05: ADLs: Assisting With Grooming

This program will present:

  • Principles for assisting with activities of daily living (ADLs)
  • Factors that can make grooming challenging
  • Provide strategies for assisting with grooming

Grooming Topics

  • Oral care
  • Hair care
  • Shaving
  • Nail care
  • Foot care
  • 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 our 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

Grooming requires:

  • Fine motor skills
  • Gross motor skills
  • Memory
  • Perception of body position

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
  • 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
  • Person-centered care
  • Know and respect individuals and their personal preferences
  • Focuses on the person
  • 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
  • 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
  • Tooth brushing
  • ? Cleaning between teeth
  • ? Cleaning the tongue
  • ? Rinsing the mouth
  • ? Denture care
  • ? Hydration
  • ? Visits to the hygienist and dentist

What was going on in this scene?

  • A. Robert wanted to do his own care, but he could not remember how to brush his teeth.
  • B. Robert could not distinguish between a toothbrush and a hairbrush.
  • C. Mary hurt Robert’s feelings by scolding him.
  • D. All of the above.

Choice A: Robert wanted to do his own care, but he could not remember how to brush his teeth, is a good answer. This is an example of apraxia.

Choice B: Robert could not distinguish between a toothbrush and a hairbrush, is also a good answer.

Choice C: Mary hurt Robert’s feelings by scolding him, is also a correct answer. People with dementia are more sensitive to scolding Choice D: All of the above, is the best answer.

  • Set out only a toothbrush
  • Use hand-over-hand guidance
  • Praise any effort, whether it is successful or not
  • Plan and prepare the equipment and environment
  • Use cueing and prompting
  • Observe a routine
  • Maintain healthy oral hygiene practices
  • Schedule regular dental care
  • Have the necessary items ready
  • Angled toothbrushes
  • Fluoride-containing products on natural teeth
  • Preferred flavor of toothpaste
  • Colored mouthwash
  • Dilute mouthwash if necessary
  • Keep items by the sink to a minimum
  • Consider the person’s physical and cognitive abilities
  • Routinely check how well the person can grip the handle
  • Place a comfortable chair in front of the sink
  • Cueing is usually visual
  • Demonstrations
  • Hand-over-hand guidance/cueing
  • Bathroom mirrors
  • Prompting is usually verbal
  • Give simple instructions
  • Find out preferences for method and schedule
  • Practice a regular routine
  • Brush after every meal and before going to bed
  • Try brushing someone’s teeth from behind
  • Brush the tongue
  • Floss
  • If tooth brushing is not possible, rinse the mouth
  • Provide sugar-free snacks and drinks
  • Prevent dry mouth
  • Check the mouth regularly
  • Remove dentures before brushing
  • Clean after meals and before bedtime
  • Regular professional cleaning
  • Prevent damage while cleaning by filling sink with water and close toilet lid
  • Store in water or denture cleaning product overnight in the same place
  • Mark dentures for easy identification
  • Check for signs of improper fit
  • Regular appointments with dentist and dental hygienist
  • Dentist with knowledge about Alzheimer’s disease
  • Schedule appointments at slow times in the office
  • Ask about reducing noise and crowds
  • Talk to the dentist about any sedation and medications for the visit
  • Have all the equipment set out in the order of use
  • Provide assistance only when needed
  • Continue routines
  • Provide a chair if needed
  • Choose an easy hairstyle
  • No-rinse or dry shampoo
  • Gentle scalp massage
  • Arrange visits with a professional hair stylist or barber
  • Have all the supplies ready
  • Bowl of warm soapy water
  • Manicure set (nail scissors or clippers, nail file, nail cleaning tool, cuticle pusher)
  • Nail polish, polish remover, and cotton wool for women who wear nail polish
  • Moisturizing hand lotion/cream
  • Hand towel or paper towel
  • Explain each step
  • Soak the nails
  • Be gentle and careful not to cut the nails too short
  • If the person wants to wear nail polish, offer a choice of colors
  • Gently apply lotion/cream
  • Give a gentle hand massage
  • Make a fun activity of the process
  • Arrange occasional trips to the nail salon
  • Check for painful joints, sores, reddened areas of skin, or discolored toenails
  • Consult a podiatrist or physician for any foot issues
  • Use gentle persuasion, not coercion
  • Pressuring someone can trigger difficult behaviors
  • Try to find out the reason that the person does not want to participate
  • Have in mind a list of reasons you can use
  • If the person remains reluctant about a grooming activity, attempt it at another time
  • Encourage individuals to do as much for themselves as safely possible
  • Provide verbal cues, prompts and assistance only as needed
  • Praise effort
  • Simplify instructions into small, manageable steps
  • Engage and use a relaxed style of communication
  • Show patience, a sense of humor, and a positive attitude
  • Make sure the environment has:
  • Good lighting
  • Provides privacy
  • Is free from distractions, clutter and other people
  • Has comfortable, sturdy furniture
  • Have only the necessary items set out in order of use
  • Observe a routine
  • Maintain healthy oral hygiene practices
  • Choose easy hairstyles
  • Make nail care a fun activity
  • Consult a healthcare professional if there is pain, a sore, or discoloration of the skin or nails

Written by:

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

Edited by:

Sasha Asdourian

www.LightBridgeHealthcare.com

04: ADLs: Assisting with Dressing

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

Click here to open Certificate of Completion

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