When Dementia Makes Dressing Difficult: Advice for Caregivers
People with Alzheimer's disease (AD) and other dementias often need assistance with such basic activities of daily living as washing, grooming, and dressing themselves. There are several reasons for this, including confusion; apraxia (an inability to carry out tasks such as bathing); resistance to caring for themselves in spite of intact strength and balance; general weakness or fatigue caused by old age or medications; discomfort from water that is too hot or cold; fear of falling in the bathing area; pain from arthritis; embarrassment or anxiety from being naked in front of family members or strangers; and confusion stemming from too varied a selection of clothing to choose from.
The amount of help a person with dementia needs for their personal care will vary, depending on the extent of their brain damage and what stage (early, middle, late) of dementia they are in; and the type and degree of neuropsychiatric symptom. For example, while some people with early AD will be able to care for themselves quite well at this stage of the disease, abilities will gradually diminish in the later stages to the point where they will need increasing amounts of help. Severely affected patients often forget how to dress or may not recognize the need to change clothes, bathe, or brush their teeth. Great care is therefore needed in helping a loved one through various daily routines.
The practical tips below can help you provide care while letting your loved one feel comfortable, independent, and respected.
1. Highlight daily activities. Put a positive spin on daily grooming and dressing. Compliment care recipients about how fresh and attractive they are after bathing and grooming. Have care recipients put on aftershave or a dab of perfume if they enjoy it. Present these activities as enjoyable tasks and that you will help them as needed. This will not work for all care recipients but frequently this approach increases cooperation.
2. Maintain a positive attitude. Most people with dementia can sense tone of voice and body language far into their disorder and respond accordingly. The caregiver's approach to care is the most important factor that influences behavior and cooperation. Hurried activity, critical speech, or harsh tones are likely to generate agitation or anger in the care recipient. Caregiving is a tough job and it's common to get upset occasionally, so take a step back and breathe when you feel your frustration level begin to rise. As a caregiver, you deserve frequent, short "time outs." Approach the care recipient as you would want to be approached.
3. Promote self-worth and independence. Let the care recipient take some initiative in bathing, grooming, and dressing. In mild or moderate stages of dementia, a person might still be capable of changing clothes on his or her own and may only need a little help selecting outfits, or you can give verbal cues on which item should be worn. In latter stages of dementia, an explanation of how to put on the clothing or even some physical assistance may be required. Whenever a care recipient needs complete help in getting washed or dressed, allow enough time, and remain cheerful and patient throughout the process.
4. Choose comfortable clothing. Some items of clothing may be difficult to put on, so eventually there will come a time to switch to wide-necked tops, trousers with elastic waistbands, and slip-on shoes or shoes with Velcro closures. This not only makes the dressing process easier, but also protects the patient against unintentional harm or discomfort.