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

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