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

03: ADLs: Assisting with Bathing & Showering

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion
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  • Brawley, EC. How to improve the bathing experience. Alzheimer Care Quarterly. 2002;3(1).
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  • Dougherty J MS, Long CO. Techniques for Bathing Without a Battle. Home Health Nurse. 2003;21(1):38-9
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  • Hoeffer, B; Talerico, KA; Rasin, J; et al. Assisting cognitively impaired nursing home residents with bathing: Effects of two bathing Interventions on Caregiving. The Gerontologist. 2006; 46(4) 524-532.
  • Kovach CR, Meyer-Arnold EA. Preventing agitated behaviors during bath time. Geriatr Nurs. 1997;18(3):112-4.
  • Mahoney, EK; Trudeau, SZ; Penya k, SE; & Macleod, CE. Challenges to intervention implementation: Lessons learned in the bathing persons with Alzheimer’s disease at home study. Nursing Research. 2006;55(26). S10-S16.
  • Naik AD, Gill TM. Underutilization of environmental adaptations for bathing in community-living older persons. J Am Geriatr Soc. 2005;53(9):1497-503.
  • Nami Kobayashi and Mariko Yamamoto.. Impact of the stage of dementia on the time required for bathing-related care: a pilot study in a Japanese nursing home. International Journal of Nursing Studies. 2004. 41(7): 767-774.
  • Potkin SG. The ABC of Alzheimer’s disease: ADL and improving day-to-day functioning of patients. Int Psychogeriatr. 2002;14 Suppl 1:7-26.
  • Rader, J; Barrick, AL. Bathing without a Battle. Alzheimer Care Quarterly. 2000. 1(4) 35-49.
  • Rader J, Barrick AL, Hoeffer B, et al. The bathing of older adults with dementia: Easing the unnecessarily unpleasant aspect of assisted bathing.Am J Nurs. 2006;106(4):40-8.
  • Rogers, JC; Holm, MB. Behavioral Rehabilitative activities of daily living. Alzheimer Care Quarterly. 2001;2(4) 66-69.
  • Sloane PD, Hoeffer B, Mitchell CM, et al. Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial. J Am Geriatr Soc. 2004;52(11):1795-804.
  • Sloane PD, Rader J, Barrick AL, et al. Bathing persons with dementia. Gerontologist. 1995;35(5):672-8.
  • Somboontanont W, Sloane PD, Floyd FJ, et al. Assaultive Behavior in Alzheimer’s disease: Identifying immediate antecedents during bathing.Journal of Gerontological Nursing. 2004;30(9):22-29.
  • Tetlow K. The dirt on bath design. Contemp Longterm Care. 1995-1996; Suppl:18-9, 21.
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