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The person with Alzheimer's disease can be combative or resistant to care. Making the experience as pleasurable as possible can eliminate fear or embarrassment while maintaining the dignity of the individual is extremely important. It is essential that the person with dementia care for him/herself as much as possible--even though this can take an extremely long period of time. This can sometimes be frustrating for the caregiver who is on a schedule, whose patience is thin, or who is trying to persuade a person who does not understand what he/she is supposed to do. Research substantiates that a person's ability to perform activities of daily living (ADL'S) such as bathing, dressing, grooming, toileting, eating, and ambulation influences a person's quality of life and need for services. As chronic problems persist however, the activities of daily living become difficult to complete without direct assistance from the caregiver.
As the disease progresses, the functional (dressing, bathing, toileting, etc.) abilities of a Alzheimer's patient declines in a predictable order. J. Cohen- Mansfield, J. Werner, and S. Resiburg, (Journal of the American Geriatrics Society, 1996), note "that bathing, dressing, grooming, toileting, walking and eating often decline in that order". (Mahoney, Ellen K, Volicer, Ladislav, Hurley, Anne,2000. Management of Challenging Behavior in Dementia. Baltimore, Md: Health Professions Press, p. 83) For this reason, it is essential that elderly individuals are encouraged to participate in the activities of daily living for also long as possible.
To find out why individuals are resistant to bathing, dressing or feeding him/herself is like being a detective. There may be physical, medical, emotional, or environmental reasons that individuals with Alzheimer's react negatively. These reasons may include: (Andresen, Gayle. Caring for People with Alzheimer's Disease. 1995. Health Professions Press, Baltimore, Md. p. 52)
- Depression
- Illness/Pain
- Inability to distinguish between hot and cold temperatures due to brain damage
- Unsteady in gross motor skills such as balance
- Changes in fine motor skills
- Side-effects of medications
- Complicated instructions
- Caregiver who is rushed
- Communicating impatience or disgust with tone of voice
- Fear and anxiety due to inability to understand
- Being humiliated at having to be reminded
- Being agitated due to previous argument with caregiver
- Too many choices
- Inability to distinguish water sensation as comforting due to brain damage
- Fear of falling
- Fear of being hurt by water
- Disruption in daily routine
- Fear of water, soap, washcloth, or sound of running water
- Fear of unfamiliar caregivers
- Being overwhelmed due to mechanics of taking a bath, feeding, or dressing, or grooming
- Inability to remember purpose of taking a bath, feeding, dressing, or grooming
- Feeling embarrassed or vulnerable about being naked, or having to be fed, dressed, or assisted with toileting
- Feeling embarrassed about having a caregiver of opposite sex
- Being impatient due to having to wait too long for the bath, meal, or getting clothes
- Inadequate lighting which makes it difficult to see
- Lack of privacy
- Room that is too cold
- Water that is too deep
- Water that is to hot or cold
- Enclosed shower stall
- Glare from walls or bathtub
To cope with these reactions a caregiver may consider some or all of the following strategies when helping a person bath:
- Encourage the person to do as much for him/herself as possible
- Develop a consistent routine
- Make sure the environment is comfortable with regard to temperature and safe with regard to non-slip rugs, grab bars, contrasting colors, etc.
- Avoid excessive noise
- Use quiet approach when giving instructions
- Test temperature of water, and food
- Distract the person, by giving a washcloth, toilet paper, or something to hold, while caregiver completes duties such as washing hair, wiping etc.
- Wrap towel around shoulders to avoid embarrassment at being undressed
- Play soft background music
- Install hand-held shower
- Be flexible
- Use humor
- Simplify choices
- Provide reminders
- Be supportive
In addition to suggestions above, a caregiver must be sensitive to the fact that at some level the person's with dementia may realize that they aren't able to perform tasks anymore due to memory problems. This is frustrating and can lead to angry outbursts. Not being able to care for one's own needs is a humiliating experience. In the later stages of dementia, individuals are not able to feed themselves or have difficulty swallowing. They may forget how to use a spoon or fork, or they forget that they have just eaten a sandwich and want to eat again. These create frustrating situations.
Practical suggestions for feeding include:
- Avoid foods that stick to roof of the mouth
- Stroke the throat gently downwards to remind the person to swallow
- Avoid foods that are difficult to chew
- Try thick liquids to avoid chewing
- Be sure that the person with chewing problems is sitting straight up with head slightly forward
- Serve soft foods
- Provide plenty of water to hydrate individuals
- Assure that the food temperature will not burn individual
- Restrict portions where appropriate and stretch the meal--give juice first, then cereal, then coffee--etc.
For individuals that over eat or have insatiable hunger provide five or six small meals per day and try to distract them with activities, walks or exercise. For individuals who are losing weight, try milk shakes, ice cream or pudding. When feeding an individual, it is important to focus the attention on the him/her rather than socializing with other individuals.
Treating the person with respect, by providing limited choices is essential when caring for an elderly person. Some of the strategies below can help when dressing an individual:
- Give person choice between two outfits
- Show person what he/she will be wearing
- Make sure the room is warm
- Label dresser drawers
- Layout clothes, and give step-by-step instructions
- Replace complex fasteners with Velcro
- Place toothpaste on toothbrush and encourage person to brush teeth whenever possible
- Place comb or brush in person's hand and "mirror" what you want the person to do
- Use compassion and sense of humor whenever possible
In the later stages of Alzheimer's individuals may lose their bladder and bowel functions. To help monitor these issues caregivers may want to consider the following:
- Use visual cues--place contrasting colored rugs on bathroom floors, use contrasting lid, and avoid having items nearby that can be mistaken for a toilet such as a trash can
- Develop a schedule and get person to bathroom before he/she needs it
- Provide reminders
- Make sure clothing is easy to remove--use Velcro fasteners whenever possible
- Respect privacy whenever possible
Not all the strategies will work, and what works one day, may not work the next. It is important for individuals to remember the following general principles:
- Remain flexible
- Communicate with patience, compassion and reassurance
- Provide appropriate choices
- Distract or divert when behaviors are difficult to manage
- Treat the elderly person as your "Best Friend" (Virginia Bell and David Troxel.(1997). Best Friend's Approach to Alzheimer's Care. Baltimore, MD.Health Professions Press)
- Best friends know each other's history and personality
- Friends do things together
- Friends communicate
- Friends build self-esteem
- Friends laugh often
- Friends are equals
- Friends work at relationships
pp. 175-236. Beckerman, Anita G. and Tappen, Ruth. M. (2000). It Takes More Than Love. Baltimore, Md: Health Professions Press:
- Review the following website and read information regarding "Hygiene and Personal Care:"
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