04: ADLs: Assisting With Dressing

This program will present:

• Principles for assisting with activities of daily living (ADLs)
• Factors that can make dressing a challenging activity
• Provide tips for assisting with dressing

• There are no easy answer when its comes to the care of another
• Our hope is to offer you useful information and guidelines for caring for someone with dementia
• These guidelines will need to be adjusted to suit your own individual needs

• Skin becomes thinner and more fragile
• Easily bruises
• Temperature regulation declines
• More sensitive to temperature
• Vision and hearing decline
• Difficulty hearing instructions and seeing things
• Joints become stiff and painful
• Limits motion and causes unsteadiness
• Falls become a greater risk

• AMNESIA: memory decline and loss
• APRAXIA: loss of automatic skills or inability to use common objects
• AGNOSIA: inability to recognize objects
• DYSPHAGIA or APHASIA: difficulty understanding and creating speech
• Attention and concentration decline
• Stress threshold recognition declines
• Ability to avoid stress decreases
• Loss of impulse control
• Organizational ability declines
• Ability to adjust to new environments declines

What might be happening in this situation?

• A. Robert put on the dirty shirt and pajama bottoms, because they were closest to him.
• B. Mary was frustrated and focused on the task rather than on Robert.
• C. Robert couldn’t figure out how to get dressed.
• D. All of the above.

ChoiceA: Robert put on the dirty shirt and pajama bottoms, because they were closest to him, is a good answer.

Choice B: Mary was frustrated and focused on the task rather than on Robert, is also a good answer. Caregivers need to monitor their stress levels and take steps to reduce unhealthy levels of stress

• Ask for help when needed
• Have outside social contacts
• Attending to personal health

Choice C: Robert couldn’t figure out how to get dressed, is a great answer. Choice D: All of the above, is the best answer.

DRESSING REQUIRES:

• Fine motor skills
• Gross motor skills
• Ability to discriminate what clothes are appropriate for the season, weather, time of day, and occasion
• Memory of where clothes are
• Ability to perceive the position of one’s arms and legs

DEMENTIA CAUSES:

• Agnosia
• Apraxia
• Loss of organizational, planning and decision-making skills

STIMULUS&RESPONSE

• Reacting mechanically to stimuli in the environment
• Increase the likelihood of getting a response by setting up stimuli
• Decrease the likelihood of a difficult behavior by removing stimuli

What might be happening in this situation?

• A.Mary had planned her day to accommodate unexpected delays and was not stressed about having to change Robert’s clothes.
• B.Mary affirmed Robert’s efforts to dress himself.
• C.Mary minimized the possibility of hurting Robert’s feelings by creating a positive scenario.
• D.All of the above.

Choice A: Mary had planned her day to accommodate unexpected delays and was not stressed about having to change Robert’s clothes, is a good answer.

Choice B: Mary affirmed Robert’s efforts to dress himself, is an excellent choice.

• Reinforce effort with appreciation and praise
• Be uplifting and positive

Choice C: Mary minimized the possibility of hurting Robert’s feelings by creating a new scenario, is also a good choice. Distraction or redirection is an important technique for refocusing someone’s thoughts Choice D: All of the above, is the best answer.

• Changing the focus
• Introducing a more positive image

Because people with dementia have shorter attention spans, they are often easily distracted from the things that made them frustrated or angry

• Opportunities to spend more quality time with the person
• Caregivers should approach ADLs with understanding and compassion
• Prevent difficult behaviors and improve quality of life
• Use an understanding and compassionate approach
• Show patience, a sense of humor, and a positive attitude
• Offer reassurance, positive affirmation, and never scold
• Physical disabilities and sensory impairments must be considered
• Know and respect individuals and their personal preferences

• Focuses on theperson
• Considers comfort and preferences
• Addresses unmet needs
• Person-centered care considers the person’s history, feelings, preferences, abilities, strengths and needs
• By gathering information and applying your knowledge about individuals, you empower yourself with the ability to enhance their quality of life

• Promote autonomy and independence
• Maximize abilities and minimize disabilities
• Ask permission to help or to touch
• Reinforce effort
• Allow choices appropriate to the person’s abilities
• Ask permission to help or to touch
• Provide cues and prompts only when needed and without taking over
• Offer reminders
• Offer practical help
• Demonstrate
• Use hand-over-hand guidance only when necessary
• Allow plenty of time for the activity

• Use effective communication skills
• Gain eye contact
• Speak clearly and slowly
• Use familiar terms
• Repeat and remind as needed
• Say the important word last
• Break up the activity into simple steps
• Observe body language for comprehension and comfort
• Adapt to functional and cognitive levels of the person
• Simplify the steps to fit the remaining abilities
• Keep reasonable expectations
• Insure privacy
• Provide adequate lighting
• Remove distractions
• Don’t argue or force the person

• Focus on the person
• Use relaxed body language
• Give simple, step-by-step instructions
• Say the important words last
• Encourage and praise
• Explain what you will do

• Label drawers and closets according to the items they contain
• Lay out clothes or hand them in the order that they should be put on
• Limit choices
• Use layers, preferably with lightweight garments
• Remain flexible
• Try scheduling the clothing change at different times of the day

• Provide clothes that are easy to put on and take off
• Dresses are easier to manage than slacks
• Elastic bands
• Velcro fasteners
• Easy to launder
• Properly fitting shoes
• Have several of the same kind or style of favorite clothing

Inappropriate layering of clothes

• Older people do not regulate their body temperature well

Problems with disrobing

• Feel too warm or uncomfortable
• Need to use the toilet or have wet or soiled themselves
• Confused about where they are, what time of day it is, or what they should be doing

Dressing for the wrong season or weather

• Confusion about season, weather, or location
• Unable to find appropriate clothes

Possible Reasons

• Afraid that they will lose the garment
• Afraid that it will be stolen
• Embarrassed or frightened
• Afraid of being hurt or violated in some way
• Wearing favorite clothes

Caregiver Tips

• Try to find out the reason for the behavior
• Offer reassurance
• Use gentle persuasion, not coercion
• Allow the person to remain in control
• Keep a list of reasons
• If the choice is not harming the person or others, do not force the issue

Physical & Human:

• Organize spaces, reduce clutter and lock away substances that can cause injuries.
• Make sure door locks can be opened from the outside, or remove or disable locks
• Make sure floors have a non-slip surface and are dry
• Place nonskid floor mats/bathmats on tile floors
• Consider installing carpeting of a single color
• Provide stable, sturdy furniture, doors and door handles
• Provide adequate lighting, reduce glare, and use contrasting colors
• Consider the sounds and smells
• Calming or favorite music
• Lavender or Melissa oil (lemon balm)

• Provide a simple, familiar, pleasant atmosphere
• People
• Sounds, smells, lighting
• Routines
• Minimize time undressed
• Set a comfortable room temperature for older people
• Monitor fatigue level
• Make sure the person is as pain-free as safely possible

• Encourage individuals to do as much for themselves as they can
• Reinforce effort at self-care
• Remain flexible and adjust to the person’s abilities and needs
• Keep reasonable expectations
• Simplify activities and follow routine

• To address challenging dressing behaviors:

• Find out the reason, address any issues, and offer reassurance
• Help orient the person who is confused
• Use persuasion, not coercion
• Allow a sense of control
• Show patience, a sense of humor, and a positive attitude
• To provide a safer environment, consider both the physical and human environments

Written by:

Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

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