People who have Alzheimer's disease or other disorders causing dementia eventually need help with daily routines, such as bathing, dressing, eating and using the bathroom. This personal and hands-on assistance requires regular, frequent closeness and touching. Sometimes this type of care is welcomed or tolerated, but a person with dementia can be uncomfortable or distressed by it.
If you care for someone with dementia, consider the following tips to help you provide care that is supportive, respectful and beneficial.
Bathing can be difficult because the person in your care may feel embarrassed about being naked in front of you, resentful of needing this care or uncomfortable with bathing. Bathing also requires your constant attention to avoid falls or other injury. Tips include:
- Make the bathroom safe. Install safety bars, put a rubber mat on the floor of the bathtub or shower, and use a sturdy chair or bathing chair. Install a hand-held shower head if possible.
- Prepare supplies. Have soap, shampoo, washcloths and towels in place ahead of time, so that you don't have to leave the person in your care unattended.
- Make the bath comfortable. Make sure the bathroom is warm and well lit. Play soft music if it promotes relaxation.
- Keep it private. If the person in your care is self-conscious about being naked, offer a towel for over the shoulders or lap. Use a sponge or washcloth to clean under the towel.
- Be respectful. Explain what you are doing and what you are going to do next. Let the person in your care help as much as possible.
- Alternate full baths or showers with sponge baths. A full bath or shower two or three times a week is likely enough. In between, use a washcloth or sponge to clean the person's face, hands, feet, underarms and genitals. Washing hair with a spray hose in the kitchen sink may be easier for some people.
- Dry thoroughly. Use towels to pat dry gently and take care to dry any folds in the skin to avoid irritation.
Dressing involves choosing what is right for the weather, following personal preferences and doing steps in a particular order. These decision-making and planning tasks can be difficult or frustrating for a person with dementia. Tips to help with dressing include the following:
- Provide direction. Lay out pieces of clothing in the order they should be put on — or hand out clothing one piece at a time as you provide simple dressing instructions.
- Limit choices. Too many choices can complicate decision-making and lead to agitation. Put away some clothes in another room.
- Consider personal tastes and dislikes. Let the person in your care make choices. If he or she always wants to wear the same thing, buy more than one of the outfits if possible.
- Make it easy and comfortable. Select clothes that fit comfortably and are easy to put on and remove. You might replace shoelaces, buttons and buckles with fabric fastening tape or large zipper pulls.
Mealtime is important for maintaining good nutrition and hydration. People with dementia may forget to eat or drink, and they may find the task of eating difficult or distressing. Ideas to make mealtimes healthy and comfortable include the following:
- Routine. Eat at the same time every day as much as possible. If mealtimes are too long or difficult, consider frequent, smaller meals throughout the day.
- Hydration. Offer small glasses of water frequently throughout the day to promote adequate hydration. Offer food with high water content, such as fruit, soups and smoothies.
- Calm environment. Avoid distractions, such as a television or radio. Remove unnecessary clutter from the table. Turn off phones.
- Dishes and utensils. Choose dishes that are easiest to use: white dishes instead of patterned dishes, bowls instead of plates, spoons instead of forks, or fingers instead of utensils. Use bendable straws or lidded cups.
- Food servings. Cut food into bite-sized pieces before serving, or make finger foods. Serve one type of food at a time, as deciding what to eat may be agitating.
- Food choices. As much as possible, make favorite and familiar foods, while ensuring generous servings of vegetables, fruits and whole grains.
- Encouragement and modeling. You can help with the basic mechanics of eating by demonstrating how to hold a spoon, when to take a drink or how to chew enough after a bite. You can gently hold the person's hand to help with using a utensil.
- Sharing meals. Eat together and treat mealtimes as an opportunity to visit.
A person with dementia may experience loss of bladder or bowel control (incontinence) for many reasons, such as medical conditions, medications, difficulty getting to the bathroom, or not recognizing the need to use the toilet. You can help with the following strategies:
- Make the bathroom easy to find. Clear the path to the bathroom by removing furniture and rugs. Keep the bathroom door open so that the toilet is visible, or post a picture of a toilet on the bathroom door. Put a portable commode in the bedroom for nighttime use.
- Create a toileting schedule. Take the person in your care to the toilet on a regular schedule, such as every two hours and before meals, bathing or other activities.
- Be alert for signs. Restlessness or tugging on clothing might signal the need to use the toilet. Learn the word or phrase the person uses to indicate the need to use the toilet — which may not be directly related to toileting.
- Make clothing easy to remove. Replace zippers and buttons with fabric fasteners. Choose pants with elastic waists rather than belts.
- Be supportive. When accidents happen, take them in stride. Use encouraging words and avoid criticism.
Contact a county or area agency for older adults or a local chapter of the Alzheimer's Association for resources to support daily care, respite services to give you a break, or support groups that enable caregivers to share ideas.