Dealing with Activities of Daily Living

General Tips to Assist with Activities of Daily Living (ADLs)

Personal care activities, e.g., eating, bathing, hygiene, dressing, grooming, toileting

  • Remove factors of “excess disability” (anything that hinders the person from being able to function, e.g., pull over clothes) i.e., find ways to simplify and KEEP IT SIMPLE.
  • Recognize their importance to self esteem.
  • Always focus on the person, not the task; don’t expect perfection.
  • Stick to same routines, habits, preferences.
  • Do something pleasant a half hour before (e.g., massage)
  • Allow the person to do as much by themselves as possible (Do “with” not “for”)
  • Begin conversationally before launching into task.
  • Let them know that’s going to happen before each step.
  • Simplify steps, one at a time.
  • Don’t rush.
  • Give choices but limit choices (Not, “what do you want to eat?”  Instead, “Do you want eggs or cereal for breakfast?”)
  • Prepare for the activity in advance and have everything you need to assist the person.
  • Demonstrate the activity, if necessary, and give multi-sensory cues (taste, smell, etc.)
  • Modify for increasing impairment – Encourage, Cue, Assist, and Do

Bathing and Grooming

  • Understand/assess/respect psychological factors such as fear, privacy, and vulnerability issues.  Fear of water is common.
  • Assure dignity by assuring privacy.  Use privacy screens.  Close doors.  Make sure the individual is covered as much as possible.
  • Determine the best time of day for your loved one (when they’re most relaxed, least interruptions)  and develop a routine around that time.  Be prepared to try again, if necessary.
  • Try to observe personal preferences (before disease) as best as possible (e.g., bath vs. shower, morning vs. evening)
  • If the individual is still able to read and follow notes, write reminders for them, e.g., “Mary needs to bathe on Monday, Wednesday, and Friday.”
  • Avoid unnecessary explanations, reminders, and discussion about the need to bathe.  Be matter-of-fact.  Don’t ask if they want to bathe in a “yes” or “no” form.  Say simply, “It’s time for your bath now.”
  • Break each step into smaller steps; involve the person in each step, as possible, to give them control.
  • Use appropriate products and adaptive safety equipment (e.g., bath benches, hand-held shower heads, bath bars, non-slip devices)
  • Observe safety factors like water temperature.
  • Prepare bathroom in advance with all supplies.  Cover mirrors and windows if necessary.
  • Make sure room temperature is comfortable and the bathroom is warmed up in advance.  Persons with AD tend to be very cold most of the time.  Use warm towels, robe, by putting in dryer first.
  • Let the person feel the water before they get into it.  Gently pouring water on their hands may reassure them.
  • Coach and cue the person to participate and use distractions, like music or snacks, if necessary.
  • Focus on pleasantness of interaction, not just cleanliness, e.g., pleasant room fragrance.  Try candles and softer lights.  Use scented soaps, bath oils, or bubble bath.
  • Modify your approach as impairment increases (encourage, cue, supervise, assist and do) – evaluate each of the changes carefully.  Never leave later-stage patient in bathroom alone.
  • Consider a sponge bath while person is on commode or “waterless” soap, if all else fails.
  • Dont get upset or confront the person if they refuse a bath.  Try again later when they are less agitated.
  • Keep hairstyles simple and quick to style, or take the person to hairdresser for hair care.  This is usually enjoyable for them and one less task for the caregiver.
  • Try applying after shave or cologne to entice.
  • Provide mouth care after each meal.  Yawning in front of someone can help trigger opening mouth.
  • Use child-sized item to reduce anxiety (e.g., hairbrush, toothbrush, combs, etc.)
  • Try oral swabs soaked in mouthwash.
  • Use soft bristle hairbrushes, large tooth combs, spray detanglers.

Dressing

  • Recognize the importance of clothing for comfort and self-esteem.
  • Select easy-to-wear clothing – avoid tight-fitting clothes, zippers, buttons.  Replace buttons with velcro.
  • Limit the number of clothing choices – only a few outfits in the closet at a time and store away off-season clothing.
  • Put complete outfits on one hanger.
  • Make separate areas for dressing and undressing.
  • Lay items on the bed in the order that they should be put on.
  • Accept change in dress and grooming as the person’s ability to make decisions changes.
  • Remove the hamper from sight to prevent access to dirty clothing.
  • If the person continually wears the same thing, create a reason to change, “you look so nice in blue…” and then remove the old clothes after they change, when the person is not watching.
  • If the person is reluctant to change or undress, create a reason, e.g., “you’ll probably feel so much better in clean, fresh clothes … this new shirt sure smells nice.”  Or “let me help you put on these fresh clothes so that we can go to the ice cream parlor.”
  • Choose washable, no iron clothing that is one size larger than needed.
  • Provide visual cues to help them change or dress, e.g., clean pants (“Mmm, these pants must have just come back from the laundry; they smell so nice!”)
  • Don’t argue over, or worry about, how the person looks – choose your battles!  (Don’t get hung up on coordination issues)
  • Don’t rush them.
  • Buy duplicates, if possible, of favorite clothing.
  • Try privacy screens to enhance feelings of security.
  • Avoid “over the head” items to decrease anxiety.
  • Remove soiled clothing immediately.
  • Contrast the colors of top and bottom to provide a visual cue to lessen difficulties with toileting and undressing.
  • Start undressing by taking off shoes – it’s less threatening than taking upper clothing off.
  • Undress the person from under a covering, such as wrapping a towel around their waist before removing pants.
  • For total hands-on care, always explain each step of what you’re doing (but avoid long explanations or arguments).  Speak conversationally in between.  (“Boy, it sure is nice outside today.  Maybe you can sit outside for a while after you’re dressed.”)

Eating

  • Limit the number of food choices.
  • Use smells or small tastes to encourage eating (e.g., fresh coffee brewing, bacon frying, increased spices and flavoring)
  • Use finger foods that are easy to eat.
  • If the individual has been accustomed to cooking, they might enjoy helping with preparations, e.g.,. setting table, stirring food, folding napkins, etc.
  • Eliminate noise and distractions while eating.
  • Follow the person’s previously established dining patterns and preferences as much as possible.
  • Use solid colored dishes, cups, tablecloths.  Contrast the color of the dishes and tablecloth so the person can clearly see where the dish ends and the table begins.
  • Follow simple rituals and routines.
  • Be aware of safety hazards, e.g., hot plates.
  • Use adaptive utensils and plates, as appropriate, and encourage independence (e.g., bowl instead of plate, spoon instead of fork).
  • Provide snacks, water, and high-calorie drinks, plain in sight, throughout the day to supplement meals, if needed.  Ask the doctor whether food supplements will help.
  • Remove utensils, when appropriate – esp. knife.
  • Avoid foods that are high in caffeine, especially after 3:00 p.m., e.g., tea, coffee, chocolate, soda.
  • Make sure the person is hydrated (6-8 cups of liquid daily).
  • If the person is restless, try smaller, more frequent meals.
  • Verbally guide the person through the meal.
  • Be alert for signs of choking.
  • Notify the doctor if the person is gaining or losing weight very rapidly.
  • When eating out, choose quiet, familiar, well-lit restaurants and go at the restaurant’s least busy time.  Try to visit the restaurant on the same day of the week at the same time of day.
  • To avoid a potential toileting problem in public, carry a card that says:  “Man (woman) in Ladies (Men’s) Room” and post as needed.

Toileting

  • Don’t accept incontinence as inevitable part of illness.  Get assessment form your doctor and seek treatment.
  • Take the Alzheimer’s person to the bathroom on a schedule (e.g., every 2 hours) or give regular reminders.
  • Be aware of non-verbal signals that the person needs to use the bathroom.
  • Keep bathroom door open, put a sign or picture on the door to label room (e.g., picture of toilet or tub), keep well-lighted pathway at night.
  • Cover mirrors and windows if necessary.  Use privacy screen.
  • Remove any obstacles; assure that clothing is easy to remove and that there is an easy path to the bathroom.
  • Consider posting a large sign reading “toilet” over the commode, use colored rug on floor and colored toilet seat to provide contrast to toilet area, and remove waste cans and plants from the floor.
  • If person resists entering the bathroom, put on a radio or tape player with their favorite music and dance or march in with them!
  • Cover sinks and keep radiators covered with colorful printed covers.
  • Keep records on when person uses the bathroom.
  • Encourage fluids early in the day; decrease or eliminate fluids before bedtime.
  • Eliminate caffeine, including chocolate, after 3:00 p.m.
  • Use appropriate products, such as adult pads and briefs, mattress covers.
  • To avoid a potential toileting problem in public, carry a card that says:  “Man (woman) in Ladies (Men’s) Room” and post as needed.

Medications

  • Keep track of all medications.  In early stages, a sectioned pillbox and a checklist might help.  Call our helpline to ask for information on other medication dispensing systems.
  • Notify all physicians involved in person’s care of all meds taken to prevent possible interactions.
  • Be aware of medication side effects.  If serious side effects occur, report them to they physician.
  • Don’t rely on their word that medication has been taken.  Watch to be sure it is taken on time and in the right amount
  • Store medications in a safe place to prevent accidental overdosing.
  • Don’t change doses without consulting a doctor.
  • If swallowing is a problem, crush or mix with soft food like pudding, mashed potatoes, apple sauce.
  • Use a pharmacy that delivers medications (one less errand to do)