisting with personal care

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10 quick tips

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1. Be Flexible – adapt to the person’s preferences
2. Help the person stay as independent as possible
3. Guide by using easy, step-by-step directions
4. Speak in short and simple words
5. Avoid rushing the person through a task
6. Watch for unspoken communication
7. Experiment with new approaches
8. Consider using different types of products such as large-grip toothbrushes or bathing chairs
9. Be patient, understanding and sensitive

The Alzheimer’s Association, the world leader in Alzheimer research, care and support, is dedicated to finding prevention methods, treatments and an eventual cure for Alzheimer’s.

For reliable information and support,

Contact the Alzheimer’s Association:

1.800.272.3900

www.alz.org

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