DIMENSIONS Summer 2001

TIPS FOR ACTIVITIES OF DAILY LIVING

by Julie Cleveland

Individuals in the middle to later stages of AD or other progressive dementia require increasing assistance with basic activities of daily living, such as bathing, dressing and eating. This can add increased stress and burden to caregivers. However, incorporating a structured routine can help alleviate this stress and make these activities less difficult for both the caregiver and person with dementia.

Mrs. S. is an experienced caregiver who has established several routines that help her with daily activities. She is a registered nurse, and has been caring for her husband over the 12-year progression of his illness. "Confronting issues as they arise, and trying to establish routines has helped me become as efficient as possible while caring for my husband," she says. She has shared some of her tips to help caregivers establish routines for bathing, dressing and eating.

Bathing:

Make sure that the bathroom area is well equipped for bathing and toileting. A raised seat on the toilet, a non-skid mat in the tub or shower, and safety handles on the walls help make bathing and toileting safer and easier. Having all of the items you need easily accessible also helps. For instance, keep paper towels, spray cleaner, baby wipes, latex gloves and plastic bags in the bathroom.

Mrs. S. starts her husband's bathing routine by shampooing his hair while he sits on the toilet and covers his face with a washcloth. She then helps him into the shower, and rinses his hair with a pitcher. She wears a quick-dry robe and uses a long handled scrubber so she stands outside the shower. She washes his front side, and then his back side. Once she dries him off she applies his deodorant, lotion, etc. She then assists her husband in putting on his incontinence undergarments. She prefers to use the undergarments that have adjustable elastic straps because they are easier to change and not visible under clothing.

Dressing:

Choose everyday clothes that are easy to put on and care for. Knit shirts and elastic waist pants are easier to put on than those that have to be buttoned or zipped. Slippers or shoes with velcro closures are easier to put on than those with laces. Leather soles on shoes can be slippery; rubberized soles have better traction. Mrs. S. purchases much of her husband's clothing from catalogs--it saves her time and energy since it can be done from her home.

Mrs. S. brings her husband's clean clothes into the bathroom with her, and helps him dress after his shower Once he has dried off and has undergarments on, he sits down on the toilet and she dresses his upper body completely. She then puts on his socks, pants, and shoes, has him stand up and pulls up his pants. Once he is dressed, she brushes his teeth with an electric toothbrush. She has found that it is easier to use, and cleans his teeth more thoroughly than a manual toothbrush. Mrs. S. keeps the clothes hamper in the bathroom, so she can put his dirty clothes directly into the hamper once she takes them off. For her, doing both bathing and dressing routines in the same room has made them easier and more efficient.

Eating:

Utensils with large rubber handles are easier to grip and manipulate, and may help the person with dementia eat more independently. Plates and bowls with rims and rubber grips on the bottom keep the food and the plate in place. Plastic cups with lids, handles and drinking spouts may be easier to manipulate and avoid spills. Many of these items can be purchased at grocery or department stores; others can be ordered through medical supply catalogs (contact an occupational or physical therapist for information on how to obtain a catalog).

If the person is no longer able to use utensils, encourage independent eating by cutting food up into bite-size pieces to make it "finger food." Foods that Mrs. S.'s husband enjoys include rolled up meat and cheese, sandwiches, cut up fruit and vegetables, cherry tomatoes, chocolate covered raisins, bite-size Ritz crackers with peanut butter or cheese spread, and cut up tortillas filled with fruit- flavored cream cheese.

Mrs. S. has found that plastic place mats and terrycloth finger-tip towels make cleaning up easier. She also recommends using aprons in "adult" fabrics and styles to help preserve both the person's clothing and dignity.

Finally, when trying to establish techniques or routines to save time and energy, remember that each person and situation is unique, and it will take some time to find routines that work well for you and the one you are caring for. Try to be patient--it will end up saving a lot of stress in the long run.


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